Residents learning in your department

[fidiasss]

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Hi! I am 2nd year pathology resident from Spain.

I am interested in finding out what the teaching organization of residents in your pathology department is like, especially the residents who have just joined.

In my department, the teaching organization is practically non-existent. We legally have a chief of residents, but he does absolutely nothing.

I am interested above all in the organization of the R1 and, especially, how grossing for the R1 is organized in your department.

In my department what is the following:

-They start in the grossing room with an older resident to see everything he does for about 2 weeks. In the 2nd week, he/she is allowed to do some small type of skin punch, skin ellipses, transurethral resections, cecal appendix, gallbladders...

- As of the 3rd week, SMALL pieces are left to do (punch-ellipses of skin, TURs, cecal appendix...).

- From the 4th week, they start a rotation in a subspecialty, for example digestive. Therefore, IN ADDITION to the small pieces, they have to start grossing ALONE large pieces of that subspecialty, for example: colon tumor. And these types of large pieces are also explained to them by an older resident.

Don't you think it's a bit hasty that they start grossing so soon? What do you think that the supervision is done mainly by the resident and not by the specialist? how is it in your service? what would be your most sense planning?

Then there is the issue of teaching under the microscope. In my service, you have to look for yourself, that is, you have to be very self-taught from R1.

Regards

 

[LADoc00]

So if you believe the legends, Juan Rosai stepped out of the jungles around Buenos Ares having completely taught himself anatomic pathology. He was such an oddity that he was brought back to the US and became the modern father of surgical pathology.

A normal human even a highly intelligent one cannot teach him or herself pathology. It’s too complex and too nuisance to get solely from reading. You will have to find a mentor which means given your situation will need to gain the respect of the senior doctors in your program.

 

[shikimate]

I think after 3 weeks of grossing small GI specimen, one can probably attempt simple larger specimens. For example colon for benign disease such as diverticuli. Maybe after 4-5 weeks of grossing one can attempt colon tumors, and eventually onto very complex specimens such as Whipple.
Nowadays there are so many online resources and videos on grossing that it's expected you'll do a lot of self teaching. UChicago has a great grossing website. There are also tons of youtube videos.
I do find the first 2.5 years a very steep learning curve, a lot of things they just expect you to somehow learn it yourself without giving you a clear instruction as to where to find good resources.
The old people always say "just go read this book" which is nonsense since nobody is going to read this 600 page textbook and just magically memorize the facts. Maybe back in their gold days when there are like 3 immunostains available that would work, but not today. Good thing these days website like libre path and path outlines pinpoint the high yield information.

 

[fidiasss]

You will have to find a mentor which means given your situation will need to gain the respect of the senior doctors in your program.

what do you mean by gain the respect of senior doctor? Thx

 

[KeratinPearls]

what do you mean by gain the respect of senior doctor? Thx

People see potential in you. You are hard working, focused and have a strong desire to become a good pathologist.

That’s unfortunate that you have to be self taught. Getting good at something requires a mentor or someone who is experienced and knowledgeable. In the US, we get taught in residency but each resident has to also do his or her learning/reading in his/her free time.

Some programs have what is called “boot camp”, where specimens are held for first year residents to gross. Maybe just one or two. Chief residents usually supervise and when they feel like the resident is ready then they gradually ease them to more advanced cases.