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surg path rotation schedule
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At the beginning of my PSF year, the department went from a 3-day schedule (Day 1: Frozens, Day 2: Grossing, Day 3: Sign-Out) to a 2-day schedule (Day 1: Grossing and Frozens, Day 2: Sign-Out), mainly due to decreased volume. I never worked the 3-day rotation, so I can only comment on the 2-day schedule.
ADVANTAGES:
DISADVANTAGES:
Some of the disadvantages can be alleviated if you have reasonable attendings (who will take care of the ditzels without you, esp. if you've already previewed and dictated the case) and a rotation partner or seniors who are willing to step in and help when you're really in the weeds, whether by taking over frozen duty or grossing your 10 billion GI biopsies.
I'm sure others can comment on the 3- and 4-day schedules I've seen mentioned on residency program websites. I'd also be interested to hear about the 3-in-1 days, if anyone has experience with that.
ADVANTAGES:
- Faster turn-around time for clinicians (i.e., fewer angry phone calls)
- It forces you to manage your time and become efficient in the gross room
- You see more cases per month, and thus more overall
DISADVANTAGES:
- Heavier case load per day compared to 3-day cycle
- Potentially less time to read up on *all* your cases
- Some cases end up with longer turn-around because of grossing delays (i.e., you cut 15 frozens for a complex ENT case, carving a huge chunk out of your grossing time before the processor starts)
- You may not get to gross every specimen you cut frozens on (This may differ depending on your program and/or how much time you have the next day. I usually came in early to knock them out so I didn't have to re-orient and explain the specimen to my fellow SPer.)
Some of the disadvantages can be alleviated if you have reasonable attendings (who will take care of the ditzels without you, esp. if you've already previewed and dictated the case) and a rotation partner or seniors who are willing to step in and help when you're really in the weeds, whether by taking over frozen duty or grossing your 10 billion GI biopsies.
I'm sure others can comment on the 3- and 4-day schedules I've seen mentioned on residency program websites. I'd also be interested to hear about the 3-in-1 days, if anyone has experience with that.
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We don't have a set cycle. First years are on AP the entire year and their schedule is something like this:
few times a month (starts out more frequently and goes down to only once or twice a month as the year progresses) - gross routine (non-frozen) specimens all day for one staff, then preview/dictate/sign out those cases out with that staff the following day.
about 1x per week - cover frozens, grossing them the same day if possible (otherwise the next morning), then preview/dictate/sign out those cases with the assigned staff the following day (usually in the afternoon). Occasionally, if we get really slammed (i.e. are actually in the frozen room the entire day and have a ton of stuff leftover to gross that won't make it onto the end of day processor), our staff will give us the entire next day to gross and then we'll sign out the day after that.
The remaining days are generally micro only (preview/dictate and then sign out all the cases a particular attending has that day with them) plus or minus autopsy coverage (if an autopsy comes in, you would do that instead surgicals for the day). We don't have a specific autopsy rotation, so the first years take turns covering the autopsy service all year during the week.
A typical week's schedule would look something like this
Mon - Micro/Autopsy coverage
Tu - Micro/Autopsy coverage
Wed - Frozens
Thur - Frozen micro
Fri - Micro
The schedule for more senior residents on AP is a little different, as seniors don't cover autopsies and don't do routine (non-frozen section) grossing.
I thought our schedule worked out pretty well. About the only downside was when an autopsy would come in later in the day (after you'd already spent a bunch of time previewing and dictating cases). You could either just let the surgical cases go, or try to scramble to follow up on how they were eventually signed out after your autopsy (and all the resultant paperwork) was finished.
few times a month (starts out more frequently and goes down to only once or twice a month as the year progresses) - gross routine (non-frozen) specimens all day for one staff, then preview/dictate/sign out those cases out with that staff the following day.
about 1x per week - cover frozens, grossing them the same day if possible (otherwise the next morning), then preview/dictate/sign out those cases with the assigned staff the following day (usually in the afternoon). Occasionally, if we get really slammed (i.e. are actually in the frozen room the entire day and have a ton of stuff leftover to gross that won't make it onto the end of day processor), our staff will give us the entire next day to gross and then we'll sign out the day after that.
The remaining days are generally micro only (preview/dictate and then sign out all the cases a particular attending has that day with them) plus or minus autopsy coverage (if an autopsy comes in, you would do that instead surgicals for the day). We don't have a specific autopsy rotation, so the first years take turns covering the autopsy service all year during the week.
A typical week's schedule would look something like this
Mon - Micro/Autopsy coverage
Tu - Micro/Autopsy coverage
Wed - Frozens
Thur - Frozen micro
Fri - Micro
The schedule for more senior residents on AP is a little different, as seniors don't cover autopsies and don't do routine (non-frozen section) grossing.
I thought our schedule worked out pretty well. About the only downside was when an autopsy would come in later in the day (after you'd already spent a bunch of time previewing and dictating cases). You could either just let the surgical cases go, or try to scramble to follow up on how they were eventually signed out after your autopsy (and all the resultant paperwork) was finished.
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I spent a couple of years doing basically a 2 day rotation, and a couple of years doing basically a 3 day rotation -- two different programs.
In the 2 day setup the gross room was also the frozen room, and also had a full time very very good pathology assistant who was capable of handling the entire grossing load alone. On day 1 we would gross and handle frozens if the attendings didn't sneak in and do it themselves; the group was private and still had a sense of treating surgeons as personal clients (also a big part of the reason we had a 2 day rotation as they wanted as fast a turnaround time as possible). Slides would start to become available about 6 AM on day 2 but most of the attendings wanted to start signing out by about 9 AM, so preview time was often quite limited. Unfortunately as that program only got ~50 autopsies per year we mostly did them on a rotation (other variables came into play so pretty much those on AP rotations or just SP did them, but not worth trying to detail all that), so you could lose out either grossing or signout days pretty easily. The worst part was the difficulty in getting decent preview time; we tried various things to work around this, such as starting signout later or previewing half while the attending signed out half, then swapping, then briefly flying through all of them together at the end of the day, but it never seemed to work out particularly well as a system.
The 3 day setup was at a more traditional academic program. The gross room was separate from the frozen room. On day 1 we grossed, focusing primarily on the larger/excision specimens and usually letting a PA or PA student handle popping biopsies into cassettes. On day 2 we did frozens and read out biopsies from the previous day (so, biopsies from our grossing day but probably NOT grossed by us), which usually finished in the early to mid afternoon; most days we were able to preview biopsies in the morning, and finish biopsy sign out by early afternoon, unless there were a lot of frozens -- but for better or worse, most days did not require a lot of time on frozens. In mid to late afternoon the slides from day 1 grossing were out or coming out so we could begin previewing; we had until the start of sign-out the following day to preview, do initial dictations, etc. On day 3 we would start sign-out often between around 9-10 AM with the attending. The case load was such that some days were busy, but enough days were sparse enough to find a window to follow up on special/immuno stain cases, intradepartmental consults, recuts, going back to the gross bucket, etc. so everything could be completed in a reasonable timeframe while still having some time to preview and read. There were occasional long days, usually those who preferred to stay late and preview rather than come in early, but "late" still meant 7-8 PM, not 11 PM, and many senior/efficient residents were regularly out before that. The down side in terms of competing with a private group was primarily turnaround time, but it worked much, much better for a training program IMO. It might have been able to work by grossing on day 1, preview & sign-out big specimens on day 2, then frozens and sign-out biopsies you didn't gross on day 3 -- I seem to recall it being discussed but, frankly, it's all a blur now.
In the 2 day setup the gross room was also the frozen room, and also had a full time very very good pathology assistant who was capable of handling the entire grossing load alone. On day 1 we would gross and handle frozens if the attendings didn't sneak in and do it themselves; the group was private and still had a sense of treating surgeons as personal clients (also a big part of the reason we had a 2 day rotation as they wanted as fast a turnaround time as possible). Slides would start to become available about 6 AM on day 2 but most of the attendings wanted to start signing out by about 9 AM, so preview time was often quite limited. Unfortunately as that program only got ~50 autopsies per year we mostly did them on a rotation (other variables came into play so pretty much those on AP rotations or just SP did them, but not worth trying to detail all that), so you could lose out either grossing or signout days pretty easily. The worst part was the difficulty in getting decent preview time; we tried various things to work around this, such as starting signout later or previewing half while the attending signed out half, then swapping, then briefly flying through all of them together at the end of the day, but it never seemed to work out particularly well as a system.
The 3 day setup was at a more traditional academic program. The gross room was separate from the frozen room. On day 1 we grossed, focusing primarily on the larger/excision specimens and usually letting a PA or PA student handle popping biopsies into cassettes. On day 2 we did frozens and read out biopsies from the previous day (so, biopsies from our grossing day but probably NOT grossed by us), which usually finished in the early to mid afternoon; most days we were able to preview biopsies in the morning, and finish biopsy sign out by early afternoon, unless there were a lot of frozens -- but for better or worse, most days did not require a lot of time on frozens. In mid to late afternoon the slides from day 1 grossing were out or coming out so we could begin previewing; we had until the start of sign-out the following day to preview, do initial dictations, etc. On day 3 we would start sign-out often between around 9-10 AM with the attending. The case load was such that some days were busy, but enough days were sparse enough to find a window to follow up on special/immuno stain cases, intradepartmental consults, recuts, going back to the gross bucket, etc. so everything could be completed in a reasonable timeframe while still having some time to preview and read. There were occasional long days, usually those who preferred to stay late and preview rather than come in early, but "late" still meant 7-8 PM, not 11 PM, and many senior/efficient residents were regularly out before that. The down side in terms of competing with a private group was primarily turnaround time, but it worked much, much better for a training program IMO. It might have been able to work by grossing on day 1, preview & sign-out big specimens on day 2, then frozens and sign-out biopsies you didn't gross on day 3 -- I seem to recall it being discussed but, frankly, it's all a blur now.
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At Wash U/Barnes, we did it on a one day rotation: sign out routine gross in the am, sign out biopsies in the pm, gross in the evening/night and preview in the wee hours of the morning either before you go home or get there early.
I've read that description before and it's not any less frightening on subsequent retellings. I could see you totally blowing out current duty hours requirements. You'd also see a whole bunch of cases, too.
Our current setup:
Day 1: do frozens and gross them. PAs/residents gross biopsies and routines.
Day 2: signout frozens and non-frozen complex cases
Day 3: Gross routines. This can turn into a mini reading day if the PAs keep things under wraps.
Day 4: signout routines and biopsies
Autopsy and Cyto are separate rotations. There is adequate time with the glass before signout, generally, but more signout days per month would preferable.
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We have a similar setup. It's a 5 or 6 day rotation (depending on the number on service):
Day 1: Routines (grossing)
Day 2: Sign out routines from day 1
Day 3: Biopsies (sign out biopsies only)
Day 4: Frozens (do frozens and gross frozens)
Day 5: Sign out frozens from day 4
Day 6: Float (catch up on pending cases and help out those on frozens or routines if needed)
We don't gross biopsies unless the PA is swamped and needs help (I've done it a handful of times in my 4 years). Cyto and autopsy are separate rotations for us as well. If we don't have enough people on service and/or people are taking vacation that month we may not get a float day with every cycle.
It works really well for us and we generally have enough time to get our work done. If there are pending cases from frozens or routines after the sign out day then the attendings will either take care of finishing it (for lower levels) or the upper levels just fit it in with the rest of their duties on subsequent days.
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That's a really nice rotation, very conducive to learning.
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I've read that description before and it's not any less frightening on subsequent retellings. I could see you totally blowing out current duty hours requirements.
If it came up that we were getting close to going over our duty hours, we were told 1) it was impossible to go over your duty hours in pathology; 2) the hours were being inappropirately counted i. e. when the surgeon tells you he will need you at any minute but doesn't call for 5 hours the wait time doesn't coun't; and/or 3) you were slow and should use your time more efficiently with the implication that hours over the limit were not to be recorded.
If it came up that we were getting close to going over our duty hours, we were told 1) it was impossible to go over your duty hours in pathology; 2) the hours were being inappropirately counted i. e. when the surgeon tells you he will need you at any minute but doesn't call for 5 hours the wait time doesn't coun't; and/or 3) you were slow and should use your time more efficiently with the implication that hours over the limit were not to be recorded.
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But those specimens aren't underpants. Must have underpants 🙂
We have the subspeciality signout.
Our surgical rotations are divided for each subspeciality like GI (includes liver and pancreas),GU,GYN, Breast, Chest, Bone and soft tissue, head and neck, endocrine and frozen. THe autopsy rotation is combined with neuropath, pedipath, renal path and dermpath.
We spend one month in each subspeciality.
I like this system because we learn good grossing skills and gain good experience examinig slides. We can actually focus on one thing each month.
What I dislike is sometimes I get bored like looking at tons of prostate each day.
Our surgical rotations are divided for each subspeciality like GI (includes liver and pancreas),GU,GYN, Breast, Chest, Bone and soft tissue, head and neck, endocrine and frozen. THe autopsy rotation is combined with neuropath, pedipath, renal path and dermpath.
We spend one month in each subspeciality.
I like this system because we learn good grossing skills and gain good experience examinig slides. We can actually focus on one thing each month.
What I dislike is sometimes I get bored like looking at tons of prostate each day.
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