Pre-July 1st Reflections

So, July 1st is fast approaching. It is that date each year when new residents officially start their employment. And for us senior residents, even though it may not be as momentous as our first, it still is the start of our next year of rotations and a great time for reflection. As I sit here amidst an apartment full of unpacked and half-packed boxes as I prepare to move cross-country to start my new residency, like many of the PGY-1’s, I’m reflecting on what I’ve learned, what I should’ve learned but haven’t yet, and the journey that is to come at my new residency.

First, I’d like to congratulate all the graduating seniors and fellows! You finally are on to the next phase, whether that means fellowship or employment. Most of you have put the dreaded beast of boards behind you and have reached a milestone that says you are assumed to be ready for practice with less supervision. Gone is the safety net of having your attending verify the cases but you are not completely on your own because you will still have more veteran physicians who can help you. I know that there is a lot of negativity, especially on the internet, about the current job market and decreasing reimbursement codes, but persevere. There are pathologists and advocacy organizations lobbying for our profession. It’s easy to become disillusioned but uncertainty about our future can also be looked at in a ‘glass half-full’ view – we can shape how that future evolves because nothing is set in stone as of yet. In my grassroots organizing experiences, I have seen the underdog aka ‘the little guy’ win but only when they believe that they can bring about change, mobilize and organize together with like-minded individuals, and fight for what they believe is right.

Next, I’d also like to congratulate the incoming PGY-1 again for surviving that beast we call med school. You should be very proud. I know you are probably moving cross-country now and excited about what is to come. There’s a lot to learn but it’s a great time for you. My guess is that most of you will start with an introductory surgical rotation, although I do have some friends who are starting with a CP rotation. Either way, you have probably started your orientation and/or ‘boot camp’ so you can get acquainted with your hospital’s medical record system, dictation system, and pathology basics. Although I know that some of you won’t get a boot camp and will start on rotation immediately after orientation. Don’t despair…every first year in your program with you is in the same boat. And even if some people start off ahead of others on the learning curve, what I’ve seen is that by the end of first year, most people are caught up and at the same place. The thing that may set others apart is more the effort that they put in once residency starts.

So, what is essential during residency, not just for newbies but for all of us? Here’s some surgpath advice that can also apply to other rotations:

  1. Comfortable footwear: I can’t stress this enough, especially on rotations where you may standing for all or most of the day. I personally like Merell’s but I know that Dansko clogs are also popular – these may be expensive and sometimes not the prettiest but oh so worth every penny when your feet are not killing you at the end of the day.
  2. Teamwork: Working long hours with high expectations where your work will impact a patient’s health can be daunting. This element really can make things easier or much harder for you. So, be observant of your peers when they are having a hard time, don’t just point out that they “are getting slammed,” offer to help (eg – gross, take pictures for a conference they need to give soon but are stuck grossing, etc) and hopefully, they will return the favor. Sharing resources with each other is also helpful. Think of the Golden Rule.
  3. Responsibility: Pathology is one of those specialties where our hours can be reasonable and we do not have overnight call or night float. It’s also one where residents can feel as if they can leave the hospital early (especially on CP rotations) and no one will notice. But your attending will notice, especially if you are on call (eg – autopsy) and you’re not there when a task does come up. Make sure that you really take ownership of your assigned tasks. People want to know that you are reliable and keep your word (implied and explicit). And be honest…people don’t like liars who say they completed a task when they haven’t.
  4. 100% commitment: There will always be a task/rotation that we are not thrilled about (eg – performing/writing up autopsies) but remember that for each task, there is a patient attached to it. Even with autopsy, there is the patient’s family. There is always someone waiting for your diagnosis so take that responsibility seriously even though we may not feel the same urgency as those in fields who take care of the patient in person. Don’t cut corners (we all know what this means and have seen residents who do this even while we were in med school). Do things right the first time and you won’t have to repeat and waste resources.
  5. Make a plan and set aside dedicated study time: It helps if you have a (mental) checklist (eg – read one chapter or half of one in Robbins/your book of choice, work on writing that publication, etc) of tasks and a consistent time that you devote to it each week (eg – every Sunday night), otherwise, it’s very easy to get distracted…and behind…and it will just get worse as more time passes until you re-commit to doing this. But if at first you don’t succeed, you can always try again until you perfect your discipline and time management. A few trusted sources that fit your learning style is better than having too many sources. The internet is great for this (but also make sure that the info you get is correct and from a trusted source).
  6. Never stop reading: In addition to studying, you need to keep up on what’s current, whether via hard copy or the internet. This will help you in your daily work and also help develop yourself as a lifelong learner.
  7. Find a good mentor and learn from them: Learn from their experience and knowledge but also develop rapport with them as these are the people who will ‘go to bat’ for you and give you recs when you apply for fellowship or a job. Be a role model and give them good things to say about you through the quality of your work and dedication. And also don’t be afraid to ask for advice or help but be humble.
  8. Get involved: Whether it’s research, the GME council, a pathology advocacy organization, or something else, participate. It will enrich your experience and also help prepare you for when you are in these types of leadership roles as an attending.
  9. Learn to tie in the clinical with the practice of pathology: Make sure you know the clinical history, radiology, and previous pathology on your patient and tie them together. Get the previous slides or lab results for your patient (eg – biopsies) and compare the diagnosis with what you are seeing now. It usually matches up but occasionally you may get a surprise. Understand what’s needed for staging and the implications (eg – surgery, radiation, amputation, etc) of our diagnoses for our patients.
  10. Double check your work and QA yourself: One of my attendings has this method and I find it useful for surgpath – “skim” your slides to get a “feel”, then look at them again more closely and fill out your diagnosis, and finally, QA yourself after you’ve written in the diagnosis to confirm and to check for anything you’ve missed.
  11. Fix well and cut good sections: I have attendings who for cancer specimens will have you prep the specimen but fix overnight (and others who say cut fresh). Believe me, the specimen cuts better if fixed well and if you cut with skill (and a fresh sharp scalpel blade) but not force, especially with friable lesions. If you cut good sections, then you get good slides.

Above all, put the patient first and stay positive!

 

Chung

Betty Chung, DO, MPH, MA is a second year resident physician at the University of Illinois Hospital and Health Sciences System in Chicago, IL.

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