Washington U vs Iowa

Discussion in 'Pathology' started by Pathgod2629, Feb 10, 2019.

  1. Pathgod2629

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    I am inclined to rank Iowa U higher than U Washington because the crime rate in St. Louis, my interview day impression in WU that residents weren’t very happy and the reputation that they are overworked. Am I making a mistake to rank this way?
     
  2. Unty

    Unty New Member
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    In my opinion, I wouldn't go to a program where residents are grossing late or until midnight. F that. Although being busy is good, grossing long ass hours equates to a form of slavery in my opinion. Grossing is important dont get me wrong but grossing like a gross monkey is counterproductive in a residents education. The latest I ever stayed was 730-8 pm because the processor had to be loaded. I had no issues with that abd I don't think more hours of grossing would have made me a better pathologist.


    You can still get good training with regular work hours or even staying until 7-8 pm in some cases. More grossing does not equate to better training.

    Seeing a lot of cases is important. If you are worked to the point of exhaustion I would not go to said program.

    A good training program has BALANCE and if you don't have that I wouldn't go to that program.

    In short seeing a lot of cases, being able to enter your diagnosis and sitting with the attending for feedback regarding your diagnosis is the best way to train.

    If you are sitting at signout falling asleep because you were grossing until 11 pm the night before and had to wake up early to sign out with the attending the next day is counter productive. You will get burned out especially if you are doing AP for one whole year.

    Now there will be people on here who will say I worked 80 hours a week!!!! That's great if they found that kind of training helpful but it's not for everyone.
     
    #2 Unty, Feb 10, 2019
    Last edited: Feb 10, 2019
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  3. pathslides

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    Any program the regularly has residents grossing past 5pm is a crap program. Grossing long hours is so pointless, not educational, and not indicative of actual practice. Now a program that has resident looking at slides and dictating until the wee hours is another story and is actually educational and that intensity will only help you when it comes time to actually practice and stay efficient.
     
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  4. Unty

    Unty New Member
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    Yes very true. Agree with what you said. Being gradually hammered with slides will only make you become more efficient and fast in practice.

    I think MSK and MD Anderson used to be grossing mills but from what I hear they've taken that out for surgpath fellows?

     
  5. chooks

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    Any program that has you gross needle biopsies in any forms is a waste.

    I think that grossing long hours, while not fun, actually serves more purposes than you think. For one it gives mastery over the subject. I grossed up to 14 hours a day (all bigs) and I know that no matter what gets thrown at me, I am good to go and can either direct PAs accordingly, or do it myself if there is no other assistance. Being able to gross while tired/after a long day is good for those middle of the night frozens or cases where the PAs aren't around. I've had numerous cases after hours where PAs aren't around with complicated specimens and they have not been a problem on the grossing end.

    Conversely, I think that staying up all night looking at cases is not very effective for learning/retention. The research is fairly clear on the effects of fatigue on retention. It is also exactly the opposite of the way that I (and I think most people) practice. If you are signing out cases in PP while extremely fatigued, you are asking for trouble. Now, if the training case load is such that it allows the opportunity to learn effective time management/efficiency skills such that you learn how to NOT need staying up, that is a different story and is of course very useful.
     
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  6. Spikebd

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    Excellent points about the value of grossing. I’m early in my residency and keep telling myself the pain of learning how to gross will pay off down the line.
     
  7. OP
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    Pathgod2629

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    OP here, still don't know how to rank the two programs.
     
  8. SoDakMLS

    SoDakMLS Good luck on the Path!
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    Current WashU resident. When choosing a program, I limited myself to the Midwest, and found myself weighing these two programs at the end of the interview season. When it came down to it, I picked WashU because the facilities were great, it was a place I knew I would be "pushed", and I couldn't see myself really enjoying Iowa City (I'm not against smaller towns, but a small college town that isn't where I went to school??? yuck). For the record, I own a house just outside St. Louis proper. The only crime perpetrated against me or my spouse was theft of license plate tags once, which cost us $3 and a quick trip to the DMV. The medical campus and immediately surrounding neighborhood is safe; I'm not aware of any residents being victims of crime, much less violent ones.

    To clarify, when I say "pushed", I mean that the expertise of the faculty and trainees help motivate you to be better. Think Jack Nicholson--"you make me want to be a better [pathologist]" sort of thing. Yes, it is on the high end of the spectrum for grossing, but let me be clear--you are never grossing biopsies, and there is appropriate PA staffing to keep you from getting crap cases like ostomy closures, appendices, gallbladders, traumatic amputations, etc. While there are upsides to the program's structure of essentially separate AP and CP programs (like you will see all AP specialties before it's time to apply for fellowships at the start of PGY-3 year, no weekend call outside of autopsy for the first 2 years, and you will never be pulled from CP to AP), it does make for a busy first 2 years, which may explain why residents aren't the most bright eyed and bushy tailed at interview functions.

    It is fair to say that perhaps over the past decade the program was a bit complacent and ignored a lot of trends both in residency and surgical pathology fellowship training. We have new leadership for the residency program and also a new department chair starting in May. The AP/CP program will integrate (CP rotation each PGY year) either this coming academic year (2019-20), or the year after, which will break up the intensity of the first 2 years. Fellow grossing days are numbered (beyond establishing competence). We have been working with PAs to assign time values to different specimen types, to make sure the residents don't get overworked in the gross room (piloting a 3 hour cap on a trial basis soon).

    I felt the need to speak up, because there is a lot of misinformation about our program out there. This definitely was a "gross till midnight" place in the past (probably >5 years ago), but if someone is doing that now, they're either a night owl or frankly doing it wrong. You get amazing hands-on training here, on both AP and CP services, which will serve you well whether you plan on staying in a large academic center, or heading out into the community. Plus, all else being equal, it can't hurt your job prospects to graduate from a program where it is known that you work hard!
     
  9. OP
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    Pathgod2629

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    Thank you so much SoDakMLS!
     
  10. gbwillner

    gbwillner Pastafarian
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    I think Iowa is a fine program, but WashU has a national reputation. If you are considering Iowa because of St. Louis crime, then you are making a serious mistake. Also, some of the comments here around grossing are off base- WashU will require long days on surgpath rotations but not because of grossing. You are given a very heavy volume from day 1, and you only gross what you sign out.
     

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