What's up with Cleveland?

[PathSoccerDude]

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There haven't been too many recent posts about the Cleveland Clinic or its current program...any current applicantsor residents want to chime in with their two cents on the strength or weaknesses of the path program...Thanks guys...

 

[CameronFrye]

There haven't been too many recent posts about the Cleveland Clinic or its current program...any current applicantsor residents want to chime in with their two cents on the strength or weaknesses of the path program...Thanks guys...

It's a strong program that is definitely worth a look. Their surg path system is somewhat unique, so that's something to take a look at if you interview.

 

[big_worm]

Strengths
-Amazing specimen volume/variety (around 90K) with enough PA help to ensure a reasonably decent lifestyle.
-great faculty; most all are enthusiastic and eager to teach
-Subspecialty signout
-Good fellowship options (yet not too many fellows-this isn't a place where residents sign out with fellows). At the moment there are 2 GI, 2 derm, 2 heme, 1 cyto, with bone/ST, gen surg path, and GU in the works.
- CP: tons of experience in heme/lymphoma- 5 months heme, 3 months lymphoma (busy services). as far as the rest of CP, probably like any other place.
-Atmosphere: laid back. not an east coast vibe here.

Weaknesses
-Cleveland. Nuff said
-Preview time. Here, we are on a 2 day cycle- preview time is from when you finish cutting until signout the next morning. There isn't much time to ruminate over your cases, especially during first year when you're slow at cutting. It isn't much of a factor later- with the 3 pm specimen cutoff, it's usually pretty easy to wrap up cutting by 4 pm.

In the past, some have complained about derm exposure, as dermpath was run by the clinical folks. Dermpath is now co-directed by a derm and a pathologist, so now in addition to the derm-operated conferences we also have conferences specifically for the path people. We now have required derm time (where previously, you had to burn an elective on it).

All in all, I've been happy with my training here. I'm pretty sure we're as well trained as anybody in diagnostics. Unfortunately, "top programs" in path are determined by research reputation or are largely historic. Without naming names, this isn't a place where a minority of graduates actually go on to practice diagnostic path.

 

[yaah]

big_worm - thanks for your response, can you respond to a criticism I have heard of Cleveland Clinic? That some residents who come out of the program feel they do not get as much responsibility for overall signout, case handling, etc as they would at other programs. The past reputation of CC was that of an "assembly line" type of program where the residents had very little responsibility apart from being part of a system, but to my knowledge that isn't really true anymore. Yet in talking with a recent past resident there, there was still a bit of a complaint that the residents were more of a peripheral component and not as essential to the services as at other large comparable institutions. Grossing was not that heavy, which is not always a good thing for learning.

Can you clarify the preview time issue? Do cases come out in the afternoon and you preview them for AM signout? Or do a lot come out early morning and you sign them out the same day?

Personally, I have met some of the faculty there and have always been impressed with how they seem to value teaching and resident education, so I always felt these criticisms may have been a little off base, but wasn't sure.

 

[big_worm]

yaah, great questions.
I think there has been a little shift in expectations for the residents. When I started, some of the 4th/5th year residents seemed amazed that 1st years had to preview. I also didn't get the impression that residents did a lot of dictation back then. I can assure you that residents are handling cases now- previewing from day one, dictating when staff feel you are ready, showing to other staff if necessary. As far as preordering immunos, it's pretty staff-dependent.

As far as residents being essential to services- I'm not sure how to respond to that. I think that having PAs that can knock out big specimens is a good thing. While we gross less often than other places, I'm sure all of us feel confident with grossing. For one, on gross days we're at the bench all day- not skipping out for signout or frozens. I think that volume/complexity-wise, we make up for our relatively few gross days. It's not unheard of to have 3-5 whipples, a couple total mesorectal excisions for rectal ca in addition to the parade of UC/Crohn's resections in a GI gross day or 3 bladder/uterus combos, couple adrenal tumors, the typical 5 rcc's and 5-7 prostates on a GU day. point is, it's nice to have someone that can take ditzels and mindless stuff like IBD resections/prostates so I can go read or have scope time.

About preview time- it's pretty variable. I would say that half the cases are available in the evening, with some coming out early morning and the remainder throughout the day. Between signouts ending early and lunch, you can see pretty much everything that comes out (though previewing over lunch is optional). We are not lacking in material to preview- hate to use the volume thing again, but I've often seen/dictated~100 GI biopsies by noon. It would suck if I was expected to bust that out the night before because they were all out.

overall, this has been a place where one COULD slack and still get by, becoming a decent pathologist in the process. I really think things are changing- pretty motivated residents and higher expectations from staff.

 

[raspberry009]

I really enjoyed my interview here. I was blown away by the 100,000+ surgical specimen load (not to mention the built in study days).

The day I was at the CC I missed out on meeting with the residents over lunch and the chairman himself gave me a brief tour of the facilities (very generous). The cubicles gave me a chuckle (love the drapes); it's awesome to have your own workspace. But at the end of my day I was able to sit down at talk to some upper level residents. They have a pretty sweet schedule. All the faculty I talked with were very motivated about teaching. The residents seemed happy. I'm interested in GI - very very strong here from what I gathered. It was also nice to have everything centrally located and not spread everywhere over campus.

 

[superkeith]

I really enjoyed my interview here. I was blown away by the 100,000+ surgical specimen load (not to mention the built in study days).

The day I was at the CC I missed out on meeting with the residents over lunch and the chairman himself gave me a brief tour of the facilities (very generous). The cubicles gave me a chuckle (love the drapes); it's awesome to have your own workspace. But at the end of my day I was able to sit down at talk to some upper level residents. They have a pretty sweet schedule. All the faculty I talked with were very motivated about teaching. The residents seemed happy. I'm interested in GI - very very strong here from what I gathered. It was also nice to have everything centrally located and not spread everywhere over campus.

i feel bad that you missed out on the resident lunch, though for someone interested in gi path, a personal tour from dr. goldblum must have been a treat. worm brought up atmosphere as a strength earlier and noted the dedication to teaching exhibited by staff. i think another large part of the atmosphere here is the fact that residents get along very well with one another. the concept of "team" wthin each class is very strong and extends to social functions outside of work. also, the senior residents continuously go out of their way to help out the juniors, even beyond the (sweet) 2-month training period.

on multiple occassions, seniors such as worm have allowed and encouraged juniors such as myself to sit in while they previewed. this may not seem like a big deal, but i found it absolutely invaluable. in addition to reviewing the salient histology and pathology, these sessions provide a framework with which to appraoch cases (gi biopsies, for example) and act as high-yield primers. this is in addition to all the systems-based learning that occurs. is this just basic information that i could learn through reading? i'd answer definitely not as well, and certainly not as quickly. as senior residents everywhere can recognize, this can add several hours to one's preview time, which is especially significant at an institution with a 2-day sign-out system. the seniors here do not have to do this, but they do, and that is what makes it special.