I'm guessing also places that don't have FMGs/IMGs as residents as well?IMHO there are many factors. The two you mention are as good as any. It also depends on your specific goals as well- if you want to eventually settle in a specific city, a solid regional program may be as good as a top national one because you have the opportunity to establish local connections and join regional societies.
But I would include the following criteria in addition to the two you mention:
AP:
Sufficient volume that you see a wide variety of specimens and you see many of them
Opportunity for responsibility in generating reports and frozen sections
Minimize scut work and grossing of simple biopsies
AP/CP:
Well-respected faculty
Good lecture schedule with daily learning events
Good program history with network of alumni
Opportunity to do independent research, with money and time and faculty support
Opportunity to go to national conferences
CP:
Independence from AP (can't be pulled to cover AP)
Transfusion service that is involved and has you round on patients
All services with individual attention from faculty with daily learning, minimized "self study"
I'm guessing also places that don't have FMGs/IMGs as residents as well?
To be fair, you work in Canada, not the United States.No, you guess wrong, in my opinion. That's a xenophobic attitude. Plenty of solid programs have IMG residents, and plenty of those IMG residents are brighter and harder working than their American counterparts. I would be somewhat concerned of a program with > 50% IMGs, especially if a high proportion of the IMGs are North Americans. Gb's comments are insightful.
But that's hard for any program to keep track of, right?The ideal way to assess quality would be to see where the residency graduates are 5-10 years after residency. Most programs track where they go for fellowship but that's it. Fellowships usually know where their graduates go but that can be less useful.
I'm American born and raised, and did all my training in the US. My comments referred to US programs.To be fair, you work in Canada, not the United States.
But that's hard for any program to keep track of, right?
I'm talking about medical school applicants looking for that information, that is not divulged on websites. No need to be mean.No, not really. It's 2014. You just need to drop your graduates an email once a year asking what their current employment status is. I've gotten a few such emails from my program.
You seem to counter the suggestions and advice of the people you're asking here. So why don't you tell us what you're looking for, and we'll tell you if it exists.
I was saying that UTSW's Pathology program is very well regarded. It likely won't be taking DOs/IMGs/FMGs.DV there is not a single pathology residency program in the county which is not open to FMGs. In fact we had a recent discussion on this forum that at the best ones it is likely easier to get in as an FMG than it is as a DO or an American IMG. Pathology is the sine qua non of specialties interested in intellectual firepower and research chops, so many FMGs with PhDs and impressive publication track records are welcomed evening they're several years from med school.
For me, I wanted a program with a variety of practice settings from which to draw specimens (university hospital, cancer center, county hospital, freestanding children's hospital, VA) as I think it's crucial in path to really try to see everything that's ever been described in a medical textbook. Autonomy, flexibility to tailor training to my interests, substantial research opportunities, and mentorship were also quite important to me. I ended up selecting my program based on these factors-- while I'm well aware it doesn't have the biggest name in the country, it had everything I was looking for (its only competitors were UW and Emory in my book) and I have been very pleased thus far.
I was saying that UTSW's Pathology program is very well regarded. It likely won't be taking DOs/IMGs/FMGs.
DV there is not a single pathology residency program in the county which is not open to FMGs. In fact we had a recent discussion on this forum that at the best ones it is likely easier to get in as an FMG than it is as a DO or an American IMG. Pathology is the sine qua non of specialties interested in intellectual firepower and research chops, so many FMGs with PhDs and impressive publication track records are welcomed evening they're several years from med school.
For me, I wanted a program with a variety of practice settings from which to draw specimens (university hospital, cancer center, county hospital, freestanding children's hospital, VA) as I think it's crucial in path to really try to see everything that's ever been described in a medical textbook. Autonomy, flexibility to tailor training to my interests, substantial research opportunities, and mentorship were also quite important to me. I ended up selecting my program based on these factors-- while I'm well aware it doesn't have the biggest name in the country, it had everything I was looking for (its only competitors were UW and Emory in my book) and I have been very pleased thus far.
But that's hard for any program to keep track of, right?
I dunno, if I was a PD I would personally make an effort to track down every graduate from the past 10 years or so.
Assuming PD's actually want to know that information and are willing to disseminate it to anyone interested. Out of sight, out of mind.
I was saying that UTSW's Pathology program is very well regarded. It likely won't be taking DOs/IMGs/FMGs.
Am at a name program in the east coast, and we have a two or three FMG's and a DO (probably one the smartest ones in our residency.). Some of the top places I rotated during medical school had at a DO in one program (NYU), and a few IMG's (Cornell, Columbia). Some of the most prominent figures in Pathology are IMG's (Rosai for example). You know you are at a good pathology program when the individuals who make up the constituency are driven, have high expectations of themselves and those around them, and aren't afraid to work hard/study in an intense environment; all of this is independent of whether you are a foreign or american graduate.I'm guessing also places that don't have FMGs/IMGs as residents as well?
Recruiting highly qualified IMGs who have accomplished so much in Pathology and Path research is one thing. Recruiting IMGs (esp. those in Path in their home countries) bc your program is so poor, or bc you don't have to actually teach them and thus you can shirk your responsibility to teach as a faculty member is a whole another thing.I'm at an ivy program in the east coast, and we have a few FMG's and a DO. Some of the top places I rotated during medical school had at a DO in one program (NYU), and a few IMG's. Cornell has IMG's for sure. Some of the most prominent figures in Pathology were IMG's (Rosai for example). The IMG residents in our program, especially those who have already trained in pathology overseas are held with pretty high regard because they already know so much and are the most efficient in completing their duties. Not to mention, it's a privilege to have a fellow resident who can teach you while you are training together... i mean studying some of this stuff can get pretty overwhelming
Some of the most prominent figures in Pathology are IMG's (Rosai for example).
Some of the things you describe are seen in many places, good or bad. It's a fallacy to think that a good program will always have a faculty willing to teach. Good programs drive their residents to do A LOT of work; preview everything, gross as much as possible, and read all the time. Not go in at 9 AM and leave 5 PM, have a gentle pathology attending spoon feed you diagnostic parameters while your institution rolls in dough.Recruiting highly qualified IMGs who have accomplished so much in Pathology and Path research is one thing. Recruiting IMGs (esp. those in Path in their home countries) bc your program is so poor, or bc you don't have to actually teach them and thus you can shirk your responsibility to teach as a faculty member is a whole another thing.
I'm referring to the trend. Good programs (however, you choose to define that) don't have high numbers of Caribbean school graduates or DO graduates.Some of the things you describe are seen in many places, good or bad. It's a fallacy to think that a good program will always have a faculty willing to teach. Good programs drive their residents to do A LOT of work; preview everything, gross as much as possible, and read all the time. Not go in at 9 AM and leave 5 PM, have a gentle pathology attending spoon feed you diagnostic parameters while your institution rolls in dough.
I'm referring to the trend. Good programs (however, you choose to define that) don't have high numbers of Caribbean school graduates or DO graduates.
Even with IMG grads now, it's not like you're going to find the next Rosai or Kumar.
It's not the ONLY indication. Pathology is a wonderful specialty. But med students who have 6 figures of loans over their heads have the right to know there is a difference between the Pathology program at Albany Medical Center vs. the Pathology program at Emory. You can see that easily based on the people they are able to recruit on their websites. As far as the next Rosai, I tend to go based on probabilities not exceptions.A program with only AMG's is also not an indication of how good a program is. And how would you know whether an IMG is or isn't going to be the next Rosai... Are you God? (assuming God exists)...
It's not the ONLY indication. Pathology is a wonderful specialty. But med students who have 6 figures of loans over their heads have the right to know there is a difference between the Pathology program at Albany Medical Center vs. the Pathology program at Emory. You can see that easily based on the people they are able to recruit on their websites. As far as the next Rosai, I tend to go based on probabilities not exceptions.
Programs that are CONSISTENTLY recruiting DOs, Caribbean grads, or IMGs, aren't good programs, and you can't expect American grads putting all their eggs in one basket in Path not to look into that very intently.
It's not the ONLY indication. Pathology is a wonderful specialty. But med students who have 6 figures of loans over their heads have the right to know there is a difference between the Pathology program at Albany Medical Center vs. the Pathology program at Emory. You can see that easily based on the people they are able to recruit on their websites. As far as the next Rosai, I tend to go based on probabilities not exceptions.
Programs that are CONSISTENTLY recruiting DOs, Caribbean grads, or IMGs, aren't good programs, and you can't expect American grads putting all their eggs in one basket in Path not to look into that very intently.
Many very good prestigious programs have IMG's every year. It's unavoidable. Not many USA applicants want to go into pathology, and the applications are decreasing..
We had an applicant come interview for a PGY2 spot when someone left to transfer to family medicine. That candidate asked the most relevant questions, and came at around the same time as the MS4 applicants. Its unfair, but there is almost NO WAY to know what makes a good program til you have spent a year in residency. Most programs are pretty decent and have a mix of good and less great points.
But again, I cannot stress enough that as a med student, you simply have almost NO perspective as to what your life as a resident will be like and the finer points of what path training is all about. Having said that, and realizing that there is no utopia, in no particular order:
1) lots of grossing bigs
2) zero to as little biopsy grossing as possible
3) opportunity to attend meetings with funding from institution
4) avoid places where there is obvious hatred/drama/infighting
5) pick a place with a heavy call schedule - more learning for you, take the reins after hours, etc - this is CRUCIAL now that PGY1 not allowed to be on call (so short-sighted)
6) leadership is present, expectations are clear
7) good camraderie among staff, among residents - you'll spend a lot of time at work
8) good amount of previewing time
9) maybe most importantly, pick a place with high volume and low enough # residents such that each resident gets their OWN CASES to preview AND DICTATE, does not share cases with other residents OR FELLOWS, works up case with attending, orders own stains, signout consists of attending correcting minor errors/wording in RESIDENT report, and pressing sign out button: hands on for the resident! Approach like apprenticeship! Get your hands dirty, pretend you have only 4 years to learn it all, pretend you won't do a fellowship, etc.
10) good/full conference schedule, variety of conferences, well attended by residents/fellows/staff
11) good case variety, not only big cancer cases but also high volume of inflammatory lesions, skin, liver, kidney, GI, lung, all the non-cancer stuff. There's more to life than cancer, and cancer can look easy compared to some of it!
12) regularly scheduled feedback, structure of feedback
13) Is there a schedule? Is it controlled chaos or just chaos? Are people pulled from one service to cover another? How are absences handled so residents can attend meetings? Etc, etc.
14) conferences are mix of resident-led and attending-led. There is no fun in being a powerpoint monkey, and there is limited education from residents teaching other residents all the time.
15) Does program treat residents like junior staff or like idiot children? Some big name places reserve the grown-up duties for the fellows. Do residents present at tumor boards? Do residents present at CPC? Medical lung and kidney and liver conference? I would stay away from any place where the fellows outweigh and outshine the residents. When you are a resident, you need to be PUSHED to the front of the team, to learn and think like a physician. You cannot do this if fellows are taking all the tumor boards, cases, etc.
I think advice to pick a program based on the number of fellowships is poor advice. Get the best training possible as a resident, then you will get a good fellowship at the same place or outside. My place is high volume, low # residents compared to high volume, each has own cases and dictates from day 1, heavy call, and a few fellows.
I did an outside rotation at a huge name place and was stunned that their 2nd and 3rd year residents had zero experience doing what we do from the first month of residency: tumor boards, dictating our own cases, etc. There, they only do such things if the fellow is out sick, and then there is panic over whether the poor widdle wesident will be able to handle it. I nearly fell over. Not all places are big name, but some places teach you like an apprentice from day 1 to do your future job. Not spend 4 years waiting in line to maybe get the chance to practice your future job when the next person up the totem pole is out sick.
IMHO, #9, 6, 4, 5 above are most important, also #1.