Resident Concerns, Part 3: Networking Opportunities

Just as an addendum to my previous post about fellowship applications, my suggestion would be to have everything ready to send by July 1st or earlier, if possible. I’ve found that some programs started accepting applications on July 1st. And this includes asking for letters of recommendation as early as possible so that they are ready by then as well or you may find yourself, like I have, in the bottleneck with programs emailing weekly that all they need are your letters because they have started reviewing and/or interviewing already and won’t look at your materials until its complete with letters of rec. I submitted most of my applications (minus letters of rec which still have to come) by September 9 and one of the programs had already filled for both hematopathology and molecular pathology. I would guess with an internal candidate or an early interview candidate because their website didn’t list yet that the position was filled. Some of the programs for molecular genetic pathology, in particular, have early deadlines of September 1st, so make sure you know the deadlines and have your materials ready to go way in advance.

Now on to this week’s topic: networking. Throughout our journey to and during medical school, it was often hard work and studying that got us to where we needed to be. Yes, there were the “legacy” students who got into colleges and medical school based on who their parents or families were but those are not the students that I speak of. I speak of those like myself who form the majority and who didn’t have those types of connections. But in the workplace, if we take the group of “legacies” out, we still have to deal with the power of connections but at a more palpable and potent level than previously encountered. On multiple workplace surveys, the #1 manner through which people (and pathology trainees) obtained jobs is through “word of mouth” and referrals. Having someone make a call on your behalf can be a powerful factor in helping you to obtain that fellowship or job.

With respect to fellowships or jobs, the market is tighter. There are far fewer positions available. So how do you set yourself apart from the crowd of others with similar or even, slightly better, credentials than yourself? Connections can greatly help so start early. Local and national conferences are great places to meet other residents but more importantly, other pathologists in your intended field. Make yourself business cards and give them out like there’s no tomorrow. If you impress someone, they most likely will keep your business card and remember to get in contact with you when a position opens up that you’re a great fit for. At annual meetings, there often are networking receptions for residents to meet practicing pathologists. Also at these venues, job seekers get the word out that they are available and have access to job boards. This also holds true for attending your state society or other local subspecialty meetings.

Another way to meet and make connections is through getting involved with organized medicine and advocacy organizations. ASCP, CAP, USCAP, and subspecialty organizations (like AMP for molecular pathology) often have junior positions on their committees and councils for a resident. Find one in an area of pathology that you have an interest in and apply. Many also have travel awards to their annual meetings or grants for research also set aside for residents. I’ve found that many of the people who volunteer in national leadership positions in these organizations frequently overlap so once you start meeting people, you will see them at other meetings, and it makes it easier to meet more people. So if you are able to obtain a junior member/resident position, work hard. People recognize and value hard work and enthusiasm and it’s a way to make a great impression doing work that you are passionate about. And if you apply and are not chosen, then don’t give up. These positions have many more people applying for them than positions that are available. But persistence is a virtue and when TPTB (“the powers that be”) see your name on a subsequent application, they might be impressed that you applied again.

Some of these positions are advertised and others are through referrals. As a resident, I never found it that easy to find when many of these positions have an opening so I’ll try my best to advertise through this blog when those times arise. But you can get involved early and at a more junior level first by being a representative for your program to ASCP (contact angela.papaleo@ascp.org) or a delegate to the CAP Residents Forum (contact Jan Glas at jglas@cap.org). I know that at some programs, this is through election, but even if you are not elected, you can still attend the CAP Residents Forum (you just won’t be your program’s voting delegate) and still ask to get the ASCP e-newsletter (where they advertise when new resident volunteer positions are open).

If you can decide early what you want to do when you are a pathologist (subspecialty-wise, etc), then the easier it will be for you to get involved with your specific pathology community in leadership/volunteer positions early. You can even participate in other activities such as blogging, creating podcasts, and writing for these organizations. You’ll be surprised that you meet people through these venues as well. You can write about a pathology topic of interest for CAP NewsPath which is then converted into a podcast. I blog for ASCP’s Lab Medicine Lablogatory as you all know, but we are always looking for resident bloggers. If you can’t commit to writing weekly, then contact me (chungbm@rwjms.rutgers.edu) and I’ll happily have you do a guest blog here one week! For those of you attending the upcoming ASCP Annual Meeting in Tampa, I’ll be looking for bloggers to write on their experiences at the meeting so just shoot me an email or find me at the meeting (I’ll be one of the poster judges). Check out the websites of organizations you are interested in to see how you can get involved – it does take some effort on your part but you won’t be disappointed! For positions that work through referrals (where I didn’t have one), I was still able to apply because I identified the person in charge (internet searches are your friend), contacted them, and asked. So, it never hurts to be proactive.

And in my attempt to keep you all informed of opportunities, for those of you who want to do an external/away elective or international/global elective and need financial support, the application period is now open for round 2 of ASCP’s subspecialty grants. You can find more info at the ASCP website but you need to apply by Jan 16th!

 

Chung

-Betty Chung, DO, MPH, MA is a third year resident physician at Rutgers – Robert Wood Johnson University Hospital in New Brunswick, NJ.

Steady the Ship

The relationships you have as a supervisor with the people you lead (notice I did not say “manage”) are important when it comes to day to day operations. They become especially important is when you have to guide them through change or conflict. I won’t even comment on the appropriateness of intimate relationships except to say if you engage in one then you are taking your career into your own hands and don’t plan on it lasting long. Beyond that, the lines are blurred and you may be engaging in an inappropriate relationship that won’t get you in trouble with management but will with the people you lead.

I am 31 years old and the majority of the people I lead are double my age so I have a unique (but becoming a bit more common) relationship with them. With many reaching retirement age in the near future the younger generation is taking the responsibility of leading and it creates unique issues. Do I sometimes feel awkward discussing a behavioral incident with someone who could be my grandmother? Absolutely, but my approach is what makes it a successful or unsuccessful discussion. I have learned that a “by the book” or “letter of the law” approach is not always successful. This is where emotional intelligence comes into play. As a leader you need to identify the needs of the people you lead, both as a group and individuals. It is very important to distinguish between the two because the needs of the group may be vastly different than as individuals. Once you do this it is easier to lead them because you know what they need to be successful and what you need to avoid, staving off failures. If you can successfully identify the needs of the group and individuals you can have relationships that grow and the people you lead will have confidence in you to lead them.

One issue that gets supervisor/managers into trouble is favoritism. It doesn’t even have to be true; perception in any workplace is often seen as fact. If one employee thinks that you favor another employee over them you will instantly lose their respect (not to mention a certain amount of work ethic). This can be especially difficult if you have worked with a group for an amount of time as coworkers and then you are promoted to supervisor. You will already have developed relationships and more than likely friendships with them so some of the perceptions may start with the start of your new role. If this is the case it may be a good idea to have a discussion with the group once the new role is assumed.

I have had the experience of taking over for someone that had their responsibilities taken away so I had some hard feelings to deal with when I took over. It was very difficult but I learned that if I took it day by day and worked with each individual they eventually came around and understood I was only there to help. There are all different kinds of situations that pop up as we lead our teams. We fight fires and make sure we don’t take on too much water that we cannot float. If you do not address these issues when they present themselves you may wait too long and not be able to steady the ship.

 

Herasuta

Matthew Herasuta, MBA, MLS(ASCP)CM is a medical laboratory scientist who works as a generalist and serves as the Blood Bank and General Supervisor for the regional Euclid Hospital in Cleveland, OH.

 

New National Strategy for Antibiotic Resistance

Last week, the White House published a National Strategy for Combating Antibiotic Resistant Bacteria and President Obama signed an executive order that orders the implementation of the strategy. The report covers a lot of information, but two goals stuck out as being especially pertinent for laboratory professionals.

By 2020:

  • 95 percent of hospitals report data on their antibiotic use to the CDC
  • create regional laboratory networks for testing resistant bacteria and make the data publicly, electronically, available.

Both of these goals require the cooperation of clinical laboratories including (but certainly not limited to)  infrastructure upgrades, data collection, and procedural changes. In an era when laboratories have less resources than ever before, will this stretch microbiology departments too far? Based on available resources, are these goals attainable?

If you’d like a comprehensive overview of the government’s strategy, check out Maryn McKenna’s excellent post on Wired’s Superbug blog.

Swails

Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.

Resident Concerns, Part 2: Fellowship Applications

So, continuing on with resident concerns I heard about during conversations at the 2014 CAP Residents Forum and Annual Meeting, let’s move on to the fellowship application process.

One nice offering by the Residents Forum for the past two years at the Annual Meeting is a mock fellowship interview. The process was simple in that I only needed to fill out a brief application prior to the meeting with my fellowship interests and I was matched up with a member of the CAP Board of Governors or another CAP national leader who either practiced or had experience in my area of interest (or as close to it as CAP could find out of the available pool of mock interviewers). Once matched, I emailed my personal statement and CV to my mock interviewer (who turned out to be someone I already knew from my work on a CAP Council). I also participated in the mock interviews last year with a pathologist who I didn’t know beforehand. Both times, I received valuable feedback on my submitted materials and advice for the actual interview as well as an open invitation to contact them in the future if I had questions or needed more advice. I highly recommend these mock interviews if you are attending a future CAP Annual Meeting.

Obtaining fellowships can be even more competitive than getting into a residency. There are far fewer spots in that some may only offer one position per year in that subspecialty, programs may have already filled their positions with internal candidates, and the majority of residents (96%) apply for at least one fellowship (85% of third and fourth year residents according to the 2014 ASCP Fellowship and Job Market Survey had already accepted fellowship positions by the time of this survey during the RISE).

The trend these days is to complete at least one fellowship (56% answered yes to this question on the ASCP survey) and many often complete two (39% on the ASCP survey indicated that they would pursue two fellowships). I personally also know individuals who completed three although they are in the minority.

And it’s currently fellowship application season. Even though the suggested deadline is December 1st, we all know that most programs start accepting applications in September. I called some programs in August with questions and they had received applications already! Suffice it to say, from totally anecdotal evidence that I’ve heard, it seems that there are two periods for interviews: Oct/Nov for those accepting applications early and Jan/Feb for those who wait until December 1st to look at their applications. Even from friends in other specialties also going through this process, it seems that the process actually begins the year prior to application.

For those who want to be ahead of the game, at least start getting your CV and personal statements together. Since I’ve been updating my CV whenever something new came up since college, the CV was no problem. But I can tell you that I wished that I had started on the personal statement as a second year. I thought that I was being a semi-early bird to write my initial draft in August. But it took about a month of back-and-forth feedback from people who I asked to read it for me to whittle it down to less than one page. Turns out that most programs want something short and sweet (one page or <500 words). One program even wanted <250 words so I gave them a super abridged version of what I submitted to other programs. So, second years, start now so that you can submit everything in complete form on September 1st. The other part of applications are letters of recommendation. I’ve only heard residents from one program tell me that their letter writers will give them a letter within a day after being asked. If you’re like me, you’ll probably need to ask your letter writers way in advance and sometimes, give quiet reminders. So start early if you want letters ready by the time you submit.

The controversial issue that I always hear whispers about at the three Residents Forums I have attended is that of a standardized fellowship match like we had when we applied for residency. There are pros and cons for and against a standardized match. I was speaking with someone from the Association of Pathology Chairs (APC) and he supported a match. I would agree that it would deter residents from being subjected to undue pressure from programs to decide quickly once an offer is made (most 4th year residents who I spoke with said that they had up to 1 week at most to decide). It would also eliminate the situation that many of them found themselves in where they had accepted a position but later interviewing programs encouraged them to still interview and disregard their previous acceptances (which I think is unethical and I’d politely decline to interview at that program). But I can understand the conundrum that the later interviewing programs that follow the suggested CAP deadlines are subject to when many of their desirable candidates have already signed by the time they interview.

Unlike when the NRMP decided to go a match system for residencies, and later on, to bar pre-matching from participating institutions, the incentives and ability to leverage are very different when it comes to fellowships. Most fellowship programs offer a small number of single digit positions which they can usually easily fill without a centralized application service. And fellowships are a quasi-limbo state between school and our first “real” job. The job market does not cater to regulation and it is hoped that free competition is enough to ensure that everyone ends up where they are meant to be (although we know that connections and word of mouth still matter, especially in the small world of pathology). Programs (supposedly 51% from one study) will also often fill their spots with internal candidates and residents often feel the need to apply earlier and undertake audition rotations for the most competitive fellowships (eg – 2nd year for dermatopathology). While a standardized match may alleviate some of the aforementioned pressures, it does provide some of its own. Residents often have to spend more money to interview at a larger number of programs to feel secure that they will match somewhere and they also need to wait until later in the year to learn their fate. They also would likely have difficulty if they are trying to match for two successive fellowships which is not that unheard of, especially when those fellowships are related.

So, in terms of a standardized match, even though I usually have an opinion on most topics, I’m not sure which is better and the jury is still out. But I do know that the ability to incentivize programs into such a match process is much more difficult than it was for residency programs. It does seem though that residents do prefer a standardized application timeline according to multiple ASCP surveys even if they don’t support a match process. APC and PRODS (program directors section) tend to support a pan-pathology fellowship match while other organized groups within pathology and most residents remain skeptical that one would solve all the issues on both the resident and institution sides of the equation.

Well, for my compadres who are wading in these murky waters this interview season as I will also be, it’s a moot point. So I leave you with this: CAP had a great webinar last year by two pathologists-in-training who had survived this process as well as a program director. The webinar can be accessed here as well as a Q&A FAQ PDF from that webinar.

References:

  1. KD Bernacki, BJ McKenna, and JL Myers. Challenges and Opportunities in the Application Process for Fellowship Training in Pathology. AJCP, 2012; 137: 543-552. Accessed at http://ajcp.ascpjournals.org/content/137/4/543.full.pdf+html
  2. WS Black-Schaffer and JM Crawford. The Evolving Landscape for Pathology Subspecialty Fellowship Applications. AJCP, 2012; 137: 513-515. Accessed at http://ajcp.ascpjournals.org/content/137/4/513.full.pdf+html
  3. JM Crawford, RD Hoffman, WS Black-Schaffer.Pathology Subspecialty Fellowship Application Reform, 2007-2010. AJCP, 2011; 135: 338-356. Accessed at http://ajcp.ascpjournals.org/content/135/3/338.full.pdf+html
  4. RE Domen and A Brehm Wehler. An examination of professional and ethical issues in the fellowship application process in pathology. Hum Path, Apr 2008; 39(4): 484-488.
  5. N Lagwinski and JL Hunt. Fellowship Trends of Pathology Residents. Arch Path Lab Med, Sept 2009; 133(9): 1431-1436. Accessed at http://www.archivesofpathology.org/doi/pdf/10.1043/1543-2165-133.9.1431
  6. JL Myers, SA Yousem, BR DeYoung, ML Cibull (on behalf of ADASP). Matching Residents to Pathology Fellowships: The Road Less Traveled? AJCP, 2011; 135: 335-337. Accessed at http://ajcp.ascpjournals.org/content/135/3/335.full.pdf+html

Chung

-Betty Chung, DO, MPH, MA is a third year resident physician at Rutgers – Robert Wood Johnson University Hospital in New Brunswick, NJ.

Pandora’s Box

Archived in the ever-rich and exotic mythologies of the Greeks is the story of Pandora’s Box. It was actually a “jar”—which is strangely close to a “test tube” in my opinion. Pandora was given a wedding gift, a beautiful jar, with instructions not to open it under any circumstances. Curiosity killed the cat, so to speak, and she finally couldn’t resist. When she opened it, all the evil contained in the jar escaped and spread over the earth. She tried to close it but too late—the contents had already escaped. Only one thing remained in the jar at the very bottom—the Spirit of Hope.

I’m not sure the World Health Organization would agree with me, but “Pandemic” is very close to “Pandora.” In a world where international travel is commonplace the spread of contagious disease is a major concern. Rats on ships carrying plague may be a thing of the past, but viral-loaded passengers on an international flight happen every hour of every day. Think of all the headlines in the past decade that have highlighted international health risk issues. It seems that Pandora has unleashed a few additional mutated “evils,” and I doubt we’re through with all her mischief.

As laboratory professionals, we are essential to solving the public health issues confronting our world today. Rapid diagnosis, evidence-based research, viral load monitoring, susceptibility and pharmacological validation, managing toxicity—familiar territory for us, and just think of how much relies on our expertise? We are called on daily to be the platform and framework for “pandemic control” measures. Sitting in our clean, efficient, well-lit, safe and busy laboratories throughout our country it’s easy to forget there are bacterial and viral war zones not far from our shores…all it takes is a small rat on a creaky ship (or a young child on a red-eye international flight) to initiate a modern day plague world-wide.

Next time you hear “pandemic”, remember Pandora. Wash your hands, put on a mask, and peer inside that jar of hers and shake out some Spirit of Hope. Sprinkle it liberally around our laboratories and colleagues, and let’s roll up our lab coat sleeves—we have a lot of work to do!

 

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Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

 

Dried Blood Spots – Sample Extraordinaire

When you mention dried blood spot samples (DBS), most people think of newborn screening. That’s natural because the most common usage for DBS is newborn screening. However, DBS samples are actually one of the most versatile, stable and easily stored samples that it’s possible to collect from a human. And did I mention useful?

To create a DBS sample, whole blood, often from a finger or heelstick, is spotted onto a very specific weight of filter paper. The weight and type of filter paper is important so that all DBS are created equally, and so that differences in testing are not introduced due to filter paper differences. Enough blood is used to thoroughly saturate the paper (in most case roughly 50 uL will saturate the marked dot) and then the blood spot is allowed to dry completely.

DBS are ideal samples for population based testing. The list of positive attributes is long. They are easily obtainable (fingerstick). They use very little blood (50-60 uL). Once dried they are not subject to the sample degradation effects that plague liquid samples. They are simple to transport with no possibility of spilling or breaking. They store easily, taking up very little space, and studies suggest that once dried, the sample is stable for years, whether at room temperature, refrigerated or frozen.

In addition to these obvious benefits, a truly remarkable number of analytes can be measured from one or two 6 mm punches out of a dried blood spot, with a punch containing roughly 10 uL of blood. Protein enzymes are generally stable in a dried blood spot, allowing enzyme activity to be measured from DBS. Viruses such as HIV can be measured in DBS. Even RNA and DNA is stable in these spots, as evidenced by the PCR assays that are being performed using them. These assays include such things are Cystic Fibrosis (CF) mutation testing and screening for severe combined immunodeficiency (SCID).

Besides the PCR testing for CF and SCID, the newborn screen itself uses the DBS sample to measure some or all of the following: either T4 or TSH for hypo- or hyperthyroidism, hemoglobin variants for sickle cell anemia, 17-hydroxyprogesterone for congenital adrenal hyperplasia, immunoreactive trypsinogen for CF, amino acids and acylcarnitines for amino acid, fatty acid and organic acid disorders, and an enzyme for galactosemia. Each one of these assays is performed using the single punch from a DBS. The DBS is an almost overlooked sample type. However it has the potential to be used for a huge variety of testing.

 

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-Patti Jones PhD, DABCC, FACB, is the Clinical Director of the Chemistry and Metabolic Disease Laboratories at Children’s Medical Center in Dallas, TX and a Professor of Pathology at University of Texas Southwestern Medical Center in Dallas.

Perfection

When I was in school I learned a lot about science and the laboratory science body of knowledge. The one thing that was emphasized over and over was accuracy and precision. It wasn’t until I secured my first position and started training did I realize just how important those two words were. Not only are we counted on for our accuracy, we are counted on for the repeated accuracy of everything we report to physicians. I have heard some statistics reported that up to 80% of physician decisions on courses of treatment are based on lab results. I really do not get caught up in that number because if you think about it every single value we report is going into a patient’s clinical picture and can affect a decision on a treatment one way or another. So the question always comes up, how do we deal with errors? This question is multifaceted and as a supervisor/administrator we are responsible for much more than just the correction of the error.

I wrote this in my 5 year progress report article but I think it deserves repeating. Everyone makes mistakes, but, it is how you recover and learn from your mistake that is most important. Everyone has had that sinking feeling in their stomach when they learned they have either reported out an incorrect result or have mislabeled a specimen. As a laboratory professional it is our biggest fear and each and every day we sit down at the bench and are expected to be absolutely perfect. Zero errors are a standard that not even the most efficient manufacturers know is possible yet we are expected to perform on this level each and every day. Errors happen to everyone, and when they do it is what happens afterwards that is key to inhibiting that error to occur again. Especially with newer technologists it is important to teach them so that they are able to recover and not make the mistakes again.

The first thing I do when an error is discovered is address it with the technologist. Ask them, “do you remember this sample or this patient? Do you remember what you were doing at the time this error happened?” One thing to watch is how much the technologist can remember. If they cannot remember too many details, were they trying to do too much at once? If they mislabeled did they have a pile of tube and labels while also trying to result specimens? With mislabels I found it helpful for myself to read the name in my head as I was labeling the tube. That way if what I was reading in my head did not match the label underneath I would stop to look. If it is a procedural error why did the technologist deviate from the actual process? Did they learn a shortcut but that shortcut actually increases the chances of error? Going over this with the technologist also will help them with their problem solving skills. Especially with new technologists building problem solving skills is vital to the success or failure of a young technologist. We know humans are not perfect, but when you work in an industry that accepts nothing less, each error made is amplified but also that much more important.

 

Herasuta

Matthew Herasuta, MBA, MLS(ASCP)CM is a medical laboratory scientist who works as a generalist and serves as the Blood Bank and General Supervisor for the regional Euclid Hospital in Cleveland, OH.