PGY-1: First Month

So, as another July 1st has come and passed, neophyte first years have begun their training in pathology residency training programs across the country. Many will begin with either a bootcamp-style orientation and/or an introduction to surgical pathology. Although I do have a PGY-1 friend who started with a CP rotation (and not an intro one at that).

I was fortunate to have a creative surgpath director who has an interest in different styles of medical education during my PGY-1. During the last two weeks of June, in addition to the general administrative orientation requirements, we had what we affectionately refer to as our “bootcamp.” First, we were taught proper blade/cutting technique with various food products (eg – potatoes, bratwurst) to get a feel for how to adjust our cutting technique for various specimen consistencies.

She was truly dedicated and personally went to a butcher in Chicago and picked up pig organ blocks three times for us during those two weeks. Then she and one of our two surgical fellows instructed us in the Rokitansky en bloc method of autopsy dissection after we had watched a narrated DVD that she had created from the previous year PGY-1 training sessions. We then would have to complete a fourth unsupervised pig block dissection and need to score at least a 75% in order to pass our autopsy competency exam. Those who did not pass, had to repeat the exam.

We also learned how to cut mock uteri and prostates since these are common specimens. She had molded and frozen ground turkey to simulate these organs and even added surprises like chick peas to represent leiomyomas. We practiced how to bivalve and cut the uteri for both endometrial and cervical cancers as well as how to gross prostates…although I did go through the whole year and never get one until I rotated in the fall of my second year at the VA where I got them almost daily.

Additionally, in order to learn how to cut frozen sections, we took ten sections from various organs from our pig blocks and embedded, cut, and stained frozen sections. This way we could understand how certain sections cut better than others (eg – fatty tissue is more difficult to cut), how to orient them, and how to cut them well without folding and unevenness. We were then graded on our sections for frozen section competency exam. For those who did not pass, they got some personal remediation at the cryostat with our assistant director of surgical pathology.

In the gross room, we had PAs who were good at teaching. We practiced dictating biopsies and placentas, grossing placentas, and grossing “smalls” like an appendix or gallbladder. Twice a week, we had multi-scope subspecialty sessions in dermpath, liver, renal, and neuropath since most of these types of specimens go to either our fellows or the subspecialty pathologists and our first years rarely saw them.

We initially started with a six-person, six-day schedule of frozens, grossing biopsies/smalls/bigs preview, grossing bigs, autopsy, peds path, and neuropath for 1.5 months. Our PAs usually gross our biopsies and benign smaller specimens. Then we were whittled down to a four-person, four-day schedule of frozens, preview, bigs, and autopsy with two of us taking “mandatory” vacations. The two residents that remained on SP after our five months of intro to SP were incorporate into our standard three-person, three-day schedule of frozen/grossing bigs, biopsy/smalls signout/bigs preview, and bigs signout.

At my new program, it is different because we don’t have surgpath fellows. Since we are a small program, each senior resident serves as a co-chief and one of their responsibilities is the training of the PGY-1 residents in surgpath during an initial one-month intro to SP rotation. Other senior residents on the surgpath rotation also help out with the teaching. They also give AM lectures on grossing topics in Lester’s Manual of Surgical Pathology and the specific nuances of the grossing preferences of our attendings.

As for me, I start off with a comprehensive CP rotation that combines working in both the chemistry and microbiology sections. As a PGY-1 here, they have 2 months of ‘Wet Lab’ or an intro to CP rotation. But since I am a PGY-3 transfer, I am a cross between a PGY-1 in terms of knowing how things are exactly done here and a senior resident. So this month for me combines intro to SP, Wet Lab, and the subsequent comp CP rotation that would come after Wet Lab. So, I get to gross a little (since things may be done differently here), learn about where and how things are done in the labs, and study more specialized CP topics. Since I came from a program where we rotate at four different hospitals for surgpath and can be self-directed in terms of CP, this works fine for me but still can be initially daunting in terms of trying to fit in do things the way they would like them done here.

So what do you think are the best ways to train PGY-1 residents most effectively? Should they start off with an intro to SP rotation and how should that be structured in terms of time, topic areas, and teaching of those topic areas? Or does it matter if they don’t do an intro to SP rotation and go straight into a CP rotation? And who should teach them how to gross? Let us know how things are done at your institution.

 

Chung

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

Advice for the Incoming PGY-1 Residents

As I am repeating the motions of yesteryear when I was moving from NJ to Chicago to start my residency, except this time in reverse to return to NJ to complete the final two years of my residency, I’m reminded that it’s always good to ask for advice from those who have blazed the trail before me. And so I’d like to start with a hearty CONGRATULATIONS to the incoming pathology PGY-1 residents! This is truly a time of excitement and maybe a little apprehension of the new and unknown for you. So, I thought that I’d devote this week’s blog to pearls of wisdom I’ve picked up along the way. Fellow residents, please pipe in if you also have some advice for our incoming residents.

  1. Enjoy your time before residency (and in some of cases, June orientation a la boot camp style) starts. Take that vacation backpacking through Europe that you always dreamed of…or volunteer overseas if you’re so inclined. Whatever you do, take some “me time” now. I know it’s easy to think that you might need to read up on your pathology but there’s time for that later. Once you start working (residency, fellowship, job), even if you are promised 4 weeks, it might be difficult to schedule that time off due to grossing schedules, your colleagues’ vacation requests, and so on. So decompress from the past 4 years of medical school and enjoy what’s left of your summer.
  2. Hopefully, you already have done this but look for your housing way in advance, especially if you are out-of-state from where you will be a resident. Apartment websites and Craigslist are good but be careful of scams especially if they ask you send in a deposit ahead of time without seeing the place. If something sounds too good to be true, it probably is. I strongly suggest going in-person or having a trusted friend or family member check out places for you if you can’t. A great piece of advice that was given to me was to use a realtor (or more than one) who can line up places and show you around. They are usually a good source of information about where is best to live and what are reasonable prices…and you can ask them to only show you places where the landlord pays the commission. It saves time to have someone organize the appointments according to your specifications (pets, within X distance to the hospital, safety, covered utilities, parking, amenities, etc) so that you only need to show up and view the places you like and decrease the number of apartment hunting trips/calls you make. You can even search for places you like off the realtors’ website just like you’d do on Craigslist, Trulia, or Zillow especially if you want to rent or buy a condo unit. Sometimes you may need a letter of employment stating your salary and a credit report (by federal law, you can get this free q12mo from all 3 credit reporting companies through www.annualcreditreport.com but you will need to pay a small fee, about $10, to get the credit score – you can get the score free via Credit Karma but a lot of realtors will not accept it from this company so be forewarned)
  3. Think about selling any large items you may have (such as furniture) to save on moving costs. If you really must move a lot of large items, look into moving options early because June/July is a busy moving cycle and you don’t want to be left with the less reputable companies that may be cheap but do not do a good job or very high prices or even worse, no options. You can either hire a moving company or use portable containers such as PODS, U-Haul’s U-box, or ABF U-Pack where you pack the container yourself and they drive the container to your new home and often have options to store it until you are ready to access it. Check to see if your program has an Employee Assistance Program (EAP) that can help you with relocation services and/or discounts but either way budget yourself 1-2 grand.
  4. Get all your paperwork done ASAP. You will receive mountains of forms that need to be filled out to obtain your (temporary) medical license and allow you access to the various hospitals you will rotate at. Make it a habit now to not procrastinate because once residency starts, you will find yourself often too busy and too tired. You also do not want any delay in starting your job due to incomplete paperwork. Better to find out now if you are missing an item (eg – vaccination, physicals) and take care of it before you arrive to start.
  5. Get to know your colleagues. Introduce yourself to everyone over email and offer to help out if they need (such as unloading their moving stuff). It’s a great way to break the ice and meet your fellow residents and start off on a friendly foot. You can even suggest some chillaxing activities to do together at the start of residency to explore your new city to get to know each other and your new home. Bonding starts from day one and it is difficult to do once the hustle and bustle of work starts and if you are in a program where you are separated to different hospitals. Also, you’ll find that your senior residents will have a lot of good advice to give and you might even find a new friend or mentor.
  6. Join pathology advocacy organizations like the American Society of Clinical Pathology (ASCP), the College of American Pathologists (CAP), and your state/city pathology societies because they often have resident resources and this is the last time you can get free membership. Once you graduate, then you have to pay membership dues. CAP has a Residents Forum with 2 meetings per year that I found a great place to meet other residents. Both ASCP and CAP have a Resident Council and Residents Forum Executive Committee, respectively. Get involved and run for a position on either of these or on ASCP or CAP committees where you will serve with attendings. Other international organizations such as USCAP or subspecialty organizations may have dues but these are often greatly discounted for trainee members and you get discounted registration if you need to attend their conference (eg – to present a poster) so it still makes sense to join – find out if your program will pay for the dues.

Once you start residency, I won’t lie, it will be stressful. There will be times you wonder what you’ve gotten yourself into and when you may doubt if you can do all that is expected of you. But persevere and this, too, shall pass. Find yourself some good mentors – other residents, attendings, and/or ancillary staff. You may feel that you are behind and that there is so much to learn but I promise if you make sure you have a solid foundation at each step, one day you will be that senior resident who seems to know so much more than you did on day one. But for now, enjoy yourself! The studying can wait–at least until July 1st!

 

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.