residency advice

[AnaPlasia]

---

Members do not see this ad.

Hi everyone,
I'm currently a PGY1 and I'm looking to transfer out of my current training program. I am wondering if anyone has any experience doing this and could offer any advice on the best way to go about it gracefully and what my best options are. I would even be willing to re-enter the match for a PGY-1 spot next year- but I seriously doubt that the NRMP would allow that.

 

[SLUsagar]

Hi everyone,
I'm currently a PGY1 and I'm looking to transfer out of my current training program. I am wondering if anyone has any experience doing this and could offer any advice on the best way to go about it gracefully and what my best options are. I would even be willing to re-enter the match for a PGY-1 spot next year- but I seriously doubt that the NRMP would allow that.

which program? what are the issues at hand? i hate to sound like a parent, but the grass is often appears greener on the other side. i know of several folks who started out on back2back2back2back months of autopsy and thought, wtf? path sucks, i'm gonna quit - which some did, much to their mistake.

 

[ABC789]

Hi everyone,
I'm currently a PGY1 and I'm looking to transfer out of my current training program. I am wondering if anyone has any experience doing this and could offer any advice on the best way to go about it gracefully and what my best options are. I would even be willing to re-enter the match for a PGY-1 spot next year- but I seriously doubt that the NRMP would allow that.

I transferred after PGY-1 year. I actually went back through the match for pathology and even interviewed at a couple of programs that way. In the end, it didn't work out, so I contacted path programs I had interviewed at as an M4. Luckily the program I am at now remembered me well.

 

[ABC789]

I transferred after PGY-1 year. I actually went back through the match for pathology and even interviewed at a couple of programs that way. In the end, it didn't work out, so I contacted path programs I had interviewed at as an M4. Luckily the program I am at now remembered me well.

On thing to keep in mind, if for some reason you end up going through the match again, is the '4 year rule'. Pathology residency is only funded for 4 years and you will have used one already as a PGY1. Programs would have to fund the extra year or you might potentially have to do AP or CP only.

Your best bet would be to transfer into a PGY-2 spot instead.

 

[AnaPlasia]

I appreciate your point about the grass being greener (it's how I ended up in this program), but I have enough prior experience in pathology to know that grossing everyday and working 14hrs/day is not the norm in pathology. Back to back months on autopsy would feel like a vacation. I love pathology, but I don't know if my body can keep up with this schedule.

 

[malchik]

I appreciate your point about the grass being greener (it's how I ended up in this program), but I have enough prior experience in pathology to know that grossing everyday and working 14hrs/day is not the norm in pathology. Back to back months on autopsy would feel like a vacation. I love pathology, but I don't know if my body can keep up with this schedule.

I think that is about the norm among good programs, assuming you also have some lighter rotations with 9 hour days like cytology or autopsy. Stick with it, you can do it.

 

[pathgrrl]

I have enough prior experience in pathology to know that grossing everyday and working 14hrs/day is not the norm in pathology. Back to back months on autopsy would feel like a vacation.

14hrs/day on AP sounds reasonable to me...if you are grossing a higher volume you will learn more. Are you spending more than 20% of your grossing time on cases that are no longer educational? Are you consistently violating duty hour rules? Are the attendings abusive somehow? Do you have time to preview cases? Those are things to complain about. No residency is easy, and even in pathology, residents work hard. If you aren't working hard, (especially your first two months!!) you probably aren't learning.
It seems a bit early to give up, and forgive me, but with what you've posted you sound a bit...like you're whining. But, please enlighten us if there is more to the story.
Why don't you consider trying to be a leader in the program, working to change things to make the training program better?

 

[SLUsagar]

14hrs/day on AP sounds reasonable to me...if you are grossing a higher volume you will learn more. Are you spending more than 20% of your grossing time on cases that are no longer educational? Are you consistently violating duty hour rules? Are the attendings abusive somehow? Do you have time to preview cases? Those are things to complain about. No residency is easy, and even in pathology, residents work hard. If you aren't working hard, (especially your first two months!!) you probably aren't learning.
It seems a bit early to give up, and forgive me, but with what you've posted you sound a bit...like you're whining. But, please enlighten us if there is more to the story.
Why don't you consider trying to be a leader in the program, working to change things to make the training program better?

agree 100% w/above. and not trying to be a gossip-hound or anything, but i'm quite certain that current med students considering path would be more than grateful to know the name of your institution so as to a) avoid it, if what you say is indeed true, or b) at least find out more info when on the interview trail. help others not end up in your (what sounds like) unfortunate shoes.

 

[2121115]

I appreciate your point about the grass being greener (it's how I ended up in this program), but I have enough prior experience in pathology to know that grossing everyday and working 14hrs/day is not the norm in pathology. Back to back months on autopsy would feel like a vacation. I love pathology, but I don't know if my body can keep up with this schedule.

If you are an intern on surgical pathology, 14 hour grossing days are not unreasonable. Been there, done that. If you are at a good program, you'll be working those hours at first on surgpath. Stick it out until you get a mix of other rotations in and the hours won't be so bad.

Yeah I agree, 14 grossing days suck- no argument there. But stick it out, it gets much better.

 

[MirkoCrocop]

You also can't forget that, when you first start, grossing takes at least twice as long.

Once you become efficient you do things 2-3x faster, at least.

 

[LADoc00]

Assuming you dont have kids and/or spouse who you might be doing irreversible harm by having to work 14hrs/day, I would say suck it up and learn to deal. Leave your social life on hold until the weekends and have a bottle of Captain Jack near the bed to help you sleep.

 

[KluverB]

14 hrs/day x 5 days/week = 70 hrs/week, with no in-house call. Please, for the love of Science, get out... and stay out. You crazy kids and your 35 hr work week. When I was a PGY-1 I grossed 22 hrs/day, 7 days/week, in 6 feet of snow, then I had to process my own blocks, and pour the hot wax, and boy did it hurt when it ran down my forearms and then I had to cut the blocks and make my own slides, and endure all the cuts that those gosh-darn coverslips would cause me, not to mention the microtome blades, and all the while the chief resident would beat me with a BKA.

I suppose you could consider CP-only.

 

[yaah]

14 hrs/day x 5 days/week = 70 hrs/week, with no in-house call. Please, for the love of Science, get out... and stay out. You crazy kids and your 35 hr work week. When I was a PGY-1 I grossed 22 hrs/day, 7 days/week, in 6 feet of snow, then I had to process my own blocks, and pour the hot wax, and boy did it hurt when it ran down my forearms and then I had to cut the blocks and make my own slides, and endure all the cuts that those gosh-darn coverslips would cause me, not to mention the microtome blades, and all the while the chief resident would beat me with a BKA.

I lost an arm my first year but didn't stop grossing. Just grossed in my own arm, found an incidental giant cell tumor, and went on to the next specimen.


But yes, 14 hrs a day is not unheard of nor is it unreasonable for your first few surg path rotations. It will improve with time, and you will become a better pathologist as a result. I am not sure when residency became less about learning and more about getting the heck out of the hospital.

 

[LADoc00]

I would put 100 bucks on a wager the OP is complaining about MGH or Stanford.

 

[Pathwrath]

I would give it some time--you are still really early in your residency.

Having said that, there are 14 hour/day residencies that are worthwhile and others that are worthless. Grossing those kind of hours past the first six months is a colossal waste of your training, unless your secret dream is to become a PA. Time not spent behind a scope or reading about what you are seeing on the slide is time pissed away.

 

[Pathwrath]

I would put 100 bucks on a wager the OP is complaining about MGH or Stanford.

The grossing times are right enough, but the attitude is all wrong. MGH residents take great pride in their long hours spent slicing meat and sharing the same rarified air as our profession's luminaries.

 

[2121115]

I would put 100 bucks on a wager the OP is complaining about MGH or Stanford.

You're right, but I 'd say it could apply to Hopkins, or Duke, or WashU, or Michigan, or any other program with large volume. I would say that 14 hour days are pretty standard at large high volume centers.

Plus, as stated above, residents at these types of places tend to be self selected gluttons for punishment (I know I am) 🙂

 

[Absidia]

The original poster said he or she is grossing every day. That description does not apply to training at Hopkins, and I doubt it applies to Stanford, MGH, and the other programs mentioned either.

 

[gbwillner]

The original poster said he or she is grossing every day. That description does not apply to training at Hopkins, and I doubt it applies to Stanford, MGH, and the other programs mentioned either.

Why not?

 

[Absidia]

We don't gross every day at Hopkins. And my recollection from interviewing was that most programs had similar cutting schedules, but I can't be sure about any program other than my own. Cutting every single day would suck. If you want more specifics about the JHH cutting schedule feel free to PM me.

 

[LADoc00]

Fairly certain you gross everyday at Stanford and MGH...unless that changed.

Anyone else want to bet on a location?

We need the OP's outing though

 

[SLUsagar]

I would put 100 bucks on a wager the OP is complaining about MGH or Stanford.

you're 1/2 way to owing me 100 bones, baby. PM me and i'll send you my addie. check or money order will suffice if you can't find enough strip-club left-over Washington's to stuff in an envelope.

since you've left, stanford has adopted a much more pleasant 3-day schedule...gross, cytology/preview, s/o...repeat as gross/frozens, cytology/preview, s/o. the days of doing all 3 in the same day are gone. at the VA things might occasionally still be all in the same day, but the volume is so much lower it's not a biggie. the new schedule has been in place for like 5 years or so, working really well. still uber busy, but at least folks have time to read and learn about cases.

MGH folks can chime in, and help me acquire my fair share of LaDoc's hard-earned cash.

 

[LADoc00]

You have to guess the location for the win! I stand by my bets.

And if Stanford cowered to complaints and does a wussy rotation system, then woe is the day. No more ironmen capable of grossing until 10pm...previewing until 12am, hitting Nolas for martinis until 2am and then waking up at 6am...sad.

 

[gbwillner]

You have to guess the location for the win! I stand by my bets.

And if Stanford cowered to complaints and does a wussy rotation system, then woe is the day. No more ironmen capable of grossing until 10pm...previewing until 12am, hitting Nolas for martinis until 2am and then waking up at 6am...sad.

WashU still fits this criteria.... and the first years are putting in some long hours....

 

[pathstudent]

WashU still fits this criteria.... and the first years are putting in some long hours....

How do they get past the ACGME and residency review committees if they are maintaining those hours? Are you all told to lie?

 

[2121115]

How do they get past the ACGME and residency review committees if they are maintaining those hours? Are you all told to lie?

I am at one of the programs mentioned above, so I know. As mentioned above, these types of programs are self selecting. To specifically answer your question though, residents don't have to be told. Patient care comes before the silly restrictions that are in place. Besides, there are plenty of 8-5 rotations in residency and you only have to average 80-hours over a period of time.

 

[gbwillner]

How do they get past the ACGME and residency review committees if they are maintaining those hours? Are you all told to lie?

I am at one of the programs mentioned above, so I know. As mentioned above, these types of programs are self selecting. To specifically answer your question though, residents don't have to be told. Patient care comes before the silly restrictions that are in place. Besides, there are plenty of 8-5 rotations in residency and you only have to average 80-hours over a period of time.

We are not told to lie. We are told to average our hours over the course of several months. I've seen several first years this year log 15-16 hr days on surgpath... but if you average in their next month on service, which is a lighter rotation, you are not over 80 hrs (not even close, really). Don't forget that if you don't come in over the weekend (which most of us do) you need to log 16 hr days every day to get 80/week. Frankly, I doubt anyone is actually going over 80 hrs/week, and if they are, they will soon learn to do things quicker anyway. The only real concern is getting 10 consecutive hours off service. First years would probably go over if they were to only consider the 4-week block they are on that rotation.

 

[pathstudent]

Well here are the real rules that your program has to follow or risk losing the accreditation.

Duty Hours


Duty hours are defined as all clinical and academic activities related to the residency program, ie, patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.


Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.


Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities.


Adequate time for rest and personal activities must be provided. This should consist of a 10 hour time period provided between all daily duty periods and after in-house call.

 

[pathstudent]

I am at one of the programs mentioned above, so I know. As mentioned above, these types of programs are self selecting. To specifically answer your question though, residents don't have to be told. Patient care comes before the silly restrictions that are in place. Besides, there are plenty of 8-5 rotations in residency and you only have to average 80-hours over a period of time.

You sound like a robot. Of course patient care is important, but they could address it by letting residents work over 80 hours a week, or go without 10 hours off between every single shift. Or they could hire a couple extra PAs.

 

[2121115]

You sound like a robot. Of course patient care is important, but they could address it by letting residents work over 80 hours a week, or go without 10 hours off between every single shift. Or they could hire a couple extra PAs.

Yeah, you're right. I suppose that did sound rather "robot-ish". However, after first year we are much faster and can do the same work much more efficiently and don't come close to duty hour violations. Speed is important. When joining a practice after residency, being able to do the work competently is not the only thing to worry about. You have to be be fast and efficient to seemlessly blend into a high volume practice. From what I'm told (as I'm still a resident), if you haven't been in an environment where speed is learned and emphasized then you may drown when you get out in practice. IOW, just because you're fresh out of training doesn't mean that a practice will tolerate you being a weak link.

That is why I don't mind the hours. Looking back I think that the high workload is a strength of our program and we are all better for it. With that said, our program is not one where the hours are scut. The hours are spent grossing, previewing and signing out. I suppose if it were 80-hour weeks of scut I'd be pretty discouraged about it.

 

[KluverB]

Well here are the real rules that your program has to follow or risk losing the accreditation.

Thank you, Mr. Duty-Police. I think we all know what the rules are. Your point is...?

 

[pathstudent]

Thank you, Mr. Duty-Police. I think we all know what the rules are. Your point is...?

I don't know if you all do because two people were saying that it evened out over a period of months. That's not the police. It has to even out over 4 weeks.

If you stay in the hospital until working until 11pm, you can't show up until after 9am.

The rules are very specific, and they are created to improve education and patient care. If your program isn't following them, you better do something about it because they might get shut down.

 

[SLUsagar]

Well here are the real rules that your program has to follow or risk losing the accreditation.

Duty Hours
Adequate time for rest and personal activities must be provided. This should consist of a 10 hour time period provided between all daily duty periods and after in-house call.

while i generally agree with all the posted ACGME rules, and agree that to hit 80hrs is pretty hard for most path residencies (fellowships not included), this 10-hour rule is a joke. I mean yeah, for medicine folks especially after a long post-call day this makes sense. But you're telling me on a preview evening/night, when you finish up at 11pm you're gonna miss the regular 8am lecture and show up at 9am just to coincide with the rules? and 11pm for a newbie 1st year previewing?? that can be early. And let's just say you go a bit slow and take your time reading about cases instead of flying through them and getting out early. Well, that "reading" apparently counts towards your hours. Again, BS. Medicine folks don't have the luxury to sit and read like we do about cases and frankly our field is much more book-oriented, often requiring frequent lit. searches/etc. I'd often play the devil's advocate with our program director, joking asking how the rules would apply if I previewed a few cases, then left the hospital and sat outside in the grass (off hospital grounds) with my big ass sternberg in my lap and read about the few cases i'd peered at, then ran back in and finished up the next batch. Would THAT reading count towards my hours??!! And don't even get me started on hours that "go towards" research projects...
this of all the rules needs to be modified for path residency. we don't do day call or have post-call scenarios, that HAS to factor in.

Of the several residency programs i know that have had to quickly modify their internal regulation of rules (b/c of whistle-blowers or in fear of such imminent foul cries), THIS stupid rule has created the most anxiety.

 

[pathstudent]

while i generally agree with all the posted ACGME rules, and agree that to hit 80hrs is pretty hard for most path residencies (fellowships not included), this 10-hour rule is a joke. I mean yeah, for medicine folks especially after a long post-call day this makes sense. But you're telling me on a preview evening/night, when you finish up at 11pm you're gonna miss the regular 8am lecture and show up at 9am just to coincide with the rules? and 11pm for a newbie 1st year previewing?? that can be early. And let's just say you go a bit slow and take your time reading about cases instead of flying through them and getting out early. Well, that "reading" apparently counts towards your hours. Again, BS. Medicine folks don't have the luxury to sit and read like we do about cases and frankly our field is much more book-oriented, often requiring frequent lit. searches/etc. I'd often play the devil's advocate with our program director, joking asking how the rules would apply if I previewed a few cases, then left the hospital and sat outside in the grass (off hospital grounds) with my big ass sternberg in my lap and read about the few cases i'd peered at, then ran back in and finished up the next batch. Would THAT reading count towards my hours??!! And don't even get me started on hours that "go towards" research projects...
this of all the rules needs to be modified for path residency. we don't do day call or have post-call scenarios, that HAS to factor in.

Of the several residency programs i know that have had to quickly modify their internal regulation of rules (b/c of whistle-blowers or in fear of such imminent foul cries), THIS stupid rule has created the most anxiety.

during residency i violated this rule more often than Michael Jackson violated his pediatric "pals"

YOu are just foolish as everyone know you went to Stanford and now you are broadcasting that Stanford Pathology doesn't enforce the ten hour rule as you claim to broke it over and over.

It is not stupid. It is about quality of life issue for residents and about patient care. Fresh rested residents learn more and provide better care. How path residents get hosed is that most take at home call, so if you come in for a few NP frozens in the middle of the night you still are expected to come in the next day for your 7 or 8 am conference. That's absurd, as it is bad for the resident's education, bad for the resident's well being and bad for patient care.

 

[AnaPlasia]

I wasn't trying to whine. Sorry if it came across that way. I am a very hard worker and don't mind the hours when I'm learning- it's why I don't mind coming in on the weekend to work on things (and the grossing suite is closed!). But grossing when I should be pre-viewing or while my cases are being signed out REALLY bothers me. Even the staying late wouldn't be so bad if the nieghborhood was safe. We are actually under orders not to stay late for safety reasons but the work isn't going to do itself so there seems to be a disconnect on that subject.

 

[KluverB]

I don't know if you all do because two people were saying that it evened out over a period of months. That's not the police. It has to even out over 4 weeks.

Exactly. The prior 4 weeks. So, if your last 4 weeks happen to coincide with a heavy surgpath rotation and 16 hr days, than yeah, if you're slow as molasses, you'll prob. be in violation. If however, your last 4 wks include 1 wk of surgpath, and 3 weeks of micro sans call, chances are you are nowhere near the ballpark for duty hour violations... as averaged out over 4 wks.

If you stay in the hospital until working until 11pm, you can't show up until after 9am.

The rules are very specific, and they are created to improve education and patient care. If your program isn't following them, you better do something about it because they might get shut down.

The rules are anything but very specific, as you have clearly posted above...

Duty hours do not include reading and preparation time spent away from the duty site....

Does anyone in pathology actually take in-house call? I would definitely like to out that program.

Adequate time for rest and personal activities must be provided. This should consist of a 10 hour time period provided between all daily duty periods and after in-house call.

So, if you drag your butt and read up on every single case you preview and look at each field of of every slide at 40x, you could easily be in violation.

I have seen the rules cut both ways. They're there, supposedly, to make sure patients get the best care and to make sure you, as a resident, don't cut yourself, or kill yourself or someone else on the way home. Still, there are plenty of non-ACGME accredited residencies and fellowships, and these rules don't apply to them, so what about patients at those institutions? Also, the attendings are not bound by any duty-hour rules. So, what happens when they're tired? Etc. Etc.

Not to mention that the jury is still out on whether more frequent hand offs are better for patient care compared to longer hours. Again, we all know that working long hours is not in the best interest of anyone, but there just isn't enough money in the system to have enough residents to cover enough shifts, not be in violation of duty hours, still learn something, all without extending the length of residency training. Also, path is already producing too many grads as it is. But, at this point I digress... these horses have been beaten to death on several of these forums.

Still, as an aside, except perhaps for doing frozens without supervision, how much of a direct impact do you actually have on patient care on a day to day basis, I mean really?

I would dare say that path residents are the least necessary to the entire "medicine" process at most residency programs, save perhaps for the grossing services they provide. I would even go as far as saying that path residents are actually in the way of faster turnaround times. There are a few programs out there (you know who you are) that run resident-less services, and you can be sure that those services get signed out a lot quicker than anything that involves residents. But once again, I digress.

What I wanted to say, is that I agree with SLUsagar. These rules are not there for pathology. As SLUsagar eluded to... What if you're on a research rotation, and that requires you to come in every single day to work on your experiments... for 4 wks in a row... even if you come in for 1 hr a day... Ooops... suddenly you're in violation of the rules, b/c you didn't get your 24 hrs off. Really?! Yeah, I know, that doesn't count because it's not actually "duty" hours per se... or is it... what if it involved being on the CP pager, and involved having to come in on the weekend for 10 minutes to sniff some plates? Etc. Etc.

Also, I have seen those rules over-interpreted the other way, i.e. with someone watching the clock and thus sending residents home if they've stayed too long, or if they did not have a long enough break between shifts. And concurrently, I have seen residents abuse said system by dragging their feet, staying "late", and thus getting a free pass to go home early the next day.

I don't agree with having to work an 80 hr week... I mean, what other professional, or for that matter non-professional, group does that?!... But, the current rules are completely arbitrary, and make no sense when applied across different specialties, or even for different rotations within specialties...

 

[KluverB]

... But grossing when I should be pre-viewing or while my cases are being signed out REALLY bothers me. ...

Ah yes, sorry for all that. We didn't realize you were at one of "those" programs. But that just proves my point about the duty hour rules, that perhaps I did not spell out. I'm sure you're well within the 80 hrs/wk, the 10 hrs off daily, and the 24 hrs off contiguous; after all, the gross room is closed over the weekend, how convenient. But, unfortunately your program has deemed the ACGME duty-hour requirements as more important than the educational objectives. Not sure you're going to find what you're looking for at any number of the other high-volume places. Though, I only have experience with what I know.

 

[SLUsagar]

What I wanted to say, is that I agree with SLUsagar. These rules are not there for pathology. As SLUsagar eluded to... What if you're on a research rotation, and that requires you to come in every single day to work on your experiments... for 4 wks in a row... even if you come in for 1 hr a day... Ooops... suddenly you're in violation of the rules, b/c you didn't get your 24 hrs off. Really?! Yeah, I know, that doesn't count because it's not actually "duty" hours per se... or is it... what if it involved being on the CP pager, and involved having to come in on the weekend for 10 minutes to sniff some plates? Etc. Etc.

Also, I have seen those rules over-interpreted the other way, i.e. with someone watching the clock and thus sending residents home if they've stayed too long, or if they did not have a long enough break between shifts. And concurrently, I have seen residents abuse said system by dragging their feet, staying "late", and thus getting a free pass to go home early the next day.

I don't agree with having to work an 80 hr week... I mean, what other professional, or for that matter non-professional, group does that?!... But, the current rules are completely arbitrary, and make no sense when applied across different specialties, or even for different rotations within specialties...

thanks for your support. agreed, especially on CP, maintaining the day off once a week rule is hard, especially if you have to come in to look at a smear or something (which often doesn't take more than 1 hr...but "technically" could violate the rule).
Speaking of violating, YES, studentofpath, Stanford (as well as UCSF) does enforce the 10hr hour, just as they do all ACGME rules, in full extent. I think they even have a case cap now, precluding these issues. Most of the big california academic training centers for path don't end up violating. I never said I went anywhere btw and have rotated out at a bunch of places to be able comment on institutional practices...furthermore, I was being sarcastic, so calm the hell down. Yeah, i did sometimes violate the rule on a technicality (see CP example above), but see I actually tried to do best for my patients and sometimes had to put in the extra effort to finish my work, even if that meant bending the rules. [and NO, if i really was THAT tired, i wouldn't jeopardize quality work or patient care, so let me go ahead and stop you now].

See, out in the real world when you are a grown-up pathologist, when it's 6 or 7 or even 8pm, and you're not done signing out and you have a frozen or an urgent case, you can't b*tch out and say, well, today i've worked too many hours today and have to go home; methinks i'll finish up tomorrow...in residency training, sometimes that translates to staying later if needed, to read, work, whatever.

I agree that we have to deal with the cards we've been dealt in all the ACGME rules and reg's...but all i'm trying to get across is that path needs a Barry Bonds-type asterisk if you're gonna try to apply it equally across all specialties. our field is different, deal with it.

 

[spin2]

YOu are just foolish as everyone know you went to Stanford and now you are broadcasting that Stanford Pathology doesn't enforce the ten hour rule.

LONGtime lurker, 1st time poster. what prompted me to come out of my shell? well i had to come and take a stance against bogus comments like this. i can verify 1sthand that Stanford path has NO issues with work hours violation (if anything, the recent case cap that has been alluded to has made it much easier to get out at a reasonable timeframe).

so before you go and start making inflammatory comments, please consider the significance of them. this is a ridiculous and fraudulent accusation, without merit. isn't there a moderator that scans or proofs these posts? i actually agree with sluseger, i think his/her point was that the work hours issue for PATH needs clarification with likely modification. if any 1 particular resident wants to stay late to read or whatever, yeah, you're not supposed to (and hope that rats like pathstudent wouldn't try n' call you out) but frankly it's not that hard to just lie when entering your work hours. yeah my prgm really does enforce ALL the ACGME work hour rules, but no one is gonna police the hallways okay, we'll all adults here and can make adult decisions.

 

[deschutes]

To clarify: The role of the moderators isn't to proof every single post or verify accuracy of the information (like any other Internet forum, SDN is free and public). Moderators are here to encourage discussion and usability of the forums, as well as deal with Terms of Service violations.

The best way to deal what you think is false information is to provide information that will counter it. Evaluating residency programs solely based on information from an Internet forum is of course a silly practice.

 

[Pathwrath]

But grossing when I should be pre-viewing or while my cases are being signed out REALLY bothers me. Even the staying late wouldn't be so bad if the nieghborhood was safe. We are actually under orders not to stay late for safety reasons but the work isn't going to do itself so there seems to be a disconnect on that subject.

This is a problem. If the grossing hours are no better for senior AP residents, I would seriously consider transferring. You've got two years to get a decent grasp of general surgical pathology, and a boutique fellowship doesn't make up for mediocre AP training. There's enough marginal surgical pathologists out there already.

 

[LADoc00]

This thread is spiraling down, quite amusing.

I still think the OP is whining, which is fine. I whined, alot. But you suck it and deal with it..and it makes you stronger.

How can you enjoy private prac when life is cush if all you have to look back is more cush during training? seriously, they need have you path interns/residents do something crazy in lieu of long hours, perhaps MMA fighting or in a ring with Mike Vick's dogs.

 

[KluverB]

SLUsagar or spin2, can you please enlighten as to what this specimen "cap" is, and how it works? Thanks.

 

[SLUsagar]

SLUsagar or spin2, can you please enlighten as to what this specimen "cap" is, and how it works? Thanks.

others can chime in, but last i recall basically hotseat fellow (initially previewing ALL resident cases for the day) will tease out "garbage" cases for residents if it seems they might go over the "cap" (i.e. max. # of cases) based on their R1 vs R2 status. If the # is below that, residents get all the cases. [extra cases are signed out directly by attending]. All in all, the aim is to focus on the challenging cases with time to read up and properly have them tee'd up for the next day's signout. You still see a lot of normal and usual stuff, but (FOR EXAMPLE) instead of having say 8 colonic TA's on your s/o day you'll have 3-4. make sense? it's been instituted for the past few years.

overall i think it's intent is good, but at the same time being out in prv practice i find myself appreciating my days of training with NO cap, forcing you to be efficient even with a boatload of garbage cases...but then again, if i had more time, i would have LOVED to have time to read more about the weirdo, cool cases. I suppose always gonna be greener grass on the other side.

 

[pathgrrl]

But grossing when I should be pre-viewing or while my cases are being signed out REALLY bothers me.

If the more senior residents are still doing this (not previewing, not present at sign-out), I would consider this a huge red flag. Take a stand and make waves or keep working hard and get out while you can with a reasonable rec letter.
If they aren't, then ask them for efficiency tips. Little things can make a big difference. For example:
-- use the same inking schema for every skin ellipse and lumpectomy
-- put the same number of sections in each block, so that you don't need to keep track as you go
-- use the minute or two while your frozen is staining to dictate the gross description or something else useful
Most important, IMO, is to let go of perfection. We're all a little OCD or we wouldn't be pathologists. If it doesn't matter for patient care, estimate measurements and use the word "approximately". As someone taught me, if it is the size of a standard cassette, it is 3.5 x 2.5 x 0.5cm. (Caveat -- obviously, tumors should be measured carefully)

 

[Neddy]

Fairly certain you gross everyday at Stanford and MGH...unless that changed.

Anyone else want to bet on a location?

We need the OP's outing though

We still gross everyday at MGH - we have over a dozen surg path subspecialty services, and never more than one resident on a service at a time, so a rotation schedule wouldn't work. But I've never spent more than half of any given workday grossing - usually much less. We never miss signout to gross, we make our work hours, and if any of our first-years are unhappy, they are hiding it pretty well (and I would buy them extra drinks tomorrow night to cheer them up). Also, I don't think either Beacon Hill or Palo Alto qualifies as an "unsafe neighborhood." So I think you'd lose your bet, LA.

 

[LADoc00]

Hmm, Im going to call bullshiat on the OP having to gross "while my cases are being signed out". That makes no sense. You would literally learn nothing about surgical path aside from reading...that is a very dangerous internet claim to make.


My guess is, one rare time while the OP was grossing her junior attending signed out some trash cases to speed up the day.

I really do sympathize with Anaplasia though, it can really really suck balls. But it does get better.

 

[LADoc00]

We still gross everyday at MGH - we have over a dozen surg path subspecialty services, and never more than one resident on a service at a time, so a rotation schedule wouldn't work. But I've never spent more than half of any given workday grossing - usually much less. We never miss signout to gross, we make our work hours, and if any of our first-years are unhappy, they are hiding it pretty well (and I would buy them extra drinks tomorrow night to cheer them up). Also, I don't think either Beacon Hill or Palo Alto qualifies as an "unsafe neighborhood." So I think you'd lose your bet, LA.

EPA and J. Plains arent supersafe either...and Ive lived near both.

 

[yaah]

Hmm, Im going to call bullshiat on the OP having to gross "while my cases are being signed out". That makes no sense. You would literally learn nothing about surgical path aside from reading...that is a very dangerous internet claim to make.

I have heard some residents make these claims - some of them were at big city programs (NYC mostly) where they spent most of their day grossing, and they said that the attending would sign cases out and then leave the trays for them. I have no reason to not believe what they were telling me. Perhaps these programs think that surg path fellowship is where you learn surg path 🙄

 

[pathstudent]

LONGtime lurker, 1st time poster. what prompted me to come out of my shell? well i had to come and take a stance against bogus comments like this. i can verify 1sthand that Stanford path has NO issues with work hours violation (if anything, the recent case cap that has been alluded to has made it much easier to get out at a reasonable timeframe).

so before you go and start making inflammatory comments, please consider the significance of them. this is a ridiculous and fraudulent accusation, without merit. isn't there a moderator that scans or proofs these posts? i actually agree with sluseger, i think his/her point was that the work hours issue for PATH needs clarification with likely modification. if any 1 particular resident wants to stay late to read or whatever, yeah, you're not supposed to (and hope that rats like pathstudent wouldn't try n' call you out) but frankly it's not that hard to just lie when entering your work hours. yeah my prgm really does enforce ALL the ACGME work hour rules, but no one is gonna police the hallways okay, we'll all adults here and can make adult decisions.

I never said it. The other guy said he broke the 10 hour rule many times.