Insider's Guide

Insider’s Guide: Top 10 Things to Look for When Selecting a Pathology Residency Training Program

The purpose of this document is to serve as a tool for medical students to make well-informed decisions when deciding what elements of a pathology training program are most important to their career objectives. The following questions will help determine what a pathology residency program does (and does not) offer and what you want and/or need to learn for your future practice. Most residency programs will provide adequate training in general pathology. How much you glean from that experience will be up to you; hence, it is vital to choose a program that most closely matches your interests, learning style, and career/life goals. This document will guide you in elucidating the differences between various programs and assist in your selection process. Keep in mind that there are no “wrong” answers.

1. General Questions:

Overall

• If you had to do it all over again, would you come to this program?
• What are the strengths and weaknesses of the program?
• How is the program implementing the new Milestones Assessments with regard to graduated responsibility?
• Are your rotations at one hospital or do you rotate through multiple sites?

Anatomic Pathology:

• Is there adequate volume and diversity of cases?
• Are there outside opportunities for experience in areas of special interest or program weakness?
• Are external rotations allowed and what are the stipulations?

Clinical Pathology:

• How much real responsibility do the residents have when on service? Is there “hands-on” experience?
• How much interaction do the residents have with clinicians and laboratory staff?
• How prevalent is new technology and how is it taught?

2. Fellowships and Jobs:

• Does the program offer fellowships? If so, ask about the quality and quantity.
• Does the department give preference to internal candidates for fellowships?
• What support is given to residents to find a fellowship or job?
• After completion of training, where do most residents end up practicing (e.g. community hospital, large academic centers, etc...)? Identify a program with goals similar to your own.
• How well do current residents believe they’ve been prepared? If possible, speak to a recent graduate.
• Does the program provide opportunities to learn about issues relevant to private practice (e.g. CPT codes, payer relationships, contract negotiations, labor law, anti-trust law, Stark Laws)?

3. Residency Program:

• Is the program open to new ideas?
• Does this program seem like a comfortable environment for you and how you learn best?
• Do you work better as a team player or as an individual? Do you like large or small settings?
• When was the last Accreditation Council for Graduate Medical Education review of the program, and what was the outcome?

4. Education:

• What is the primary method of education (didactic, slides, self-study)?
• How many didactic lectures are scheduled each week?
• Is there "protected time" for dedicated resident didactics (off service, off pager)?
• Are the attendings interested in teaching?
• Is there a structured study program or reading schedule?
• What is the level of resident-driven education sessions?

5. Surgical Pathology:

Grossing

• What are the specifics of the grossing schedule?
• How many specimens do residents gross per day? Do residents gross biopsies?
• Are there pathologist assistants? If so, what are their duties?

Preview Time and Sign-Out

• Does the resident have ample time to preview cases prior to sign-out?
• Is sign-out generalized or structured according to subspecialty?
• How many people attend sign-out? Is it one-on-one or are multiple residents/fellows present?
• Are residents expected to write up a complete report prior to sign-out? Are they allowed to order IHC stains or recuts prior to sign-out?
• Is sign-out similar at all hospitals or does it vary from site to site?
• Do residents preview the same day as sign out – or the day before?
• Who do the residents generally sign out with? (Faculty? Fellows?)

Frozen Sections

• Does the specimen arrive via a “drive through window” or does the resident go to the operating room and interact with the surgeon?
• Does the program allow for after-hours preliminary frozen section diagnoses that are later confirmed with an attending in the morning?
• Are residents encouraged to view the slides first and propose an interpretation to the attending?

6. Board Examination:

• Ask for the five-year average pass rate for both AP and CP.
• Are residents able to complete 50 autopsy cases comfortably as required to sit for the Pathology Boards?
• Will residents be required to “double up” to meet the minimum number?
• If fellowships are offered, what is the pass rate for pathology subspecialty boards?

7. Residents:

• Do the residents seem happy? Do they get along with each other? Are they motivated?
• In the last 10 years, have any residents left before completing the program, and what were the reasons?

8. Call and Weekend Schedule:

• How often do you take call?
• Does the program combine AP and CP call?
• Are there autopsies on weekends?

9. Faculty:

• Ask about attending turnover. Is the department growing, shrinking, or static?
• How many attendings are established and experienced? What is the ratio of junior to senior faculty?

10. Miscellaneous:

• Does the program support CAP/ASCP/USCAP participation (e.g. Residents Forum, committees, councils)?
• How is it determined which residents can attend which meetings? How many meetings will the department fund?
• Is there a book fund? Be sure to ask about the size (i.e. dollar amount) and what items you can purchase (e.g. books, membership dues, etc...).
• Is research required, encouraged, or not available?
• Do you have a dedicated molecular rotation? What exposure do residents have to molecular diagnostics?
• Do residents get to perform bone marrows and fine needle aspirations? If so, how many?
• How does the program feel about moonlighting? What are the rules for moonlighting?

Prepared by the 2014-15 CAP Residents Forum Executive Committee