Surgical Pathology Fellowship

[Parfocal]

Hi all, I am beginning the search for surgical pathology fellowships and am finding that there are so many to choose from and quite frankly, the info on the pathtraining.org site is fairly generic and not very helpful. I was hoping that some of you could post (or PM) your thoughts about the surg parh fellowships at your program or have experience with. With so many programs out there, I imagine that the spectrum of quality is quite broad. My intention is to go somewhere to tighten up my diagnostic skills and maybe do a few months subspecializing in a single organ system to get me ready for private/community practice. Elective time in cyto would be a plus. I see that lots of the larger academic centers seem to push research on their fellows (what can you really accomplish in one year anyway?) with less emphasis on diagnostics. I am willing to help academic types pad their CV's if I get excellent diagnostic pointers in return, although a career in academics in NOT in my future...all input is appreciated

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[yaah]

Well, the "research" at large academic centers during surg path fellowships is not that intense. They will probably encourage you to do a project or try to publish something, but it's not 6 months research/6 months clinical (in general).

Unfortunately as you say a lot of the info out there (as on pathologyoutlines.com or even on individual program websites) is often out of date or not that helpful. Cleveland Clinic and Northwestern, for example, don't even offer a general surg path fellowship anymore. That being said though, the best resource will be each program's website, it is pretty easy to call or email the person listed to get more info. Based on your goal, most fellowships would probably suit your needs - programs without sufficient volume don't usually have a fellowship at all.

 

[gungho]

having just finished interviewing at multiple spots and being turned down in one program, doing the turning down in another, and landing a spot at a REALLY good place, i can testify to the wide variety of programs. i would suggest you decide what you want, call the program director and tell him what you want before you spend the time and money for an interview. everyone i've met (other fellows and residents) have been very honest (as far as I can tell) regarding positives and negatives.

 

[DarksideAllstar]

The surg path fellowship here is broken down into a series of rotations, of which, you do each about twice. These include: Specialty consults, confirmatory consults, hot seat, surgicals, gross room supervisor, kidney-transplant, and elective. Obvioulsy, there are seven fellows/yr. I can't speak for the quality, but fellows in the past have spoken highly of their experience, and based on the type of cases that we get on our surg path rotation, I can imagine that the consults services get good cases. I think this year 1 of 7 fellows is from an outside institution. Maybe one of current fellows might read this thread and offer some more insight as to how their experience has been for the first ~8 weeks.

Personally, I would prefer to do 6 months of a gen surg path fellowship and then 6 months of a specific organ I was interested in (ie GI, GU, etc). It would be more worth my while. I heard from someone who completed the surg path fellowship at Hopkins, that it is legit and you will be well-prepared. Essentially you are junior faculty and sign out an @ss-load of cases.

 

[pathstudent]

The surg path fellowship here is broken down into a series of rotations, of which, you do each about twice. These include: Specialty consults, confirmatory consults, hot seat, surgicals, gross room supervisor, kidney-transplant, and elective. Obvioulsy, there are seven fellows/yr. I can't speak for the quality, but fellows in the past have spoken highly of their experience, and based on the type of cases that we get on our surg path rotation, I can imagine that the consults services get good cases. I think this year 1 of 7 fellows is from an outside institution. Maybe one of current fellows might read this thread and offer some more insight as to how their experience has been for the first ~8 weeks.

Personally, I would prefer to do 6 months of a gen surg path fellowship and then 6 months of a specific organ I was interested in (ie GI, GU, etc). It would be more worth my while. I heard from someone who completed the surg path fellowship at Hopkins, that it is legit and you will be well-prepared. Essentially you are junior faculty and sign out an @ss-load of cases.

WTF is the point of doing a couple months of renal tx path as part of a surgical pathology fellowship.

 

[DarksideAllstar]

WTF is the point of doing a couple months of renal tx path as part of a surgical pathology fellowship.

WTF do I know about it? All I know is they look at renal, cardiac, and liver bxs. Its not like I've done the rotation or discussed the role of this rotation with the surg path fellowship director. At the community hospital I was at as a med student the transplant surgeons/nephros would send quite a few r/o rejection bxs to the pathologists there. I can't see how 6 weeks of transplant wouldn't help you at all--its not like its something you are inundated with during residency (like, for instance, neoplastic resections).

Isn't the point of the surg path fellowship to get you to be more comfortable signing **** out yourself your first year out of training? I mean, hell, why do I need another year of looking at the same **** that I looked at the first two years of AP? Presumably, most of what I will be seeing during a fellowship I will have previously seen. So whats the point? What are your ideas of the types of rotations you'd implement to fill up a year of surg path?

/rant

 

[trent05]

Cleveland Clinic and Northwestern, for example, don't even offer a general surg path fellowship anymore.

I think we will see fewer and fewer of the gen surgpath spots since we no longer need the 5th year. I think many will opt to go directly into community practice or do a fellowship in a surgpath subspecialty or something like heme or cyto. IMHO if you want a community job the best way to prepare you will be starting that community job. Doing a subspecialty fellowship will definitely help you get that job, but it's not required. If I were an employer I would rather someone with one year of experience in community practice than someone with a one year general surgpath fellowship.

 

[LADoc00]

Transplant pathology is a waste. So is ANY renal. I would try to get out of those. I would load up on derm, GI and heme rotations if possible.

Each program does SP years a bit different. The "model" of a SP training was invented at WashU in St. Louis by Lauren Ackerman after WWII so you want the real deal that would be a good place to start. From my experience, WashU's version is very much hardcore and the UCSF, Stanford and Penn versions are bit on the "lite" side.

 

[SLUsagar]

Hi all, I am beginning the search for surgical pathology fellowships and am finding that there are so many to choose from and quite frankly, the info on the pathtraining.org site is fairly generic and not very helpful. I was hoping that some of you could post (or PM) your thoughts about the surg parh fellowships at your program or have experience with. With so many programs out there, I imagine that the spectrum of quality is quite broad. My intention is to go somewhere to tighten up my diagnostic skills and maybe do a few months subspecializing in a single organ system to get me ready for private/community practice. Elective time in cyto would be a plus. I see that lots of the larger academic centers seem to push research on their fellows (what can you really accomplish in one year anyway?) with less emphasis on diagnostics. I am willing to help academic types pad their CV's if I get excellent diagnostic pointers in return, although a career in academics in NOT in my future...all input is appreciated

From what I've heard (both inside, and from outside) our surgpath fellowship here at Stanford has been very well received (excluding my own bias and plan to do the fellowship). It's considered a "general" SP fellowship which sort of correlates with our 'general' s/o approach, although we often end up showing interesting/challenging cases to our organ-specific experts. We do 4 months of the Kempson consult service, 2 months of hot seat, 1 month as junior attending, 1 month of as frozen section attending, and 4 months of elective...although I must admit that nearly all fellows end up doing a month of fellow heme (heme: I/O's, consults, IPOX). That leaves 3 months of electives, where fellows have done things from cytology or derm to molecular or genetics...pretty flexible really.

 

[LADoc00]

From what I've heard (both inside, and from outside) our surgpath fellowship here at Stanford has been very well received (excluding my own bias and plan to do the fellowship). It's considered a "general" SP fellowship which sort of correlates with our 'general' s/o approach, although we often end up showing interesting/challenging cases to our organ-specific experts. We do 4 months of the Kempson consult service, 2 months of hot seat, 1 month as junior attending, 1 month of as frozen section attending, and 4 months of elective...although I must admit that nearly all fellows end up doing a month of fellow heme (heme: I/O's, consults, IPOX). That leaves 3 months of electives, where fellows have done things from cytology or derm to molecular or genetics...pretty flexible really.

the leg up I give Stanford over UCSF, is the flexibility to load heavily up on Derm which really is invaluable especially if you dont do a derm fellowship. Now, that might not be the case anymore tho. I dont know how many UCSF SPers do sessions with Leboit and co.

IMO, Stanford would be well served by breaking GI off routine surgicals, getting a small team of GI path specialists and making that a high volume training experience. I would also break GU off, but doubt that will happen.

 

[yaah]

Surg path fellowship at U of Mich is structured as:

3 months of main "Room 1" surgical pathology which consists of covering frozen sections, doing head and neck transfer cases, and varying levels of involvement in signout (usually preview all of the cases, sometimes don't bother to actually sit in on signout as many cases are straightforward).

1 month each of breast, GI, GU, Gyn (all four as the resident doing transfer cases and sitting in on signout, pretty low stress except for breast). Remaining time (I think) is pretty optional and structured however you want. Some people do consult months, particularly in GI or soft tissue, or spend time on derm or heme. Some do research months.

I guess because the residency here is pretty much "resident" driven you don't do a lot with signout as a surg path fellow. As a subspecialty (GU, GI, Breast, pulmonary) fellow you do the consults and towards the end of the year can sign out cases yourself, in addition to seeing most of the in house cases. So the surg path fellowship experience here varies depending on your own motivation. Some people don't do very much and get good training but don't take advantage of it fully. Others immerse themselves and get very good training. There is no "hot seat" or anything like that.

IMHO, a general surg path fellowship is a good idea for someone who wants to be a generalist and is doing that as their only fellowship. But to do general surg path + something else (particularly a subspecialty) is a bit overkill. I talked to a couple of "icons" at the USCAP house staff hospitality and they all said it wasn't really necessary unless it was your only fellowship.

At programs like ours where you get a decent amount of elective time, you can do a lot of stuff and basically do a de-facto surg path fellowship before you complete your four years (3 years if AP only). I have like 7 months of elective this year, one of which I selected to do as a surg path fellow (frozens, etc), another derm, 1 on GI consults, 1 on pulmonary consults. Will probably also do some soft tissue. I basically feel like I am doing a surg path fellowship so doing another one would be overkill and kind of unnecessary.

I do think however that most employers will be looking for some sort of fellowship training, and for those who want to be generalists a surg path fellowship (in a larger high volume program) would be a good thing.

 

[LADoc00]

Surg path fellowship at U of Mich is structured as:

3 months of main "Room 1" surgical pathology which consists of covering frozen sections, doing head and neck transfer cases, and varying levels of involvement in signout (usually preview all of the cases, sometimes don't bother to actually sit in on signout as many cases are straightforward).

1 month each of breast, GI, GU, Gyn (all four as the resident doing transfer cases and sitting in on signout, pretty low stress except for breast). Remaining time (I think) is pretty optional and structured however you want. Some people do consult months, particularly in GI or soft tissue, or spend time on derm or heme. Some do research months.

I guess because the residency here is pretty much "resident" driven you don't do a lot with signout as a surg path fellow. As a subspecialty (GU, GI, Breast, pulmonary) fellow you do the consults and towards the end of the year can sign out cases yourself, in addition to seeing most of the in house cases. So the surg path fellowship experience here varies depending on your own motivation. Some people don't do very much and get good training but don't take advantage of it fully. Others immerse themselves and get very good training. There is no "hot seat" or anything like that.

IMHO, a general surg path fellowship is a good idea for someone who wants to be a generalist and is doing that as their only fellowship. But to do general surg path + something else (particularly a subspecialty) is a bit overkill. I talked to a couple of "icons" at the USCAP house staff hospitality and they all said it wasn't really necessary unless it was your only fellowship.

At programs like ours where you get a decent amount of elective time, you can do a lot of stuff and basically do a de-facto surg path fellowship before you complete your four years (3 years if AP only). I have like 7 months of elective this year, one of which I selected to do as a surg path fellow (frozens, etc), another derm, 1 on GI consults, 1 on pulmonary consults. Will probably also do some soft tissue. I basically feel like I am doing a surg path fellowship so doing another one would be overkill and kind of unnecessary.

I do think however that most employers will be looking for some sort of fellowship training, and for those who want to be generalists a surg path fellowship (in a larger high volume program) would be a good thing.

I believe that is the training models at many places including BWH/MGH, UCLA etc.

The places I think that are hotseat models are: WashU, Penn, UCSF, UCSD, Stanford and Emory (I think..). No clue about Duke or Yale. Please correct that list if needed.

the first decision in your SP fellow trail should be whether you want a hotseat experience or not. That will really dictate where you apply.

 

[Brian Pavlovitz]

I believe that is the training models at many places including BWH/MGH, UCLA etc.

The places I think that are hotseat models are: WashU, Penn, UCSF, UCSD, Stanford and Emory (I think..). No clue about Duke or Yale. Please correct that list if needed.

the first decision in your SP fellow trail should be whether you want a hotseat experience or not. That will really dictate where you apply.

Forgive my inexperience: I always thought "hot seat" was "frozen section". What's the difference?

 

[DarksideAllstar]

Forgive my inexperience: I always thought "hot seat" was "frozen section". What's the difference?

Hot seat essentially sees all the slides (surgicals and bxs) before the resident and attending sign them out and records a prelim dx. Clinicians typically will call the hot seat in order to get a prelim before the final is signed out. They also may order stains, etc preemptively in order to get the case moving. Essentially it allows a surgical case to be signed out on day 3 instead of day 2, and thus gives the resident time to preview and write it up prior to sign out. Biopsies are still signed out on day 2 (the hot seat and resident look at the case in the AM and the attending and resident sign it out in the PM).

 

[DarksideAllstar]

Now, that might not be the case anymore tho. I dont know how many UCSF SPers do sessions with Leboit and co.

You get two electives, so in theory you could spend both on dermpath. I think its common for the fellows to spend at least one elective on derm (obviously it depends on the fellow). This is in addition to the derm time you can spend as a resident here.

 

[Gene_]

In choosing a SP fellowship, I would be clear about grossing responsibilities. For example, you don't want to be grossing every third day like a resident. I mention this because I've seen it.

 

[Parfocal]

Thanks for the input/advice everybody, 'tis very helpful...

I checked out the program at JHU, not a fellowship per se, they bill it as "junior attending" for the year, I imagine you sign out all your cases by yourself, could be a sink or swim situation...anybody have any first hand knowledge?

 

[Logos']

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[CameronFrye]

WTF do I know about it? All I know is they look at renal, cardiac, and liver bxs. Its not like I've done the rotation or discussed the role of this rotation with the surg path fellowship director. At the community hospital I was at as a med student the transplant surgeons/nephros would send quite a few r/o rejection bxs to the pathologists there. I can't see how 6 weeks of transplant wouldn't help you at all--its not like its something you are inundated with during residency (like, for instance, neoplastic resections).

Isn't the point of the surg path fellowship to get you to be more comfortable signing **** out yourself your first year out of training? I mean, hell, why do I need another year of looking at the same **** that I looked at the first two years of AP? Presumably, most of what I will be seeing during a fellowship I will have previously seen. So whats the point? What are your ideas of the types of rotations you'd implement to fill up a year of surg path?

/rant

I think pathstudent interpreted your post as saying you do two months of "renal transplant path" instead of "renal plus transplant path". Obviously a big difference.

 

[CameronFrye]

load heavily up on Derm which really is invaluable especially if you dont do a derm fellowship.

I agree. I know a lot of discussion on this board focuses on dermpath fellowships, but even residents not going into dermpath still need to acquire a working knowledge of derm. Every brand new community pathologist that I've talked to has told me that the hardest thing to get used to is the derms they have to sign out.

 

[caffeinegirl]

The MGH Surg Path fellowship is based on subspecialty sign out. So, you choose 2-3 subspecialties you want to sign out during the year (it can include cytology). For the first couple of weeks you're co-signed by an attending, and then after that you will sign out cases independently. I think this is huge (in a good way), since you'll be able to gain confidence and independence in a protected environment (the attendings are really great in offering help/advice).
For more info...
http://www.massgeneral.org/pathology/train/fellowships.htm

 

[LADoc00]

The MGH Surg Path fellowship is based on subspecialty sign out. So, you choose 2-3 subspecialties you want to sign out during the year (it can include cytology). For the first couple of weeks you're co-signed by an attending, and then after that you will sign out cases independently. I think this is huge (in a good way), since you'll be able to gain confidence and independence in a protected environment (the attendings are really great in offering help/advice).
For more info...
http://www.massgeneral.org/pathology/train/fellowships.htm

That is an interesting model because you tailor your needs and prop your weakness. The biggest problem I have is rarely to residents know their weakness or have any clue where they will working what the case mix will be.

Yes, if I could go back now in a time machine I would do derm/cyto/GI for a year. Or maybe derm/GI/GU...but I would hope they offer some guidance from the total clusterf--k that might choose something like renal/soft tissue/head and neck for example.

 

[b&ierstiefel]

That is an interesting model because you tailor your needs and prop your weakness. The biggest problem I have is rarely to residents know their weakness or have any clue where they will working what the case mix will be.

Yes, if I could go back now in a time machine I would do derm/cyto/GI for a year. Or maybe derm/GI/GU...but I would hope they offer some guidance from the total clusterf--k that might choose something like renal/soft tissue/head and neck for example.

In addition to the fact that residents rarely know their weakness, I'll venture to take this a point further. Let's say you're at an institution where a certain subspecialty is strong diagnostically. Sure, you can get a lot of exposure by rotating on that subspecialty but at the same time, doing so can increase one's insecurities about his/her aptitude in that subspecialty. And is it worth it?...especially if the subspecialty sees specimens that represent a huge minority of overall specimens.