what qualifies as scutwork?

[Dr. McDreamy]

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MS4 here thinking about path. I'm on my surg path rotation now, and I'm getting the feeling that my med school's path program is not very strong. The residents i'm working with seem to spend most of their time grossing. And they gross everything. I can understand doing the complicated cases, but it just doesn't seem like there is all that much educational value in straining itty bitty peices of tissue out of formalin or cutting thousands of polyps in half. I'm pretty sure you could hire a high school graduate to do this. Or am I being naive?

 

[sohsie]

MS4 here thinking about path. I'm on my surg path rotation now, and I'm getting the feeling that my med school's path program is not very strong. The residents i'm working with seem to spend most of their time grossing. And they gross everything. I can understand doing the complicated cases, but it just doesn't seem like there is all that much educational value in straining itty bitty peices of tissue out of formalin or cutting thousands of polyps in half. I'm pretty sure you could hire a high school graduate to do this. Or am I being naive?

No, I don't think you are being naive. There is nothing to be gained by grossing "No brainpower, just transfer from container to cassette" cases more than maybe three days total (and if you are reasonably intelligent, you can cut that total down to zero days).

However, in the grand scheme of things, it could be worse. You could be mopping the floor of the autopsy suite and cleaning out the drains every day 🙂

 

[green mantis]

MS4 here thinking about path. I'm on my surg path rotation now, and I'm getting the feeling that my med school's path program is not very strong. The residents i'm working with seem to spend most of their time grossing. And they gross everything. I can understand doing the complicated cases, but it just doesn't seem like there is all that much educational value in straining itty bitty peices of tissue out of formalin or cutting thousands of polyps in half. I'm pretty sure you could hire a high school graduate to do this. Or am I being naive?

At my residency, we grossed everything. However, we also got to sign everything out.

I think it's unreasonable to expect not to gross or gross minimally during a residency. It's much more of a problem if you're grossing, & you don't get to see those cases.

If you were a medical student at my residency, & you chose to do a rotation in surgical pathology, you'd probably be stuck w/ a junior resident (1st or 2nd). People in those years tend to be the grossing residents. If you chose to do a rotation in blood bank, it'd be completely different.

There's some benefit to grossing cases that you sign out. You're the one who's responsible for it. It's also less problematic when you encounter problems. If you discover 4 PNB's in a jar that's supposed to contain 5, you can try to contact the urologist then instead of trying to figure out what happened when you get handed the case after a PA grossed it.

In conclusion, consider multiple factors when choosing a residency. Don't just base it on the amount of grossing.


----- Antony

 

[Nilf]

I spend about 2.5 days per week grossing in my program -- which doesn't seem too onerous. I would be curious to hear from others. Perhaps a grossing survey would be useful...

That sounds about right.. . However, as somebody insightfully stated above... It's not how much you gross, but it's WHAT you gross.

IMO if your program makes you gross little biopsies, or if you do not see the cases that you have grossed, this constitutes MAJOR RED FLAGS.

 

[yaah]

At many programs, particularly larger ones, residents do not gross small biopsies at all. They may have an orientation period where they learn to do it, but not for that long. Smaller programs, which often have fewer PAs, often have residents doing some of this. It's definitely something to consider when you look at programs - as the residents how often they spend grossing and what they actually gross.

It is definitely also important to get sufficient experience in grossing of large specimens, both routine (colon cancer, prostate, lung lobe) and complicated (large head and neck, whipple, sarcoma). Some programs have the problem of residents not having enough grossing responsibilities to become competent.

 

[sohsie]

Just to clarify ... you do need to gross, a lot, as part of your training. However, I don't consider transfering tissue from container to cassette grossing in this sense (although it is technically grossing). I consider that scut. Grossing to me is dissecting a specimen that requires at least one brain cell to fire, even if its just "where is the margin" or "should I ink this" or "in what direction should I breadloaf this"

 

[Gyric]

Sounds like you are at a small path department; definitely look around. Volume and diversity are important and your competence starting out in practice will vary depending on the quality/intensity of your training.

At large high volume programs you will not gross biopsies and should, most of the time, have help grossing trivial cases. This was the case at my program and we certainly grossed all complicated specimens. Grossing is useful at first, but honestly it is not that hard (even the most complicated specimen becomes routine after completing a few cases). Once you gain competence the challenge, and fun imo, of grossing is seeing how quickly and efficiently you can process a specimen (this also allows you to preview much faster).

Grossing, unlike microscopy, is not a skill that requires continued exercise to stay competent; I think that the ideal residency program would transition more experienced residents out of grossing and into review of consult material, hot seat, etc. Maybe some do, but I think the cheap labor is too tempting and so many larger programs do not reduce/eliminate grossing responsibility till fellowship.

 

[levels x3]

Grossing small biopsies is scut, I'll grant you that. Larger specimen grossing is definitely not scut however. Try to pay attention to just how much actually depends on grossing. Screw up a margin, miss a small focus of tumor in a mastectomy...sure these things can all be fixed, but these errors make life much more difficult.

That's not my primary point here though. You don't know scut until you've started doing CP consults.

Pathology resident to clueless medicine intern: "You ordered test X, but it isn't really indicated. You probably really wanted test Y"

Clueless intern to Path. resident: "My attending told me to order test X"

Path. resident to clueless intern: "...sigh..............."

 

[mlw03]

i'm varying from 1-3 hours per day in the gross room. only time i'm grossing a biopsy is when it's part of a larger case (ie, TAH-BSO for ovarian cancer along with numerous small containers of peritoneal biopsies).

this is stuff to ask about on the interview trail, and then you need to decide on what your priorities are. find out how much, and what type of specimens, the residents gross on a daily/weekly basis.

 

[DarksideAllstar]

Grossing small biopsies is scut, I'll grant you that. Larger specimen grossing is definitely not scut however. Try to pay attention to just how much actually depends on grossing. Screw up a margin, miss a small focus of tumor in a mastectomy...sure these things can all be fixed, but these errors make life much more difficult.

That's not my primary point here though. You don't know scut until you've started doing CP consults.

Pathology resident to clueless medicine intern: "You ordered test X, but it isn't really indicated. You probably really wanted test Y"

Clueless intern to Path. resident: "My attending told me to order test X"

Path. resident to clueless intern: "...sigh..............."

Sounds like 75% of my CP experience during my first year. The "unofficial" consult service (read: calling an intern about a send-out test that they ordered) was responsible for my painful demise over the last 12 months-- only bone marrow and flow cytometry rotations kept me from killing myself.

I agree with other posters in that grossing biopsies should be considered scut. Scut can also vary by site (ie. your program rotates you through 3 hospitals: VA, county, quartenary referral center). At the main hospital scut could be non-existent (partly because you are so busy with other stuff), the PAs do more, the support staff is better. As you progress down the hierarchy of hospitals, you'll find that the scut tends to increase (ie grossing POCs at the county; grossing biopsies and perpetually looking for slides, paperwork, etc at the VA).

If you interview at programs that have multiple sites, make sure you inquire about what you are responsible for at the hospitals that are not at the "main" campus --for instance: call schedule, transcription, PA support, what you are responsible for grossing (ie biopsies and bigs, or bigs only), etc. Its the more annoying parts of residency (looking for paperwork or trying to find missing slides-- not the grossing of my 3rd TAH-BSO of the day) that really fries my ass and makes me want to bring in a weapon: