What is a good pathology program?
- Thread starter DermViser
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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"
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"
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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.
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.
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.
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'm American born and raised, and did all my training in the US. My comments referred to US programs.
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'm talking about medical school applicants looking for that information, that is not divulged on websites. No need to be mean.
I was saying that UTSW's Pathology program is very well regarded. It likely won't be taking DOs/IMGs/FMGs.
If so, that is quite a change from last year. They had nine PGY-1's in pathology; four were IMGs, including one US IMG.
By the way, I'm a non-US IMG doing a path residency. I practiced in my original specialty for a few years in my home country and held a university faculty position for a few years in the US before deciding I wanted to practice again. My program (which is a decent university program) is about 50% IMG's, most of whom have similar backgrounds to mine.
A program that takes IMGs is not necessarily a bad program.
When selecting programs, I looked at the things that other people on this thread have mentioned already: variety and volume, minimal scut work, strong didactics, good facilities, where previous alumni had gone, and what fellowships were offered.
(Ultimately I was constrained by geography, but it was nice to look.
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The classic "FMGs are good at research" fallacy.
If an FMG is recruited to a research-heavy program like MGH or the like, then good on them. Large programs have the resources to foster researchers.
Most programs are not like that. The mid and low-tier programs do not have the research resources or pedigree to train FMGs to be researchers. They take who they can get. Saying that its because "FMGs come with PhDs and are good at research" is patently false.
Folks are generalizing way too much here. All this IMG stuff is rather xenophobic - if you can speak fluently in the language of your program (this kind of thing is interesting to observe in a bilingual country where not everyone is bilingual), that's all anyone should care about. The criteria GB listed above are solid initial criteria for an applicant to consider, with other specifics being dependent on what the candidate is looking for. For example, someone set on dermpath would be smart to favor programs with DP fellowships, even better if the program is housed in path. Or if you really enjoy head and neck, going to a place with some of the big names in that subspecialty has value. That kind of stuff. People come and ask these kinds of questions, and I just don't think it's realistic to expect perfect advice without very explicit details about one's situation(s), both professional and personal.
Amen to Mlw. And who said all FMGs are good at research? Certainly not me, but the people who are from overseas and who match to top programs certainly are.
DV my program is very friendly to all. I have great colleagues who run the gamut from just-graduated-AMGs to foreign attendings to DOs to Carib grads.
DV my program is very friendly to all. I have great colleagues who run the gamut from just-graduated-AMGs to foreign attendings to DOs to Carib grads.
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IMGs come in all shapes and sizes, and are found in all specialties. I wouldn't use the presence of IMGs as a measure of a program's quality. I WOULD however, view a program very negatively if all the residents were IMGs, or if those that were there had poor communication and or social skills. That tells you people are avoiding that program for a reason, and only lower-quality applicants are being picked up there. So on average, I think AMGs are far superior to IMGs, but any one individual IMG can be solid and/or superior to their AMG counterpart.
UTSW has accepted at least 1 DO, because I went to school with him. As for FMGs/IMGs, some of the ones in my program are truly intimidating with fantastic resumes and years of experience. If a program has no US grads that might be a tip-off, but it really depends on the caliber of the individual resident.
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It shouldn't be (in theory), but it is. PDs have a lot to do, and keeping track of changing emails and contact lists is not really at the top. Plus PDs change. In addition, you might be amazed (or maybe you aren't) but people just don't answer their damn email. You would think it would be easy to hit reply and say, "thanks, got your message" but for some reason this is an exceedingly difficult task. I guess that happens when you don't stay on top of your email and your inbox has >1000 messages like a lot of people I know.
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.
[QUOTE="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.[/QUOTE]
This is required by the ACGME as part of the annual residency program review to be presented to all faculty members. It's not required the length of time, but it has to be done. We just discussed the last 5 years worth of data for ours.
This is required by the ACGME as part of the annual residency program review to be presented to all faculty members. It's not required the length of time, but it has to be done. We just discussed the last 5 years worth of data for ours.
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.
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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.
Why ask this question and counter many of the replies? You seem to be very against programs with FMGs, and we're telling you that plenty of solid programs have some FMGs amongst their ranks. If you want a program with no/few FMGs, good luck with that, but I don't see the point in coming onto an internet forum for advice, asking a question, and then refuting the answers of the people who've replied. This kind of attitude will not win you friends among the faculty or senior residents... I say this from experience. Humility is an asset in any pathologist.
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.
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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.
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). I understand what you mean. I was there a few years ago too. "beware of the programs with too many FMG's..blah blah blah" when you interview. etc etc etc
But the truth is, there is no hard or fast rule as to what determines a good places based SOLELY on whether the resident constituency is IMG/DO or mostly AMG... that's. just. not. true. It's based on many factors that you wish you understood when you interviewed, but only now appreciate while in training.
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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.
I think people are splitting hairs now. There seems to be general agreement on the above bolded line (which I concur with as well). As I said in a prior post, a program with admixed FMGs is nothing to be remotely concerned about, but > 50% would give me pause. There's also the quality of the FMGs to consider, and the quality of their English. Learning a second language ain't easy (I'm slowly working on French... ce n'est pas facile). I don't think it's fair to pick on accents, but the ability to understand, speak, and write well in the language of the region in which one works is essential, all the more so in medicine and pathology, where our written reports are our work product. FMGs with weak language skills are at a massive disadvantage. I say all this to make the point that if you can't have a normal conversation with your tour guide because they can't converse in English, that's a red flag.
Look, you need to look at a pathology program as a WHOLE. Not just based on whether the residents are IMG's, DO's, etc. And as someone who has six figure loan, I can understand where you are coming from...If you are going to look into a program, you need to see the program as a WHOLE: how much research opportunities do they have?, how much specimens do they get and variety, WHO teaches in that institution (prominent pathology figures who are part of the faculty), the resident schedule and expectations in their duties (is there enough preview time, is there hot seat? are the resident duties going to train you well enough so that when you leave you will feel confident signing out cases on your own, do you get adequate call on CP so that you know how to handle lab issues,), available support (is there adequate resources and training personnel to teach you, is the program director receptive to resident concerns, does the program have a lot of fellowships?-programs usually like to take their own). Good places have the above things. Usually those types of places are also intense, do a lot of research to advance the field, and expect you to work hard; that means they look for anyone who is willing to do that work regardless if you are from outside or inside the USA.
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..
Yes, our field is one of the least popular and least competitive, but that does not justify lowering standards to far as to accept whichever IMG/Carib walks through the door.
We've all seen it. Program X can't get any AMGs interested, so they fill the program with IMGs who did pathology in their home countries. These IMGs end up being either unteachable, unable to grasp concepts, unable to communicate in English etc.
The whole point of the AMG vs IMG debate is that with AMGs you're getting a known quantity, whereas with IMGs the spread is so wide you never know what you'll end up with. Programs that have to dig deep into the IMG pile are like someone who couldn't afford a Honda so they had to settle for that used Lada.
Dang, lots of negativity toward DO's. What's so bad about a DO going into Path? We don't have our own residency, so we have to apply to MD programs. It's the one specialty that I've really enjoyed.
What's so bad about a DO going into Path? We don't have our own residency, so we have to apply to MD programs. It's the one specialty that I've really enjoyed.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.
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.
I'd say to make sure that every subspecialty that sends a lot of specimens is present at the program. A good path program will have a concomitant heavy-volume derm program and all subspecialty surgeries minus cardiac. You need this kind of exposure to work in the real world. There are a lot of programs out there that are missing many of these services. I recall a recent thread about a program in Florida that had just opened in a hospital that did not have a lot of these services. Nobody but the most desperate of IMGs should match to that.
Make sure that PAs are the norm at the program and that all resident grossing is for learning purposes, not crucial for departmental functioning. It would get mighty old in your last year of residency grossing the xth benign uterus when you're preparing for boards.
I hate to say it but if fellowships are your thing, and for most they are, going to a name program would be beneficial.
Going to a program with limited time on autopsy/forensics is a good thing as well i.e. shared autopsies, mostly observing etc. You won't be doing forensics in the real world(unless you do the fellowship and go in that direction, but odds are you won't), and autopsies are rarely performed anymore as well. Time spent on autopsy is time that could have been spent on derm or GU or something.
Make sure that PAs are the norm at the program and that all resident grossing is for learning purposes, not crucial for departmental functioning. It would get mighty old in your last year of residency grossing the xth benign uterus when you're preparing for boards.
I hate to say it but if fellowships are your thing, and for most they are, going to a name program would be beneficial.
Going to a program with limited time on autopsy/forensics is a good thing as well i.e. shared autopsies, mostly observing etc. You won't be doing forensics in the real world(unless you do the fellowship and go in that direction, but odds are you won't), and autopsies are rarely performed anymore as well. Time spent on autopsy is time that could have been spent on derm or GU or something.
Ha ha. My program is good, but not perfect. No, I won't name it here. Don't think the sun shines from heaven directly upon us....as I said, no place is perfect. What I listed above is my ideal program, which doesn't exist of course. Here are some downsides where I am:
1) we do gross biopsies. Not many, but I honestly think after PGY1 that number should = 0.
2) We are in one hospital. High volume for one place...but the downside is, our PD can keep quite close tabs on us. There is no such thing as ghosting out early or hiding. I mean if you were a mouse you wouldn't be able to hide. Our department is not small, but it is centralized and there are only so many places you are supposed to be.
3) Call is quite heavy. A good point as I said, but I mean there is a TON of call.
4) See #2. When I hear of my friends in other programs who say they haven't seen their PD in "months and months" I think to myself....well mine just saw me waiting outside the bathroom. Before that he saw me making copies. Before that, he saw me sneak into morning conference 2 minutes late. We were on call last night together and I spoke to him last at 3 AM. That kind of thing. I'm a decent trainee, so I don't worry too much about it, but there is definitely no hiding!
5) See #2. When I hear of my friends say they leave work at 2-3 PM, that is just not an option here. We are very regular, 8-5 people, but the trade off for that is, you will NEVER, and I mean NEVER EVER leave here before 4:45 PM at the earliest, unless violently ill. But like I said, you will also almost NEVER leave after 5:30, 6 at the latest if you are grossing, unless you are on call. I actually prefer this. I like having the same schedule from day to day unless on call...I would find it stressful if I grossed til 11 PM some nights, then other times I just left work at 2 PM. Here, even if you are on chemistry, you have to stay bc we have late conferences.
So nothing is perfect....plus we have our fair share of weirdos from time to time....
Best of luck to all applicants. Go with your gut is my opinion. Do not pick a name place if your gut tells you it is abusive and horrible. There is such thing as excellent training at non-name places. Just bc we don't have a huge name doesn't mean we are stupid. Just bc someone went to a name place doesn't make them a genius, either.
One thing I really don't like about the US is the unforgiveable snobbery from the coasts towards....well the entire rest of the country! Its as if the middle of the country does not exist. In blood bank terms, most donors live in "fly-over" territory. They donate the most blood, which is of course used mostly on the coasts. But I digress...Don't overlook the middle bulge in your program search! We are here!
1) we do gross biopsies. Not many, but I honestly think after PGY1 that number should = 0.
2) We are in one hospital. High volume for one place...but the downside is, our PD can keep quite close tabs on us. There is no such thing as ghosting out early or hiding. I mean if you were a mouse you wouldn't be able to hide. Our department is not small, but it is centralized and there are only so many places you are supposed to be.
3) Call is quite heavy. A good point as I said, but I mean there is a TON of call.
4) See #2. When I hear of my friends in other programs who say they haven't seen their PD in "months and months" I think to myself....well mine just saw me waiting outside the bathroom. Before that he saw me making copies. Before that, he saw me sneak into morning conference 2 minutes late. We were on call last night together and I spoke to him last at 3 AM. That kind of thing. I'm a decent trainee, so I don't worry too much about it, but there is definitely no hiding!
5) See #2. When I hear of my friends say they leave work at 2-3 PM, that is just not an option here. We are very regular, 8-5 people, but the trade off for that is, you will NEVER, and I mean NEVER EVER leave here before 4:45 PM at the earliest, unless violently ill. But like I said, you will also almost NEVER leave after 5:30, 6 at the latest if you are grossing, unless you are on call. I actually prefer this. I like having the same schedule from day to day unless on call...I would find it stressful if I grossed til 11 PM some nights, then other times I just left work at 2 PM. Here, even if you are on chemistry, you have to stay bc we have late conferences.
So nothing is perfect....plus we have our fair share of weirdos from time to time....
Best of luck to all applicants. Go with your gut is my opinion. Do not pick a name place if your gut tells you it is abusive and horrible. There is such thing as excellent training at non-name places. Just bc we don't have a huge name doesn't mean we are stupid. Just bc someone went to a name place doesn't make them a genius, either.
One thing I really don't like about the US is the unforgiveable snobbery from the coasts towards....well the entire rest of the country! Its as if the middle of the country does not exist. In blood bank terms, most donors live in "fly-over" territory. They donate the most blood, which is of course used mostly on the coasts. But I digress...Don't overlook the middle bulge in your program search! We are here!
