Top 10 general surgical pathology fellowships?

[greencreek]

Can anyone give a list of the top 10 general surgical pathology fellowship programs? By no means the following list is accurate, just a way to stimulate discussion.

1. Johns Hopkins
2. MSKCC.
3. MD Anderson
4. Harvard (any surg fellowships?)
5.Upenn
6. Stanford
7. Yale
8. U. Chicargo
9. U.Michigan
10. Mayo Clinic
10.Washington U

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[KCShaw]

Not saying that I have any reason to discount any of those institutions, but do you have any personal knowledge of any of those general surg path fellowships, if they have them, or is this just a list of big names? Personally I really don't know beyond a couple of people who went to a couple of those places, and seemed to be pleased with it beyond the heavy workload (but part of what they knew they were signing up for).

There's nothing wrong with giving people an idea of programs with a good reputation, but in general I think these kinds of "lists" are a bit misleading -- there's no hard and fast measurement of what makes a program good, though a lot of flags, and a lot of subjectivity in trying to separate institutions into some sort of rank. Yeah, there's a lot of politics and name recognition that goes into it, which can also have a role in getting your foot in the door for a job.. don't discount that. But before making a decision on applying to or accepting a fellowship somewhere, do take the time to look at what went into the name -- and what makes a place right for you. As far as simply learning the job goes, I suspect there are oodles of places that can prepare you.

 

[greencreek]

Agree with what you just said

 

[lipomas]

Top 10 for what? Bragging rights?

 

[sleeping beauty]

Can anyone give a list of the top 10 general surgical pathology fellowship programs? By no means the following list is accurate, just a way to stimulate discussion.

1. Johns Hopkins
2. MSKCC.
3. MD Anderson
4. Harvard (any surg fellowships?)
5.Upenn
6. Stanford
7. Yale
8. U. Chicargo
9. U.Michigan
10. Mayo Clinic
10.Washington U

yale and UPenn should not be on the list.

 

[pathstudent]

Don't forget to include the one from saint lukes Roosevelt.

 

[sbp]

not that I disagree with the list but Columbia University has a great surgPath fellowship.

 

[2121115]

The fact that the poster listed "Harvard" as a top ten fellowship but then didn't even know if they have a fellowship speaks volumes. Moreover, there is no "Harvard" pathology program so the poster is even more uninformed. "Harvard" is not one hospital or even one program.

The poster just listed some well known medical schools and probably is a medical student.

 

[pathresident2]

Columbia only takes their own residents unless no one wants.

 

[zao275]

The Methodist Hospital in Houston has a great surg path fellowship. Nice distribution of both bread and butter as well as complex specimens. About 35,000 surgicals per year. Excellent teaching. Good benefits.

 

[sbp]

yes columbia takes mostly internal candidates, but that shouldn't bump it off the top 10 list

 

[sleeping beauty]

The Methodist Hospital in Houston has a great surg path fellowship. Nice distribution of both bread and butter as well as complex specimens. About 35,000 surgicals per year. Excellent teaching. Good benefits.

agree. for me their teaching is the best.

 

[caffeinegirl]

The fact that the poster listed "Harvard" as a top ten fellowship but then didn't even know if they have a fellowship speaks volumes. Moreover, there is no "Harvard" pathology program so the poster is even more uninformed. "Harvard" is not one hospital or even one program.

Agreed. I suggest anybody interested in the "Harvard" programs do a search for prior threads where this has been discussed. If anybody has any ?'s about the MGH surg path fellowship, feel free to PM me.

 

[Ombret]

Seriously, by the time you are looking for what will probably be one of your final years of training, you want your criteria to be better defined than good/better/best.

Pick a program, look at its recent graduates and see if you want that kind of job. Ask yourself if you like where the program is, because most people stay in the region where they finished training. Most people have a subspecialty interest by the time they become fellows. Look at the faculty, do you see any names you recognize in that subspecialty? These are the kinds of things you will find yourself thinking about.

Of course, if you have been holding out your whole life to have some kind of Harvard-related sheepskin--sure, this is probably your last chance.

 

[cjw0918]

In my opinion, the best surg path fellowships are the ones that allow you at some point to sign out cases independently. I think your name on the bottom line means a lot in terms of how much you REALLY care about the case.

 

[malchik]

yale and UPenn should not be on the list.

Wow, big diss for Yale/Penn, meanwhile Methodist has the best teaching? Have you spent sufficient time at all these places to know what you're talking about? Maybe you're one of these people who has done 8 fellowships. People act like they can make comparisons like this but for the most part all anyone really knows anything about is their own program.

 

[pathresident2]

Nobody even knows that yale does not have surg path fellowships any more???!!!

 

[Sulfinator]

People act like they can make comparisons like this but for the most part all anyone really knows anything about is their own program.

Right on! I have had this thought about many a post on this forum.

 

[sleeping beauty]

Wow, big diss for Yale/Penn, meanwhile Methodist has the best teaching? Have you spent sufficient time at all these places to know what you're talking about? Maybe you're one of these people who has done 8 fellowships. People act like they can make comparisons like this but for the most part all anyone really knows anything about is their own program.

RE: Yale/Penn

I worked with one of them and have interaction with both of them. sometime we receive consultation cases or request slides from them...although i did not work with Methodist, I do know many attendings there.

 

[moodydoc]

Of course if you are at a great resident program then you should not need a general Surgical pathology fellowship.

 

[Sulfinator]

Of course if you are at a great resident program then you should not need a general Surgical pathology fellowship.

Whether or not one needs a surg path fellowship depends on various factors that are likely unrelated to the 'greatness' (whatever that means) of one's residency program. I think you can still benefit from doing a surg path fellowship regardless of whether or not you need it.

 

[Tiki]

In my opinion, the best surg path fellowships are the ones that allow you at some point to sign out cases independently. I think your name on the bottom line means a lot in terms of how much you REALLY care about the case.

I agree with this. Either independent signout or some sort of hot seat (aka Stanford, WashU, Iowa). As someone who has just interviewed for surg path fellowships, I really looked for a place that would give me a decent amount of independence (but not totally on my own the whole time, like the Hopkins junior faculty surg path fellowship.)

Oh, and I probably woudn't put Kettering or MD Anderson so high. They are great places, no doubt. But the fellows do a fair amount of grossing (especially MSKCC). Plus, being a cancer center, the caseload is skewed towards neoplastic. I definitely want to get stronger in things I feel pretty weak in right now (like medical liver).

 

[raider]

MSKCC and Anderson are the best programs simply because they expose you to a lot of cancer specimens, and for certain cancer specimens (larger resections) grossing is equally , if not more important, than the micro. You will realize this when the PA calls you for guidance on a difficult cancer resection and proper orientation/sectioning/margin status are crucial. Anyone who shirks grossing, will never be a composite surgical pathologist. Be a hardworker and be grateful that you have the opportunity to gross complex resections under supervision.

In real life pathology, the cases that will be the most stressful and crucial to get right are cancer cases because you have to be definitive (non-neoplastic diseases are over-rated in terms of difficulty, as all you have to do is recognize the tissue pattern of injury (the tissue has a limited number of tissue reactions to various etiologic agents) and generate a differential diagnosis- sort of similar to radiology).

e.g. eosinophils in lung biopsy-----hypersensitivty vs. eosinophilic pneumonia vs. Churg Strauss etc.
granulomas in liver------sarcoidosis vs. drug vs. PBC vs. chronic viral hepatitis etc.
spongiotic dermatitis in skin.....contact vs. irritant vs. atopic vs. nummular vs. id etc.

However , for cancer it has to be positive or negative (and the occasional uncertain malignant potential).

As a surgical pathologist, you can never see enough cancer cases.

 

[Ombret]

(but not totally on my own the whole time, like the Hopkins junior faculty surg path fellowship.)

My understanding of the Hopkins fellow signout is that they are not just totally on their own and signing out all their cases. From what I heard they mainly do confirmations (sent in slides with existing diagnosis) and easier cases that they have with residents. Most of the cases they get are still ultimately signed out by faculty members.

If anyone has more knowledge of this feel free to correct me. I'm not saying it is not a great program, obviously it is one of the best and any signout duties the fellows do have must be great for learning.

 

[LNsquasher]

My understanding of the Hopkins fellow signout is that they are not just totally on their own and signing out all their cases. From what I heard they mainly do confirmations (sent in slides with existing diagnosis) and easier cases that they have with residents. Most of the cases they get are still ultimately signed out by faculty members.

If anyone has more knowledge of this feel free to correct me. I'm not saying it is not a great program, obviously it is one of the best and any signout duties the fellows do have must be great for learning.

The in-house surgical path material at Hopkins is divided equally between permanent faculty (7-8 pathologists) and junior faculty ("fellows" -- 4 per year). So the junior faculty sign out twice the inhouse routine material than the permanent faculty (Epstein, Hruban, etc) do. The juniors also do ALL of the frozens (can certainly show any case you're not comfortable with) and take all of the SP call. The confirmings are day three in the schedule and a small component of the responsibility. It is a very independent set up. The cases signed out by the "fellows" with the residents are not especially easy and largely consist of complicated resections.

Consider yourself corrected.

 

[pathstudent]

The in-house surgical path material at Hopkins is divided equally between permanent faculty (7-8 pathologists) and junior faculty ("fellows" -- 4 per year). So the junior faculty sign out twice the inhouse routine material than the permanent faculty (Epstein, Hruban, etc) do. The juniors also do ALL of the frozens (can certainly show any case you're not comfortable with) and take all of the SP call. The confirmings are day three in the schedule and a small component of the responsibility. It is a very independent set up. The cases signed out by the "fellows" with the residents are not especially easy and largely consist of complicated resections.

Consider yourself corrected.

Sounds like an awesome fellowship.

Do the fellows get the consult cases or do those go to faculty.

 

[Ombret]

Extremely interesting. That does sound great. Are there ever... errors?...

By the way, this discussion proves how heterogeneous SP training is (closely related to the fact that it is not a boarded subspecialty; board requirements would mean standardized curricula). The SP fellowship at my institution, which I am not doing, is more like a glorified resident SP rotation, twelve months in a row.

 

[LNsquasher]

Sounds like an awesome fellowship.

Do the fellows get the consult cases or do those go to faculty.

True consults go to faculty (most are directed to a specific faculty member -- especially Epstein, or course) and the rest -- usually only a few cases per day -- are signed out by the permanent faculty on a rotating basis.

Are there errors? I'm sure there are, but at the beginning you are especially encouraged to show a lot of cases at the concensus conference. Towards the end of the year, there is very little difference with the other pathologists in the percentage of cases shown for QA purposes.

There is no doubt that the level of responsibility is not for everyone (or perhaps most people) right out of residency, but you learn a lot, and very quickly.

And it's an especially great system if you're permanent faculty, as you have no primary frozen responsibilities or call.

 

[KCShaw]

Of course there are errors, they're just not allowed. As a visiting consultant teaching pathologist liked to say, the accepted error rate for a pathologist is zero.

What you hope for from a fellow in that kind of situation is that they know their limitations. Some fellows get ridden/supervised more than others because of the level of confidence the attendings do or don't have in them to know that line. Of course, if your title is junior faculty or somesuch (even if the job is advertised as a "fellowship"), and you're AP boarded, then it's really still your butt on the line.

And it's not just fellows/junior faculty/new hires who are susceptible to imperfection..

 

[LNsquasher]

Of course there are errors, they're just not allowed. As a visiting consultant teaching pathologist liked to say, the accepted error rate for a pathologist is zero.

What you hope for from a fellow in that kind of situation is that they know their limitations. Some fellows get ridden/supervised more than others because of the level of confidence the attendings do or don't have in them to know that line. Of course, if your title is junior faculty or somesuch (even if the job is advertised as a "fellowship"), and you're AP boarded, then it's really still your butt on the line.

And it's not just fellows/junior faculty/new hires who are susceptible to imperfection..

Agree 100%.

 

[sbp]

the surg path fellowship at columbia is very similar to the one at hopkins. The fellow signs out the frozens on their own, and is on the surgpath schedule like the attendings. The fellow actually gets a bit less than the attendigs. Of course there is back up in the department and all cases can be shown around but it is the fellows choice to what to show.

It is basically a junior attending position with the back-up of the department.

 

[Pathologee]

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• We see a ton of cases. Its mixed neoplastic and non neoplastic and we see more than enough cancer. I had a recent interviewer that was concerned we wouldn’t see enough cancer when we took them to a fancy restaraunt. I almost spit my cheddar biscuits through my nose. There are at least 40k accessioned in house surgical specimens and 40k consults. There is plenty for everyone.

• Its general signout. At frozen section, outside consults (patients coming to mayo for treatment) and non directed consults (weird cases from around the US and the World) you get everything, all the time. Gynecologic, liver, neuropath, heme, cytology all comes to you. Its your responsibility, it doesn’t go away to a soft tissue, neuropath or heme fellow. We have those fellows here, but they have plenty of their own material to review.

• Gross with instant gratification. You gross fresh tissue. If you can gross fresh for a year you can gross anything. Also you freeze it immediately so you can see exactly what it is. “What are these friable, loose brown excrescences on the colon wall? Lets freeze it and see. (1 min later). Oh its metastatic serous carcinoma!” I thought I was a good grosser before, but I am much better now. You do not have to physically do the grossing but you can if you want. The PA’s and residents do grossing but you have a chance to for an hour or so while the resident sits in the hot seat.

• You learn how to write a report. You are responsible for writing sensible reports that have all the pertinent information. Honestly, this was the most valuable part of the fellowship. All diagnoses also get reported to an attending physician, so they all know you very well.

• Consult cases. Excellent material! Seeing the consults that are sent in, you really get a sense of respect for the community pathologist. This is an atmosphere of cooperation, not condescension that can be seen at some academic centers. Our phone calls and letter to the pathologist reflect this. A benefit of this is job opportunities. You are calling back private practices and it is very easy to give them the diagnosis, exchange pleasantries and conclude with “So….jobs?” You get so many connections like this. I have never heard of a fellow who did not get a job after the fellowship, and it is probably largely in part to calling back cases and networking.

• Electives. You get about 5 months of elective time. You could do all breast, GI or all medical renal (etc) and make a mini fellowship so you can have an area of expertise. Alternatively you can mix it up and fix your deficient areas by doing a month in various electives.

• Study sets. The archive has everything. If you feel like looking at a bunch of glandular lesions of the endocervix, 2-3 faculty probably has a study set of 30 of them.

• Research. You can walk in the door, find the specialist you want to work with and say “I want to do a project” and its yours. There is no pulling blocks or slides, it comes to you. You just have to use your brain. There are statisticians, and even a department that will correct your paper for atrocities against the English language (as seen in this post).

• An atmosphere of respect. Fellows are treated like attendings and there are no malignant personalities. That type of behavior is simply not tolerated in the department or at the institution.

• The fellowship is attainable. The fellows are very ethnically and academically diverse. We come from both big and small programs.

• Most importantly, when you are done, you are ready to be on your own. It’s a very busy fellowship but if you can perform at the frozen section lab and work hard during your electives, you will be a solid addition to your practice.

So what are you waiting for? I encourage residents to apply!

 

[pathstudent]

The in-house surgical path material at Hopkins is divided equally between permanent faculty (7-8 pathologists) and junior faculty ("fellows" -- 4 per year). So the junior faculty sign out twice the inhouse routine material than the permanent faculty (Epstein, Hruban, etc) do. The juniors also do ALL of the frozens (can certainly show any case you're not comfortable with) and take all of the SP call. The confirmings are day three in the schedule and a small component of the responsibility. It is a very independent set up. The cases signed out by the "fellows" with the residents are not especially easy and largely consist of complicated resections.

Consider yourself corrected.

Not that I will be applying but out of curiosity how does it work with the subspecialty fellows. Do the breast and GI fellows spend most of the time on consults or do they take specimens away from the surg path fellows?

 

[LNsquasher]

Not that I will be applying but out of curiosity how does it work with the subspecialty fellows. Do the breast and GI fellows spend most of the time on consults or do they take specimens away from the surg path fellows?

GI does the mucosals and liver bxs and directed consults to Dr. Montgomery. They don't really see many resections, though recently they take a few Whipples (we have up to 4 pancreata/day). GYN has an entirely separate service. There is no breast fellowship, so that's all on the SP service (Argani sees true consults). The only things we don't see much of is GI biopsies and GYN, though you can rotate on those services during elective months, of which we have 3 during the year.

 

[Tiki]

MSKCC and Anderson are the best programs simply because they expose you to a lot of cancer specimens, and for certain cancer specimens (larger resections) grossing is equally , if not more important, than the micro. You will realize this when the PA calls you for guidance on a difficult cancer resection and proper orientation/sectioning/margin status are crucial. Anyone who shirks grossing, will never be a composite surgical pathologist. Be a hardworker and be grateful that you have the opportunity to gross complex resections under supervision.

In real life pathology, the cases that will be the most stressful and crucial to get right are cancer cases because you have to be definitive (non-neoplastic diseases are over-rated in terms of difficulty, as all you have to do is recognize the tissue pattern of injury (the tissue has a limited number of tissue reactions to various etiologic agents) and generate a differential diagnosis- sort of similar to radiology).

e.g. eosinophils in lung biopsy-----hypersensitivty vs. eosinophilic pneumonia vs. Churg Strauss etc.
granulomas in liver------sarcoidosis vs. drug vs. PBC vs. chronic viral hepatitis etc.
spongiotic dermatitis in skin.....contact vs. irritant vs. atopic vs. nummular vs. id etc.

However , for cancer it has to be positive or negative (and the occasional uncertain malignant potential).

As a surgical pathologist, you can never see enough cancer cases.

If you go to a good residency, you'll should be able to gross anything by the time you leave. By my last month of surg path, I felt confident grossing everything from complicated ENT specimens, Whipples, pelvic exenterations or an osteosarc or ES bone resection. I don't need anymore experience grossing. I'm not against occasionally grossing to help out (especially if I'm going to get to sign out what I gross), but it should not make up the majority of the fellowship.

Medical biopsies aren't important? Seriously? Say that when you are looking at a liver biopsy and trying to decide between rejection or recurrent Hep C. Or trying to decipher whether dysplasia is present in a patient with UC (or Barrett's). Or how about deciding if something is early UIP versus an interstitial lung disease that can actually be treated. Those are the things I want to get more experience with. Not seeing a bunch of rare tumors that I'll most likely never seen in real practice. And who do you think makes the diagnosis on those cancer cases that end up at MSKCC? I'm sure the pathologists there review the case, but it is the outside pathologist that is making the diagnosis off of a biopsy. Most of the cases that get referred there are already worked up by an outside institution.

I know a few people who did the MSKCC surg path fellowship. They did it so they could ultimately get a subspecialty fellowship there. None of them had particularly good things to say about the experience, except that it was worth it to get to their desired field.

 

[raider]

I am just talking about my experience signing out general surg path from a wide variety of cases both non-neoplastic and neoplastic. In most non-neoplastic diseases the clinicians already have a fair idea of what the diagnosis is and if you are even a mediocre pathologist you can do pretty well (consider your own example of UIP, the diagnosis is heavily dependent on the HRCT reading? Your other example of dysplasia does not make sense since it comes within the realm of neoplastic? And the third recurrent hep C vs. Rejection just reinforces my point of being descriptive and favoring one thing or the other and throwing the ball in the clinicians court). Again, I will reiterate in non-neoplastic you generate a differential and "favor" one diagnosis over another and the clinicians after taking all sort of data (clinical, radiologic, lab etc) proceed.In cancers, you are the "final" word. If it still is not clear how much more important neoplastic stuff is compared to non-neoplastic stuff, go through the list of things pathologists get sued for. Those are the things that will get you in deep trouble in real world pathology and those are the things you need to be really good at i.e. no chance of error.

As regards, some people not benefiting from a certain fellowship, you cannot make a silk purse out of sow's ears. *****s/slackers can only be taught so much and since the fellowships have to be filled with X number of people, quite a few *****s/slackers sneak in. It definitely does not reflect on the teaching at said program. I will re-iterate for a fellowship year, nothing beats the oncologic path year at MSKCC and Anderson. However, there are some other excellent programs e.g. Mayo etc.

Let me repeat it, as a surgical pathologist you can never see enough of cancer because only one wrong cancer diagnosis can ruin your career and reputation.

And finally about the consult cases at these institutions signed out elsewhere, these cases are the best because you get to see all the mistakes made elsewhere and learn not to make them.

Also the most stressful cases you will face in practice are neoplastic e.g. the late night neuro frozen low grade glioma vs. gliosis, the late night frozen on a lung mass with the question of reactive atypia vs. carcinoma, the pancreatic margin with the question chronic pancreatitis vs. pancreatic cancer. These kind of cases can give you a lot of stress and land you in a lot of trouble if you are wrong. Depending on the case e.g. VIP patient, it may be your last mistake as a pathologist.

In the end, do what feels good to you. I can only relate what I have learnt from experience signing out cases. Best of luck in which ever fellowship you pursue.In the end the most important singular factor will be your inherent potential and drive to excel at diagnosis, because truthfully the "real learning" starts when you start signing out on your own.

 

[pathstudent]

I would say medical pathology is far more difficult and interesting than tumor pathology. It takes two seconds to look at a colon polyp and decide if it is hyperplastic, an adenoma or carcinoma. But a medical renal biopsy, brain biopsy, liver biopsy, heart biopsy, muscle biopsy or lung biopsy are so difficult they are often times sent out to a specialist.

 

[oldfatman]

<OBJECT id=ieooui classid=clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D></OBJECT><STYLE> st1\:*{behavior:url(#ieooui) } </STYLE>Why Mayo is the best (biased of course)

• We see a ton of cases. Its mixed neoplastic and non neoplastic and we see more than enough cancer. I had a recent interviewer that was concerned we wouldn’t see enough cancer when we took them to a fancy restaraunt. I almost spit my cheddar biscuits through my nose. There are at least 40k accessioned in house surgical specimens and 40k consults. There is plenty for everyone.

• Its general signout. At frozen section, outside consults (patients coming to mayo for treatment) and non directed consults (weird cases from around the US and the World) you get everything, all the time. Gynecologic, liver, neuropath, heme, cytology all comes to you. Its your responsibility, it doesn’t go away to a soft tissue, neuropath or heme fellow. We have those fellows here, but they have plenty of their own material to review.

• Gross with instant gratification. You gross fresh tissue. If you can gross fresh for a year you can gross anything. Also you freeze it immediately so you can see exactly what it is. “What are these friable, loose brown excrescences on the colon wall? Lets freeze it and see. (1 min later). Oh its metastatic serous carcinoma!” I thought I was a good grosser before, but I am much better now. You do not have to physically do the grossing but you can if you want. The PA’s and residents do grossing but you have a chance to for an hour or so while the resident sits in the hot seat.

• You learn how to write a report. You are responsible for writing sensible reports that have all the pertinent information. Honestly, this was the most valuable part of the fellowship. All diagnoses also get reported to an attending physician, so they all know you very well.

• Consult cases. Excellent material! Seeing the consults that are sent in, you really get a sense of respect for the community pathologist. This is an atmosphere of cooperation, not condescension that can be seen at some academic centers. Our phone calls and letter to the pathologist reflect this. A benefit of this is job opportunities. You are calling back private practices and it is very easy to give them the diagnosis, exchange pleasantries and conclude with “So….jobs?” You get so many connections like this. I have never heard of a fellow who did not get a job after the fellowship, and it is probably largely in part to calling back cases and networking.

• Electives. You get about 5 months of elective time. You could do all breast, GI or all medical renal (etc) and make a mini fellowship so you can have an area of expertise. Alternatively you can mix it up and fix your deficient areas by doing a month in various electives.

• Study sets. The archive has everything. If you feel like looking at a bunch of glandular lesions of the endocervix, 2-3 faculty probably has a study set of 30 of them.

• Research. You can walk in the door, find the specialist you want to work with and say “I want to do a project” and its yours. There is no pulling blocks or slides, it comes to you. You just have to use your brain. There are statisticians, and even a department that will correct your paper for atrocities against the English language (as seen in this post).

• An atmosphere of respect. Fellows are treated like attendings and there are no malignant personalities. That type of behavior is simply not tolerated in the department or at the institution.

• The fellowship is attainable. The fellows are very ethnically and academically diverse. We come from both big and small programs.

• Most importantly, when you are done, you are ready to be on your own. It’s a very busy fellowship but if you can perform at the frozen section lab and work hard during your electives, you will be a solid addition to your practice.

So what are you waiting for? I encourage residents to apply!

No offense, but this sounds like someone who drank the kool aid. Like another blue stain fanatic.

Nothing prepares you for practice like actually being in practice. Fellowship is ultimately just a glorified extra year of graduate medical education--an extra year of residency. You're still a peon until YOU are signing out the cases AND getting paid for it. Nothing will prepare you for that first year of practice like nothing was able to prepare you for the first year of medical school or the first year of residency.

BTW, I like Mayo's consult service most of the time. I send most of my really odd cases there. My clinicians/surgeons love them. They think Mayo has the final word and it's the gold standard. But I dislike their weird letter/report system and getting the dorky resident/fellow (sometimes arrogant) calls about complex cases when they don't have a clear idea of what they're talking about or the ultimate implications of the call. I'd rather get a call from another attending--they are getting paid for it.

Anyways, Mayo is a weird big place in a weird little frozen town. Go see the "shrine" to the Mayo brothers if you want to see what I'm talking about.

 

[Tiki]

In most non-neoplastic diseases the clinicians already have a fair idea of what the diagnosis is and if you are even a mediocre pathologist you can do pretty well (consider your own example of UIP, the diagnosis is heavily dependent on the HRCT reading? Your other example of dysplasia does not make sense since it comes within the realm of neoplastic? And the third recurrent hep C vs. Rejection just reinforces my point of being descriptive and favoring one thing or the other and throwing the ball in the clinicians court).
Also the most stressful cases yo

My point with the UC and dysplasia is that a place like kettering is not going to be following patients with UC. These are the types of things that are going to come through either private practice or university settings. So no disrespect to places like MSK, but I would rather see those cases (firsthand) as well as the tumor resections. And I don't want to see them after some other pathologist has already worked it up (whether or not their diagnosis is wrong or right).

I really don't care one way or the other though. I'm thrilled with my felllowship spot, it gives me independent sign out of frozens, hot seat experience, and consult experience. I interviewed at several other places that have been talked about, and didn't think I would get as good of an experience. Which is exactly why everyone needs to go out an look at those places themselves.

Oh, and I do think the Hopkins fellowship sounds awesome, and I'm all for independent signout, but I don't think I'd want the whole year to be independent. Maybe the last six months or so. But it sounds awesome for folks who are ready for it.

 

[Pathologee]

.

No offense, but this sounds like someone who drank the kool aid. Like another blue stain fanatic.

Blue kool aid. It was delicious.

Nothing prepares you for practice like actually being in practice. Fellowship is ultimately just a glorified extra year of graduate medical education--an extra year of residency. You're still a peon until YOU are signing out the cases AND getting paid for it. Nothing will prepare you for that first year of practice like nothing was able to prepare you for the first year of medical school or the first year of residency.

Agree 100%. There is nothing like trial by fire. I am about to start and I am getting nervous. I am sure I will learn more this first year than any fellowship can teach me.

BTW, I like Mayo's consult service most of the time. I send most of my really odd cases there. My clinicians/surgeons love them. They think Mayo has the final word and it's the gold standard. But I dislike their weird letter/report system and getting the dorky resident/fellow (sometimes arrogant) calls about complex cases when they don't have a clear idea of what they're talking about or the ultimate implications of the call. I'd rather get a call from another attending--they are getting paid for it.

Thank you for providing reasons 12 and 13. 12. Clinicians/surgeons think the world of it. 13. Fellow run services. This is how all of mayo is. There is only one way to do things. It doesn't matter if you are the Prince of Saudi Arabia or the guy who sang Chocolate Rain.So it is up to the fellow to get his act together or eat crow when the outside attending thinks you are a fool. This should carry over to when you are practicing and have to communicate.

Anyways, Mayo is a weird big place in a weird little frozen town. Go see the "shrine" to the Mayo brothers if you want to see what I'm talking about

 

[pathstudent]

Can you do a Mayo surgpath fellowship in Scottsdale. That would be much kinder in the winter.

 

[LNsquasher]

True consults go to faculty (most are directed to a specific faculty member -- especially Epstein, or course) and the rest -- usually only a few cases per day -- are signed out by the permanent faculty on a rotating basis.

Are there errors? I'm sure there are, but at the beginning you are especially encouraged to show a lot of cases at the concensus conference. Towards the end of the year, there is very little difference with the other pathologists in the percentage of cases shown for QA purposes.

There is no doubt that the level of responsibility is not for everyone (or perhaps most people) right out of residency, but you learn a lot, and very quickly.

And it's an especially great system if you're permanent faculty, as you have no primary frozen responsibilities or call.

Going back to Hopkins for a minute, while there is no doubt you'll be well prepared to sign out SP after the year in the real world, let's not make the mistake of overselling the experience. The SP "fellows" take ALL of the call for the department, which can be busy, and which can frankly really suck. You can potentially spend the whole weekend reading rush biopsies and organ harvests on your own, without backup. You are basically taking on the responsibility (and liability) of a busy year of signout, while getting paid essentially like a resident. Frankly, it's a complicated decision whether to pursue the experience.

 

[2121115]

Going back to Hopkins for a minute, while there is no doubt you'll be well prepared to sign out SP after the year in the real world, let's not make the mistake of overselling the experience. The SP "fellows" take ALL of the call for the department, which can be busy, and which can frankly really suck. You can potentially spend the whole weekend reading rush biopsies and organ harvests on your own, without backup. You are basically taking on the responsibility (and liability) of a busy year of signout, while getting paid essentially like a resident. Frankly, it's a complicated decision whether to pursue the experience.

^^^ This ^^^

Just get a regular job and sign out a variety of cases. If you don't like it, leave after the year and call it equivalent to a "surgpath fellowship" and/or sell yourself as having experience. If you do like it, you've got one year down on your partnership track.

 

[Ruination]

I am 4 weeks from finishing my surg path fellowship. AP/CP trained at a program with a decent volume and good exposure to a variety of neoplastic/non-neoplastic disease.

Here are the things that I would look for if one were inclined to do a surg path fellowship:

- Independence: I don't think that this can be overstated enough. Pathology is probably one of the only fields in medicine where you can pretty much go through your entire residency and make few, if any critical decisions. You want a fellowship where at the very least you can sign out frozen sections and issue prelim diagnoses to clinicians (i.e. hot seat rotation). Ideally, it would be great to actually sign out cases and develop some degree of confidence. Doing it all over again I would probably prefer the Hopkins model for my surg path fellowship.

- Flexibility: This year should help you "fill in" the gaps of your residency training. Electives are a valuable time to gain extra exposure in areas that you feel particularly weak in.

- Limited grossing: As long as you trained at a moderately busy program, you should feel comfortable with almost every type of specimen. If your residency program was weak in specimen complexity, then I don't think that this applies to you.

- Access to faculty consult material: Many of our faculty receive personal consults which really enhances the experience. You get to see difficult cases and learn how to approach them.

- Variety: I personally like the fact that we see a variety of neoplastic and non-neoplastic disease and that we get exposure to non-tumor biopsies.

 

[Sulfinator]

Thanks for sharing you experience and insight with us, Ruination. Given that your fellowship ends in 4 weeks, will you be doing another fellowship in July or do you have a job lined up?

I am 4 weeks from finishing my surg path fellowship. AP/CP trained at a program with a decent volume and good exposure to a variety of neoplastic/non-neoplastic disease.

Here are the things that I would look for if one were inclined to do a surg path fellowship:

- Independence: I don't think that this can be overstated enough. Pathology is probably one of the only fields in medicine where you can pretty much go through your entire residency and make few, if any critical decisions. You want a fellowship where at the very least you can sign out frozen sections and issue prelim diagnoses to clinicians (i.e. hot seat rotation). Ideally, it would be great to actually sign out cases and develop some degree of confidence. Doing it all over again I would probably prefer the Hopkins model for my surg path fellowship.

- Flexibility: This year should help you "fill in" the gaps of your residency training. Electives are a valuable time to gain extra exposure in areas that you feel particularly weak in.

- Limited grossing: As long as you trained at a moderately busy program, you should feel comfortable with almost every type of specimen. If your residency program was weak in specimen complexity, then I don't think that this applies to you.

- Access to faculty consult material: Many of our faculty receive personal consults which really enhances the experience. You get to see difficult cases and learn how to approach them.

- Variety: I personally like the fact that we see a variety of neoplastic and non-neoplastic disease and that we get exposure to non-tumor biopsies.

 

[Ruination]

Thanks for sharing you experience and insight with us, Ruination. Given that your fellowship ends in 4 weeks, will you be doing another fellowship in July or do you have a job lined up?

I will be pursuing a subspecialty fellowship, then <hopefully> job opportunities.

 

[Absidia]

Going back to Hopkins for a minute, while there is no doubt you'll be well prepared to sign out SP after the year in the real world, let's not make the mistake of overselling the experience. The SP "fellows" take ALL of the call for the department, which can be busy, and which can frankly really suck. You can potentially spend the whole weekend reading rush biopsies and organ harvests on your own, without backup. You are basically taking on the responsibility (and liability) of a busy year of signout, while getting paid essentially like a resident. Frankly, it's a complicated decision whether to pursue the experience.

Let's also not make the mistake of underselling it. A few points:

- While they can be busy at times, the vast majority of weekends and call nights are relatively uneventful.

- Unlike MSKCC or MDA, there is no grossing.

- Admittedly the pay is not much more than that of a resident (it's your PGY level + 5K), but it is just one year, and I would argue that the training you get more than compensates.

- While the attendings certainly do not baby you, there is tons of backup should you need it (even on weekends, though it is rarely done, you can call someone in or use virtual microscopy).

- Finally, rarely mentioned is the ability to rotate 3 months on a specific service (e.g., GU with Epstein or GI with Montgomery), creating a "mini-fellowship" complete with research opportunities for those that desire them.

I would argue very strongly that there is no better SP training ("fellowship") experience.

 

[pathstudent]

Is Montgomery more of a gi expert or soft tissue expert.

Let's also not make the mistake of underselling it. A few points:

- While they can be busy at times, the vast majority of weekends and call nights are relatively uneventful.

- Unlike MSKCC or MDA, there is no grossing.

- Admittedly the pay is not much more than that of a resident (it's your PGY level + 5K), but it is just one year, and I would argue that the training you get more than compensates.

- While the attendings certainly do not baby you, there is tons of backup should you need it (even on weekends, though it is rarely done, you can call someone in or use virtual microscopy).

- Finally, rarely mentioned is the ability to rotate 3 months on a specific service (e.g., GU with Epstein or GI with Montgomery), creating a "mini-fellowship" complete with research opportunities for those that desire them.

I would argue very strongly that there is no better SP training ("fellowship") experience.

 

[Ombret]

Both; first phase as a soft tissue person at AFIP; second and current phase at Hopkins more in GI; both phases very successful! A Medline search more or less tells the story.

 

[LNsquasher]

Let's also not make the mistake of underselling it. A few points:

- While they can be busy at times, the vast majority of weekends and call nights are relatively uneventful.

- Unlike MSKCC or MDA, there is no grossing.

- Admittedly the pay is not much more than that of a resident (it's your PGY level + 5K), but it is just one year, and I would argue that the training you get more than compensates.

- While the attendings certainly do not baby you, there is tons of backup should you need it (even on weekends, though it is rarely done, you can call someone in or use virtual microscopy).

- Finally, rarely mentioned is the ability to rotate 3 months on a specific service (e.g., GU with Epstein or GI with Montgomery), creating a "mini-fellowship" complete with research opportunities for those that desire them.

I would argue very strongly that there is no better SP training ("fellowship") experience.

I agree that it is probably the most complete SP "fellowship" experience out there. And the three month "mini-elective" can certainly be valuable. But most people right out of residency probably aren't ready for the level of responsibility and you are taking on a lot of liability (though the malpractice insurance provided is exceptional).