too much?

[Arctic Char]

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just to gauge the norms out there . . . what do you all think about a 2nd year resident handling a hemepath service solo with up to 12 bone marrows a day (yes, counting each one) plus lymph nodes, plus whatever consults come through the door?

its making for long days . . . i mean its residency, so i grin and bear it. but is this something frequently encountered out there? thoughts?

 

[caffeinegirl]

hang in there!
I did this as a first year resident for almost two whole months!
Yes it sucks while you're doing it, but it's temporary...things do get better.

 

[icpshootyz]

We used to have it almost that bad here, but the training committee decided it was too much and limited the number of marrows the residents would have to count in a day. The extras had to be handled by the fellow instead (which I'm sure they loved!). So if you get a chance to evaluate the rotation, make a note of it. Our constant bad evals of hemepath because of heavy marrow counting led to a change for the better. And as someone who doesn't have a strong love of hemepath, counting marrows REALLY annoyed me.

 

[Pathologee]

I would have killed for that. We didnt get that many bone marrows in my training. Having that kind of independence is almost unheard of in a world of hemepath fellows, visitors, busy attendings etc. If you get that kind of volume now and do not enter a hemepath fellowship you will probably be in good shape for doing bone marrows in private practice. Cherish it!

 

[KCShaw]

If you're not having to stay really absurd hours, then I agree -- cherish it, make the most of it. If you're rushing through 6 and barely even looking at the other 6, plus the other heme work, then that could be a problem. It also depends a bit on the kinds of cases they are and how efficiently your heme service works otherwise -- mostly post-treatment/follow-up marrows on known diagnoses vs new patients, etc. I spent some time with one hemepath who, while exceptionally knowledgeable and thorough, would never have gotten through that kind of caseload on a regular basis. But he managed each case like it was a consult on the President's wife, which was great for patients and he seemed very well liked by the heme/onc clinicians. I've also spent some time with hemepaths & generalists who would whip through that kind of caseload in a cup of coffee, maybe a cup and a half, but they weren't pushing the envelope in terms of thorough integrated reports or quite the volume of additional stains the former individual regularly did.

It's considerably more than I usually hear about though, yes.

 

[yaah]

That's a lot. But it's doable. Partly it depends on what kind of marrows they are. If they are all MDS or monocytosis it's very hard. If they're all Hodgkins staging marrows then not so much.

But I agree with the above that you will learn a lot. I had a couple of months where our hemepath program was in transition and residents got bombed with work. I learned a ton which worked out well because by the time I came back to doing more hemepath the program was filled out more with attendings who could devote more time to teaching, so I got the best of both worlds.

But you have to acknowledge if you need help and you spend too much time counting. Don't be a hero - the patients will suffer if you try to do too much.

 

[gschl1234]

Our program is comparably busy, though we only cover in-house marrows and outside confirming consults, no in-house nodes/spleens. They *try* to assign 2 residents on service for the first month but sometimes a first or second year will end up covering the service alone for the first month. It's busy but doable. Since we sign out the morning's marrows in the afternoon, we're still out by ~5PM which is great, but it makes for a busy day.

 

[Dawn1980]

This is the norm for our residency. I feel your pain.

Hang in there! It will be over soon!

 

[Arctic Char]

thanks all. it hasn't been a "problem" per se . . . but between counting, triaging, signing out, and dictating all the cases + flow, it gets busy, like ya'll said. i just wish i could read more about each case, but by the time i'm caught up all i want to do is hit the pillow!

its great training regardless, i admit

 

[KCShaw]

There's a fine line between getting nothing out of being too busy, and getting a lot out of being so busy that certain things become "easy" and routine.

 

[LADoc00]

I did 36 marrows in 1 day (start to finish as in signed out, all with accompanying peripheral bloods and flow cytometry), that is my personal record.

So stop whining and get back to work.

 

[Arctic Char]

I did 36 marrows in 1 day (start to finish as in signed out, all with accompanying peripheral bloods and flow cytometry), that is my personal record.

So stop whining and get back to work.

did that include 4-5 hours of signing out sloooooowwwwwwlllyy with an attending asking you questions the whole time? if not, then it sounds nice . . .

 

[KluverB]

did that include 4-5 hours of signing out sloooooowwwwwwlllyy with an attending asking you questions the whole time? if not, then it sounds nice . . .

Sounds like hemepath service is the same all over.

 

[LADoc00]

did that include 4-5 hours of signing out sloooooowwwwwwlllyy with an attending asking you questions the whole time? if not, then it sounds nice . . .

ah no, I wasnt down with the whole signing out with attendings nonsense. Stopped that like year 2.

I did my heme cases, wrote them up and dropped them in a box. If there was anything that needed to be corrected, I got it back with red ink.

Once I was able to 'bend the spoon', there wasnt much I couldnt get out of a book or article 10x faster than interacting with an attending.

 

[sirenomelia]

Twelve is pretty high in a place to not have a fellow but it depends on what they are- what manner of complexity or are they just Hodgkin staging chippies and old person cytopenias, descriptive, cytogenetics, wash, rinse, repeat. Be lucky you're not having to go get (procure) the marrow which will set you back 30-45 min/ apiece.

 

[Arctic Char]

ah no, I wasnt down with the whole signing out with attendings nonsense. Stopped that like year 2.

I did my heme cases, wrote them up and dropped them in a box. If there was anything that needed to be corrected, I got it back with red ink.

Once I was able to 'bend the spoon', there wasnt much I couldnt get out of a book or article 10x faster than interacting with an attending.

amen man, thats what i would love!