After reading several threads which either started on this topic or eventually touched on it peripherally, I wanted to reiterate two of the benefits of training at elite high volume academic centers. 1) Affiliated with a major cancer center. For the most part, this means that there is a prominent selection bias of patients with common and uncommon tumors/processes featured in nearly every subspecialty. As a result, you are exposed to a variety of routine and complex specimens. You are also exposed to the follow up and/or treated specimens from these patients. This should translate into proficiency at triaging, grossing, working up, diagnosing, grading, and staging these cases. Additionally, this usually means that attendings on both the path and clinical side are familiar with current grading/staging paradigms, pitfalls, and important prognostic features. If you end up at a major cancer center, this training will help you fit right in. If you end up in the community, this training will give you the confidence that you need to stand up to clinicians who may not be completely up to date with current protocols. 2) Receive lots of consults across many disciplines. This is very important because I would imagine that nearly every ACGME accredited program can sign out and teach the trainee to sign out at least 90-95% of routine/bread and butter biopsies and resections. The problem is that not every program routinely signs out or receives exposure to the 5% of unusual cases: unusual benign processes, common cancers in uncommon locations, rare cancers, cancers that look benign, benign masses that look like cancer, variants of common malignant tumors etc. At major academic centers where community pathologists seek expert opinions, your exposure to this 5% of cases increases exponentially. Reviewing these consults are challenging and often take 5-10X more time and energy to work up and sign out. I agree that reading and reviewing study sets may help. However, there is no substitute for struggling through these live cases with an expert. It helps you develop focused differential diagnoses, an understanding of the pitfalls, and, ultimately, the diagnostic acumen that you need when you end your training. When you are an attending, these atypical and bizarre cases are the ones that will give you a lot of stress. But even more concerning are the benign looking cases that are malignant because this usually means that the patient is given a clean bill of health when they should be receiving treatment.