Hello everyone. Congrats to all of you who matched. The matches here are freakin' impressive. It has to be an awesome feeling. Anyway, when you all were evaluating potential residency programs what sort of surgical volume did you look for? I have looked up some numbers and there seems to be a great deal of variation. The largest places like MGH and Hopkins do upwards of 70,000 per year while some of the smaller places do as little as 15,000. What sort of volume should I shoot for?
Surgical Path Volume
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I was told, more than 20k/year. The places I visited had anywhere between 17k to 60k.
Some people try to divide it up by # of residents to roughly equal caseload per individual. But that's not the most precise measure either, since path techs see a lot of the smaller specimens at larger centres. In general I think it's good to have >20k as the catchment available for teaching.
Some people try to divide it up by # of residents to roughly equal caseload per individual. But that's not the most precise measure either, since path techs see a lot of the smaller specimens at larger centres. In general I think it's good to have >20k as the catchment available for teaching.
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Yeah - it's kind of hard to equate specimen volume with training, because it doesn't mean residents even see a lot of the specimens. Some places will count their consult cases among them (cases residents often don't see), and it may be heavily weighted towards one area or another (like derm).
I have heard the >20k number as well - but # of specimens isn't important as what they do with these specimens. How is the teaching? Do you get to preview? How busy are the residents on surg path? etc. Ask questions on your interviews about this
I have heard the >20k number as well - but # of specimens isn't important as what they do with these specimens. How is the teaching? Do you get to preview? How busy are the residents on surg path? etc. Ask questions on your interviews about this
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As said by others, the important thing is the VARIANCE of specimens, not necessarily the VOLUME. And the structure of the training. If you go to a very big place without a tightly structured training schedule, you could end up looking at the same stuff for months on end, which isn't what you want. Personally, I think consultation cases is a big plus, because they can be complex. But initially, you just want to learn to differentiate among the basic stuff.
Generally speaking, academic departments usually provide a good case mix, often much better than community programs - whatever numbers they have, which is also worth taking into consideration.
Generally speaking, academic departments usually provide a good case mix, often much better than community programs - whatever numbers they have, which is also worth taking into consideration.
B
b&ierstiefel
I agree with Donut here. I mean if you have let's say 40K specimens a year but 39K are polyps, that's no dice. I thought the subspecialty based training at MGH was really interesting approach to learning surgical pathology. And of course, they see tons of specimens.PathOne said:
And I'm glad Donut raised the whole consultation issue. When surg path gets consults, who gets to see them first? You? The fellows? Or do the residents never see the consults? I think the ability of a resident to preview at least some of the consult cases is important. This is something you should definitely inquire about at your interviews.
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Case in point... Mt. Sinai in NYC still has the largest path department in the US, 110,000 surgicals per year, as compared to, say, BWH which has 55,000.
Mt. Sinai trains good pathologists, but in my own personal opinion nowhere near as well as BWH - despite the larger volume.
Why? Well, take soft-tissue pathology. I trained (fellowship) at an institution which gets a HUGE amount of cases within my subspec., including vast amounts of consultations. That was truly great, but we sent all of our non-cookie-cutter soft-tissue cases, including consultations, to BWH, as do most a lot of other institutions, both US and international.
Thus, when Andy "Suitcase" Milonakis goes to BWH and gets his soft-tissue rotation, he can see some truly amazing things in soft-tissue and bone, and understand the finer points of which diagnosis to go with, and pertinent differentials. Will that make him better? Of course!
(however, beware: consults some places only go to fellows and attendings, in which case consultant #s is a moot point).
But back to the OP: Less than, say 15,000-20,000 surgicals per year should raise a red flag. Also, a large amount of cyto to surg specimens could spell danger, as I've heard of residents being used as "pap-smear cattle". Beyond that, talk to the current residents. They're often the best at judging if they see enough different stuff to make them competent, and if the mix between viewing yourself and going over the cases with an attending is adequate.
Mt. Sinai trains good pathologists, but in my own personal opinion nowhere near as well as BWH - despite the larger volume.
Why? Well, take soft-tissue pathology. I trained (fellowship) at an institution which gets a HUGE amount of cases within my subspec., including vast amounts of consultations. That was truly great, but we sent all of our non-cookie-cutter soft-tissue cases, including consultations, to BWH, as do most a lot of other institutions, both US and international.
Thus, when Andy "Suitcase" Milonakis goes to BWH and gets his soft-tissue rotation, he can see some truly amazing things in soft-tissue and bone, and understand the finer points of which diagnosis to go with, and pertinent differentials. Will that make him better? Of course!
(however, beware: consults some places only go to fellows and attendings, in which case consultant #s is a moot point).
But back to the OP: Less than, say 15,000-20,000 surgicals per year should raise a red flag. Also, a large amount of cyto to surg specimens could spell danger, as I've heard of residents being used as "pap-smear cattle". Beyond that, talk to the current residents. They're often the best at judging if they see enough different stuff to make them competent, and if the mix between viewing yourself and going over the cases with an attending is adequate.
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Well tsj, if a case has 12 specimens it is still one case with one number, generally. Thus, the lipoma with one block submitted gets one surgical number, but so does the laryngectomy with bilateral neck dissections and 25 frozens.
Indeed though, academic centers get a lot of things. For instance, our institution gets referral patients who need large or complicated surgeries. So every week on the main service we have 5 or 6 complicated head and neck resections, 4 or 5 bone and soft tissue sarcomas, etc. At a smaller hospital you might occasionally see a biopsy for one of these things but for definitive treatment they go to a larger institution. I mean, after one month on surg path I am now almost totally comfortable with grossing in laryngectomies, pancreatectomies, large sarcoma resections, etc. At a smaller place you might see one of these specimens every couple of months.
As for consults, when we are on certain rotations we see some of the consults. But there is no way you can see everything.
Indeed though, academic centers get a lot of things. For instance, our institution gets referral patients who need large or complicated surgeries. So every week on the main service we have 5 or 6 complicated head and neck resections, 4 or 5 bone and soft tissue sarcomas, etc. At a smaller hospital you might occasionally see a biopsy for one of these things but for definitive treatment they go to a larger institution. I mean, after one month on surg path I am now almost totally comfortable with grossing in laryngectomies, pancreatectomies, large sarcoma resections, etc. At a smaller place you might see one of these specimens every couple of months.
As for consults, when we are on certain rotations we see some of the consults. But there is no way you can see everything.
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yaah said:
Agree that's how it should be. However, some seem to be a little creative. For instance, UCSF Dermpath claims 60,000 cases per year (Dermpath alone!), of which 10,000 consults. Sounds a little bit high, especially considering that I'm only aware that they have two board certified dermpaths, of which one (LeBoit) constantly travels the world. But perhaps it's their fellow who looks at the rest?!
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My point being that I don't think any training place could have only 15,000 specimens. That would mean at most 4-5000 surgicals. Unless they only have 4 residents total, that just ain't enough.yaah said:
I think "surgicals" and "specimens" get mixed up in these comparisons. My guess would be a place that has 15,000 "specimens" actually has 15,000 surgical cases which would probably be like 40-50K "specimens".
Just make sure apples are being compared to apples.
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tsj said:
Interesting - I have actually never heard of any place referring to surgical numbers as anything other than 1 surgical being the entirety of the specimens involved in one patient's surgical case on one day. Interesting if that would happen!
