What makes a good Pathology Residency and examples of good residency programs

[tmandudeguy]

Hi all, I just recently applied to over 70 programs but needed some help now in deciding what makes a good program and if any current Residents could give input on their programs and things they wish they knew as they were on the Interview trail.

FYI I am a DO from a big school and decent board scores.

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[SoDakMLS]

OP, don't take this first bit the wrong way, but it might be helpful to future applicants: the time to ask that question is before applying to 70 programs. It would have saved money in ERAS, plus I'm guessing you will be put in an awkward and stressful position of figuring which programs' interview invites to accept and whose to decline (and perhaps already are based on this post!). The fact is that AMGs with average board scores, that have some exposure to pathology (be it from prior work, research, or elective rotations), and no red flags on their application will get ample interview invites, so candidates really can afford to be picky with where they apply. 2 dozen programs is a reasonable benchmark. Over the past few years, I believe AMGs match with ~10 contiguous ranks in pathology.

If you look back on prior threads about good path programs, probably the only consistent factor you will see is volume. More volume = more experience for you --> greater confidence with the bread & butter and some first-hand exposure to zebras. Closely linked to this is the volume of cases you will have to gross, and whether there are PA's available to take care of the ditzels and biopsies while you are doing the complicated cancer cases.

The importance of other factors are going to vary based on what your needs and goals are. Some really care about the name of the institution. Some need to be in a specific geographic area because of spouse/family situation. Some just want "the best training possible" while others care a lot about what city they'll be living in for 3-4 years. How the CP portion of a combined program is handled can vary quite a bit. Some want an inside track on a particular fellowship also offered at that institution. Some want access to certain areas of research or certain high-profile faculty. The list goes on...

At this point, I recommend you take stock of some of the factors above (geography, your current fellowship/practice goals), review some program sites, and winnow down your application list so that you know which interview invites are definite "yes" and some that you can automatically decline.

 

[pathslides]

Agree with above. But wow 70 programs. That must have been crazy expensive. I thought only FMG peeps apply to that many or peeps with big red flags.

 

[tmandudeguy]

OP, don't take this first bit the wrong way, but it might be helpful to future applicants: the time to ask that question is before applying to 70 programs. It would have saved money in ERAS, plus I'm guessing you will be put in an awkward and stressful position of figuring which programs' interview invites to accept and whose to decline (and perhaps already are based on this post!). The fact is that AMGs with average board scores, that have some exposure to pathology (be it from prior work, research, or elective rotations), and no red flags on their application will get ample interview invites, so candidates really can afford to be picky with where they apply. 2 dozen programs is a reasonable benchmark. Over the past few years, I believe AMGs match with ~10 contiguous ranks in pathology.

If you look back on prior threads about good path programs, probably the only consistent factor you will see is volume. More volume = more experience for you --> greater confidence with the bread & butter and some first-hand exposure to zebras. Closely linked to this is the volume of cases you will have to gross, and whether there are PA's available to take care of the ditzels and biopsies while you are doing the complicated cancer cases.

The importance of other factors are going to vary based on what your needs and goals are. Some really care about the name of the institution. Some need to be in a specific geographic area because of spouse/family situation. Some just want "the best training possible" while others care a lot about what city they'll be living in for 3-4 years. How the CP portion of a combined program is handled can vary quite a bit. Some want an inside track on a particular fellowship also offered at that institution. Some want access to certain areas of research or certain high-profile faculty. The list goes on...

At this point, I recommend you take stock of some of the factors above (geography, your current fellowship/practice goals), review some program sites, and winnow down your application list so that you know which interview invites are definite "yes" and some that you can automatically decline.

I appreciate your candid answer! I was only a bit nervous since as a DO student I only took the COMLEX. Im not certain how competitive I really am for the upper tier programs without a STEP score. However, I will defintiely factor in all these tid bids youve mentioned. Thanks alot!

 

[SoDakMLS]

I appreciate your candid answer! I was only a bit nervous since as a DO student I only took the COMLEX. Im not certain how competitive I really am for the upper tier programs without a STEP score. However, I will defintiely factor in all these tid bids youve mentioned. Thanks alot!

Actually, I'm not sure how the ACGME/AOA merger affects applicants with regard to board scores. I take it there's no plan to merge COMLEX and STEP exams, meaning "allopathic" residencies should learn to interpret COMLEX scores, but there may be a lag.

Because path programs are hungry for AMGs, I really don't think there's a stigma against DO applicants anymore. That doesn't mean there aren't challenges going DO into path, but from what I've gleaned the main one seems to be a lack of good advising for osteopathic students interested in pathology.

 

[Adrian Cocot]

As someone said, you should have figured out priorities before shotgunning your applications. It sounds like you don't know what you want, and a good PD will pick up on that during an interview.

The main things to take into consideration are: 1) where you want to work in the future, and 2) how research-oriented you are. If you want to end up doing community practice in a specific geographic location, look there for residency, because it'll be easier for you to network with the local folks over the coming years. If you want to do academic pathology, then go to one of the name-brand places that churn out tons of USCAP posters every year, because that's where you will be doing your networking.

If you still don't have an idea, then focus on places that will give you decent exposure to both AP and CP topics, with good volume of bread and butter cases, involved attendings, and happy residents. Maybe a low cost of living so you can get started repaying your student loans.

 

[octopusprime]

Hi all, I just recently applied to over 70 programs but needed some help now in deciding what makes a good program and if any current Residents could give input on their programs and things they wish they knew as they were on the Interview trail.

FYI I am a DO from a big school and decent board scores.

all DO schools are "big", and none are more/less prestigious than the next. not saying that snarkily, just that no one cares what DO school you attended unless a PD has particular knowledge from previous residents that attended specific schools.

but yeah, echo the sentiment that good programs weed out applicants that apply to 70 programs.

 

[Thrombus]

I recommend you look for a career in another field. We have a massive oversupply of pathologists and do not need any more.

 

[ScubaV]

Volume is good, but you want to know how much of that volume you actually get to interact with. During interviews ask multiple residents in different ways about graduated responsibility. It's a buzzword, but it's very important and you need to dig past the superficial layer of "oh yeah, we have graduated responsibility blah blah blah". You want to avoid a situation where attendings are "too busy" to sign out with residents. Or where they'll let you watch while they sign out without being able to see the case yourself beforehand. Ask about preview time and whether you get to dictate reports or not. Read between the lines. This applies to any aspect: grossing, slides, AP, CP. Whatever you're interested in, obviously you care more about the answers for those.

 

[tmandudeguy]

Volume is good, but you want to know how much of that volume you actually get to interact with. During interviews ask multiple residents in different ways about graduated responsibility. It's a buzzword, but it's very important and you need to dig past the superficial layer of "oh yeah, we have graduated responsibility blah blah blah". You want to avoid a situation where attendings are "too busy" to sign out with residents. Or where they'll let you watch while they sign out without being able to see the case yourself beforehand. Ask about preview time and whether you get to dictate reports or not. Read between the lines. This applies to any aspect: grossing, slides, AP, CP. Whatever you're interested in, obviously you care more about the answers for those.

Great advice, thanks alot! Ill be sure to ask around during interviews. Do you know of any particular residencies that typically fall in line with this form of teaching. Outside of the obvious big institutes like Hopkins and MGH

 

[moneybreh]

Hi all, I just recently applied to over 70 programs but needed some help now in deciding what makes a good program and if any current Residents could give input on their programs and things they wish they knew as they were on the Interview trail.

FYI I am a DO from a big school and decent board scores.

Fairly happy residents and a program that won't scut you out with endless grossing that's not educational

 

[tmandudeguy]

Fairly happy residents and a program that won't scut you out with endless grossing that's not educational

I hope to make sure my colleagues are friendly during the interview! However, how can I find out which programs have endless grossing... or make sure I only have to perform the adequate amount to learn? I feel like I couldnt bring this up during interviews haha

 

[whyisitnotmarchyet]

I hope to make sure my colleagues are friendly during the interview! However, how can I find out which programs have endless grossing... or make sure I only have to perform the adequate amount to learn? I feel like I couldnt bring this up during interviews haha

Why not? I fully plan on asking questions like that, otherwise what's the point of going to the interview? I feel like you're interviewing them almost as much as they're interviewing you. I want to know I'll like a program before I rank them up on my list just like they're gonna want to like me if they want to rank me high on their list.

 

[jupiterianvibe]

Why not? I fully plan on asking questions like that, otherwise what's the point of going to the interview? I feel like you're interviewing them almost as much as they're interviewing you. I want to know I'll like a program before I rank them up on my list just like they're gonna want to like me if they want to rank me high on their list.

since there is such little interest from amgs, maybe this is ok now.

 

[whyisitnotmarchyet]

since there is such little interest from amgs, maybe this is ok now.

Asking relevant questions about a program has no relation to "little interest from AMGs". It's not outlandish to ask either faculty or residents how much time grossing takes out of your day.

 

[ScubaV]

Great advice, thanks alot! Ill be sure to ask around during interviews. Do you know of any particular residencies that typically fall in line with this form of teaching. Outside of the obvious big institutes like Hopkins and MGH

Sorry, I don't know too much about other residencies besides the one I went to.

Re: grossing, you don't want to be doing so much that it impacts your slide-time, but you also need to know what you're doing by the time you graduate. If you're going into private practice you may have to gross some (or all) of your own cases. If you're going into academia it's probably less important, but you still need to direct PA's or residents if and when they have questions. I've heard of programs where residents handpick 1-2 (or 0) cases per day and that's all they gross when they're on AP. Personally, I don't think that's enough volume or variety. Basically you want to have enough experience where you can get a specimen you've never had before, know a basic approach that will get all the key information and then tweak/confirm by consulting a book or someone else.

 

[tmandudeguy]

This is extremely helpful advice from everyone. Thanks a lotfor taking out the time to respond. I thing the big hump will just be the first interview where I can practice asking these questions and read between the lines.

Do any of you have a curriculim-type preference? It would he nice to have specialty based electives during AP. I learn better that way than simply having everything thrown at me, at once. I also notice a lot of 3 day schedules. Grossing/Biopsy/Frozens, followed by reading time.

 

[pathslides]

This is extremely helpful advice from everyone. Thanks a lotfor taking out the time to respond. I thing the big hump will just be the first interview where I can practice asking these questions and read between the lines.

Do any of you have a curriculim-type preference? It would he nice to have specialty based electives during AP. I learn better that way than simply having everything thrown at me, at once. I also notice a lot of 3 day schedules. Grossing/Biopsy/Frozens, followed by reading time.

Any program that makes you gross biopsies is a whack program. That is a weird 3 day schedule. A true 3 day schedule is
Something like gross/signout/frozen or something of the sort.

 

[SoDakMLS]

Do any of you have a curriculim-type preference? It would he nice to have specialty based electives during AP. I learn better that way than simply having everything thrown at me, at once. I also notice a lot of 3 day schedules. Grossing/Biopsy/Frozens, followed by reading time.

I agree that having sub-specialty sign out is easier for learning, particularly for junior residents. However, if you work in community private practice, you'll likely be dealing with a grab bag each day (with some areas like derm or bone marrows earmarked for the paths boarded in those areas). Honestly, the decision on whether or not to go sub-specialty is largely related to the volume, and the presence/absence of sub-specialty trained pathologists in the group.

Similarly, the decision to have a cycle also is likely related to volume and the size of the residency program. I have also noticed most programs do some sort of cycle--2 day or 3 day. What I don't like about that concept is attendings don't practice that way. My program doesn't cycle: I preview, sign out (routines & biopsies & immunos from yesterday), gross, and typically attend a didactic every day. Frozen section is a separate rotation, and you learn to write helpful intraoperative gross summaries for the resident who grosses the case. I think the advantage of this is you learn to be efficient with your time, pretty sure I see a higher volume of cases over the course of my training, and I think it averages out the types of cases and volume better over the course of a week. At my institution, Wednesdays are almost always light due to surgical didactics, and some types of surgeries are more common on certain days. The downside is I don't typically have a light afternoon spent reading (frankly, the way I learn best, it would not be time very well spent!).

 

[jupiterianvibe]

Asking relevant questions about a program has no relation to "little interest from AMGs". It's not outlandish to ask either faculty or residents how much time grossing takes out of your day.

Of course. Were path more competitive, programs could weed out so called "problem" applicants that ask too many questions. Derm is like this.

Bad programs have too many FMGs and make you gross biopsies.

 

[MSTP18]

Asking relevant questions about a program has no relation to "little interest from AMGs". It's not outlandish to ask either faculty or residents how much time grossing takes out of your day.

I think more what people mean is you can't ask it flat out like that. You can't ask "Will I be made to do endless grossing that isn't educational?" That just makes you sound entitled and/or lazy. "How does the program handle grossing responsibilities for different types of specimens?" will get you the same answer without the negativity.

 

[whyisitnotmarchyet]

I think more what people mean is you can't ask it flat out like that. You can't ask "Will I be made to do endless grossing that isn't educational?" That just makes you sound entitled and/or lazy. "How does the program handle grossing responsibilities for different types of specimens?" will get you the same answer without the negativity.

Yeah but that kind of goes without saying. Just don't sound like a dick in general. I would hope people aren't that direct or upfront without at least during interviewing.

 

[MSTP18]

Yeah but that kind of goes without saying. Just don't sound like a dick in general. I would hope people aren't that direct or upfront without at least during interviewing.

According to attendings in virtually every specialty at our hospital, every year there's always some who are.

 

[tmandudeguy]

I agree that having sub-specialty sign out is easier for learning, particularly for junior residents. However, if you work in community private practice, you'll likely be dealing with a grab bag each day (with some areas like derm or bone marrows earmarked for the paths boarded in those areas). Honestly, the decision on whether or not to go sub-specialty is largely related to the volume, and the presence/absence of sub-specialty trained pathologists in the group.

Similarly, the decision to have a cycle also is likely related to volume and the size of the residency program. I have also noticed most programs do some sort of cycle--2 day or 3 day. What I don't like about that concept is attendings don't practice that way. My program doesn't cycle: I preview, sign out (routines & biopsies & immunos from yesterday), gross, and typically attend a didactic every day. Frozen section is a separate rotation, and you learn to write helpful intraoperative gross summaries for the resident who grosses the case. I think the advantage of this is you learn to be efficient with your time, pretty sure I see a higher volume of cases over the course of my training, and I think it averages out the types of cases and volume better over the course of a week. At my institution, Wednesdays are almost always light due to surgical didactics, and some types of surgeries are more common on certain days. The downside is I don't typically have a light afternoon spent reading (frankly, the way I learn best, it would not be time very well spent!).

This is a

I agree that having sub-specialty sign out is easier for learning, particularly for junior residents. However, if you work in community private practice, you'll likely be dealing with a grab bag each day (with some areas like derm or bone marrows earmarked for the paths boarded in those areas). Honestly, the decision on whether or not to go sub-specialty is largely related to the volume, and the presence/absence of sub-specialty trained pathologists in the group.

Similarly, the decision to have a cycle also is likely related to volume and the size of the residency program. I have also noticed most programs do some sort of cycle--2 day or 3 day. What I don't like about that concept is attendings don't practice that way. My program doesn't cycle: I preview, sign out (routines & biopsies & immunos from yesterday), gross, and typically attend a didactic every day. Frozen section is a separate rotation, and you learn to write helpful intraoperative gross summaries for the resident who grosses the case. I think the advantage of this is you learn to be efficient with your time, pretty sure I see a higher volume of cases over the course of my training, and I think it averages out the types of cases and volume better over the course of a week. At my institution, Wednesdays are almost always light due to surgical didactics, and some types of surgeries are more common on certain days. The downside is I don't typically have a light afternoon spent reading (frankly, the way I learn best, it would not be time very well spent!).

This is great! Thanks for giving me insight to your curriculum. I feel that there are so many ways for a curriculum to be succesful.. Ill just have to keep an ear open to how the program is being sold and judge for myself whether I like it or not

 

[moneybreh]

Why not? I fully plan on asking questions like that, otherwise what's the point of going to the interview? I feel like you're interviewing them almost as much as they're interviewing you. I want to know I'll like a program before I rank them up on my list just like they're gonna want to like me if they want to rank me high on their list.

Agree spot on. Just be humble about how you ask these things. The way the numbers are set up in pathology some programs are actually going to want you to come to their program! You're interviewing them, absolutely! You'll be working with these people for the next 3-5+ years. You want to know what you're getting in to. For example, just ask the residents in an open ended (AND HUMBLE!) way like "How do you feel about the grossing?" If you're good at being intuitive about people you can usually tell when someone's just blowing smoke up your ass versus really being honest about the pros and cons. No program is really perfect but you just wanna have a complete picture for yourself when it's time to make the decision.

 

[moneybreh]

I think more what people mean is you can't ask it flat out like that. You can't ask "Will I be made to do endless grossing that isn't educational?" That just makes you sound entitled and/or lazy. "How does the program handle grossing responsibilities for different types of specimens?" will get you the same answer without the negativity.

Exactly... There's always the perfect way to phrase things. Applicants - by no means ask it how i phrased it! I was just being colloquial (sry!)

 

[StaphMember]

I've seen some programs offer 3 year options in Clinical Path without Anatomical or vice versa. Is there any benefit/detriment to choosing one of these paths as opposed to doing the traditional 4 year AP+CP route?

Perhaps with an interest in forensic pathology, AP would be better suited/more utilized?

 

[moneybreh]

I've seen some programs offer 3 year options in Clinical Path without Anatomical or vice versa. Is there any benefit/detriment to choosing one of these paths as opposed to doing the traditional 4 year AP+CP route?

Perhaps with an interest in forensic pathology, AP would be better suited/more utilized?

Most people you ask will say do AP/CP for sure in most circumstances. There have been lots of posts on this so I'd try to search for them. Some of the bigger places (a few I interviewed at, at least) had the opportunity to change to a 3 year track after the first year in the offhand chance you wanted to. I think this is a nice option to have, IMO.

 

[pre med 2014]

Outside of making friends and connections my question is what are things path residents should be doing from day 1 until completion of residency to be desirable job candidates in the future?

Unlike the process in med school where grades and boards scores distinguish competitiveness, I've never heard of "getting good scores" on specialty specific boards other than the need to pass them, and am also unaware of how residents are evaluated against each other other than being required to be deemed competent enough to progress to the next phase and eventually to practice unsupervised. With most residency programs requiring some kind of research to be completed as part of ACGME accreditations it seems like all residents end up being on a level playing field with nothing to distinguish them other than subjective communication skills, connections, etc...

 

[pre med 2014]

I've seen some programs offer 3 year options in Clinical Path without Anatomical or vice versa. Is there any benefit/detriment to choosing one of these paths as opposed to doing the traditional 4 year AP+CP route?

Perhaps with an interest in forensic pathology, AP would be better suited/more utilized?

I've had a similar question and the most common response I get to not doing CP is "if you don't know what you might do in the future/maybe you decide against FP in residency then not having CP will hurt you and you may not be able to take on higher level director positions as your career progresses" essentially I take this as CP will do nothing to help your career as an FP (though I am not quite sure why this is the case, as most of toxicology involves the use of clinical laboratory methods to determine the content of bodily fluids)

Another question that I have not had answered however is that I've heard some FPs do moonlighting on the side signing off surgical slides locum tenens since some weeks less people die (and there is no way to predict) so you might barely work on one given week, while on other weeks be swamped. Though I've never heard of path being particularly suited specialty for locum work (in fact any search through a physician locum listing NEVER lists a single pathology position, it's all FM/IM/Psych) but it would be great to be able to sign out some slides when the death scene is slow to keep busy.

 

[tiredguy]

Outside of making friends and connections my question is what are things path residents should be doing from day 1 until completion of residency to be desirable job candidates in the future?

Unlike the process in med school where grades and boards scores distinguish competitiveness, I've never heard of "getting good scores" on specialty specific boards other than the need to pass them, and am also unaware of how residents are evaluated against each other other than being required to be deemed competent enough to progress to the next phase and eventually to practice unsupervised. With most residency programs requiring some kind of research to be completed as part of ACGME accreditations it seems like all residents end up being on a level playing field with nothing to distinguish them other than subjective communication skills, connections, etc...

Some suggestions:
- maintaining old/finding new hobbies so you have something to talk about besides pathology during interviews
- housestaff council, CAP representative, being involved in state society, etc. (keep building your CV during residency, doesn't have to be research)

Connections are by far most important, with publications being important/critical if you might apply to academic jobs. But continuing to embrace those "extracurricular" activities in areas of interest can help you keep your sanity and be a more interesting/well-rounded person...

 

[deleted314957]

Who would have an idle FP just sign-out some of their surgicals!?
Not a lot of liver bx's from folks with CCL4 poisoning in my hospital
practice.

 

[pre med 2014]

Who would have an idle FP just sign-out some of their surgicals!?
Not a lot of liver bx's from folks with CCL4 poisoning in my hospital
practice.

Ok so I guess you can't. Keep in mind I'm just a med student with having done only 1 rotation on pathology so I am not going to be too well informed on these matters. Most other specialties in general have moonlighting opportunities and I am trying to understand what about pathology makes this unfeasible

 

[jupiterianvibe]

Ok so I guess you can't. Keep in mind I'm just a med student with having done only 1 rotation on pathology so I am not going to be too well informed on these matters. Most other specialties in general have moonlighting opportunities and I am trying to understand what about pathology makes this unfeasible

too many pathologists.
groups/labs overhire and underpay.
if theres a vacancy the remaining pathologists just pick up the slack.

 

[Daddydoc]

I know some forensic trained pathologists who primarily work as surgical pathologists and do some forensics work on the side.

 

[moneybreh]

Who would have an idle FP just sign-out some of their surgicals!?
Not a lot of liver bx's from folks with CCL4 poisoning in my hospital
practice.

I can't even imagine an FP not having cases, tbh. Or at least reports to work on.

 

[moneybreh]

too many pathologists.
groups/labs overhire and underpay.
if theres a vacancy the remaining pathologists just pick up the slack.

This right here is so on point!

 

[StatistPriceControlsFail]

Ask questions about the magnitude and extent of resident bypassing/coddling vs resident ownership of pathologist-level duties.

That is, determine how much of a faculty attitude there is of "you bother me, kid; go read" or "we're so afraid we won't fill that we'll do whatever the residents want so they 'like' us--including not giving them work to do" as opposed to "we're here to train our future colleagues."

Concrete questions:

1. "For each service (including the rotation and on call), what is the percentage of reports/calls/sign-able tasks that bypasses the resident and goes straight to the fellow/faculty?" The lower the number, the better the training. Pathology programs (and even services within the same department) vary widely. ACGME accreditation is a very low bar and does not ensure decent training.

2. "When residents take vacation, how are their rotation pathologist-level (not PA-level) duties covered?" Good = there is cross coverage from another resident because residents as a group own the work--just like a residency program in internal medicine or any other medical specialty. Bad = the fellow/faculty covers the absent resident because we don't expect pathology residents to have the same level of professionalism as every other medical specialty.

More details, search the pathinfo wiki for Graduated Responsibility.