Match Day Musings

I remember my match day. I actually didn’t go to the ceremony because I was two years behind having done a year of PhD before quitting and was in the midst of my MPH at Columbia the year after graduating medical school. So my original class had matched two years before and I was in NYC during exam period on Match Day and not in South Jersey. So I didn’t experience all the “bells and whistles” associated with Match Day festivities. But I do remember the anxiety of wondering at first if I would match, and then after that fateful Monday after I found out that I matched somewhere, wondering where that would be. It’s stressful and yet at the same time, a relief once you get your match results.

Now, it’s three years later. I’ve matched to two fellowships for 2016-2019 at my first choice program and I have one year left during which I will serve as Chief Resident. Match Day seems like a lifetime ago, really. So fellow, future pathology residents, enjoy this time. If you do want to do some prep because you just *have* to study, then brush up on your histology at your leisure. You can’t learn the abnormal if you don’t know the normal solidly. The first six months is the steepest in terms of learning curve and it will be expected that you already know your histology. You don’t want to fall behind because you will be learning so many new things from the get-go. Or start prepping to get your Step 3 out of the way as early as possible because the further we get out of med school, the less we will remember patient care practices and procedures that we do not practice in every resident life.

Senior residents, think back to what you wish you had known or wish that someone would have impressed upon you as to its importance when you were a first year. These are the things to pass down to your incoming juniors to help them with the transition from medical student to pathology resident. I believe that things happen in this life for a reason. So match day will bring us in contact with each other, to somehow touch each other’s lives in some way – whether it is to teach or to support each other or to work together to advocate for and transform our profession. We’ve started the journey to July 1st when we the circle of resident life begins anew.

Chung

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

Final Thoughts from the Fellowship Application Process

And with the dawning of a new year, I’m another year closer to becoming a full-fledged pathologist. Exciting and yet daunting at the same time as I have only 1.5 years and my AP/CP boards left before I start my fellowships! So, I thought I’d leave some final words on what I learned during the fellowship application process for those who have yet to go through it.

The earlier you decide on your choice of fellowship(s), the better you can prepare by presenting and publishing research in your area of interest, spending extra rotation time and study in areas related to your interest, and networking within your academic subspecialty organizations. I would say for the first half of first year, concentrate on your rotations especially surgical pathology and grossing technique. But at the latest by the second half of your first year, start honing in on what you think you’d eventually like to do and working toward that goal. Most residency programs are amenable if you ask them to adjust your schedule so you can rotate early through subspecialties of possible interest during your second or early third year. Don’t forget to ask for lighter rotation months and less/no call duties during peak interview season (Oct-Jan).

If you can, do an elective during your second or early third year in your subspecialty of interest at your dream program(s) before fellowship decisions are made and fund it through grants such as the one offered by ASCP (1/16/14 deadline; application here). I found that often, positions were already promised or eventually went to internal candidates or external candidates who had done an elective prior to their interview. Scheduling for elective rotations takes foresight, time and effort (eg – state medical license can take months), and an available rotation spot during your desired month, so start the process early!

Research early to create your application list. Only you will know the number you feel comfortable applying to which depends on your personal situation (eg – subspecialty competitiveness). I found that attending conferences and listening to speakers in my content area of interest helped me to decide which programs I may like. I’m also very active in CAP and ASCP and the physicians I work with in these roles, pointed me toward programs where the culture might be a good fit for me as they were role models of the type of people that I would like to work with. Of course, I also applied to top programs that I knew or that my attendings advised me were good.

Then check with programs about the opening date for application submissions if it is not posted on their website. I found that frequently, these were not hard deadlines. Since we don’t have a match, decisions are rolling (eg – I got promised an offer during my interview day and have friends who also had similar experiences). Once again, the early bird may catch the worm, and not because they are necessarily the best bird, but the first bird that a program likes. While some programs have a schedule for decisions, I found that just as many made offers as soon as they found someone they liked.

Make sure that personal statements are no longer than one page, shorter is better. You can follow this format: 1) how and why you fell in love with that subspecialty, 2) what you bring to the table especially for the program, and 3) what you want out of your fellowship and why that program is the best to accomplish those goals. Ask multiple people in your subspecialty or more senior residents to give you feedback on your personal statement/CV and for letters of recommendations very early – give a deadline earlier than you need so that you can have them ready by the time you want to submit.

I applied mostly to programs that had both hematopathology and molecular pathology fellowships and stated in my cover letter that I wanted to do both consecutively at the same place (but that it wasn’t a deal breaker). I received invites at almost all but decided to interview at a select number. For the ones where I interviewed for both fellowships (ARUP, Hopkins, MD Anderson, UPMC, Houston Methodist), it was usually the program looking for the fellow first who made the arrangements with the other fellowship. ARUP had interviews over 2 days (paid expenses except airfare) but the others all worked it out so that half a day was interviewing for hematopathology and the other MGP. Receiving an offer from one did not necessarily mean that I would automatically get one from the other. Scheduling both on the same day, also made things a little more difficult.

Respond to invitations quickly because this process is truly rolling. I was often given a limited choice of date(s). One place gave me only one date for an interview that I couldn’t make. Rescheduling can result in losing an interview because programs interview less people over fewer dates than they did for residency and will schedule someone else if you can’t make it. Some programs told me they were interviewing 2-3 per position while others said 5-10.

Be courteous and prompt, send your “thank you” email/note early and no later than by the next day. You can have a basic “thank you” email template ready to go that you can personalize so that you can send it even while waiting at the airport to go to your next interview. And be honest. I found that being upfront made it easier for programs to extend me a counteroffer when I mentioned that I had to make a decision soon on another offer. Once you’ve accepted a position, keep in touch with your program to hit fellowship running! I hope to do a PGY4 research elective in order to submit abstracts for conferences that occur soon after I start my fellowship and to familiarize myself with the EMR and clinical workflow in both fellowship areas.

And finally, be true to yourself about your goals, realistic possibilities, and most importantly, the program characteristics that will make you most happy. When I was applying to college, academic prestige and idealism were important, and for medical school, proximity to my aging parents. But now, what I find most important is the fit of the program. I want to be happy and feel like it is my home. I want to be at a place that hires their alumni and goes out of their way to help them find jobs. I want to be around role models working in areas that I want to as an attending: advocacy, medical education, and research…and of course, foremost, clinical diagnostic excellence…and who I feel will continue to support me as colleagues in the future. For me, fellowship isn’t just the time to merely refine my clinical expertise or learn things that I didn’t get to during my residency. It was more like interviewing for a job rather than for school admissions, making decisions with a more immediate goal of what I want to accomplish after and no longer “down the road”, and most importantly, building toward my future.

And I’m happy to say that I did get multiple offers from great programs and accepted at the place I felt the best fit. It was my last interview in mid-December, so you never know. I can say that having served in positions with CAP actually helped me because I already felt at home with 2 of my interviewers with whom I serve on a CAP Council (we just had a meeting 4 days prior) and one of the current fellows who I also met through being involved with CAP. So, networking, even when it isn’t deliberate or conscious as it was in this case, can help. In case you’re wondering, I’ll be completing hematopathology (2016-2018) and molecular genetic pathology (2018-2019) fellowships at Houston Methodist and also hope to participate in research at the Houston Methodist Research Institute.

 

Chung

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

Does Pathology Need a Modern Day Flexner Report?

Happy New Year! I hope that everyone has been having a great holiday season so far. I just wanted to share some brief musings I recently had as we start our new year…

Most of us have heard of the famous 1910 Flexner Report but for those who are unfamiliar, it is not exaggerating to state that it transformed and birthed the modern concept of biomedical education that we know today. Originally entitled “Medical Education in the United States and Canada”, it was study commissioned by the Carnegie Foundation for the Advancement of Teaching (CFAT), an American educational policy and research “think tank” founded in 1905. The report’s author, a former secondary school teacher and principal and not a physician, toured all the existing medical schools in both the U.S. and Canada and recommended reforms that would result in the standardization of the structure of medical curricula with Johns Hopkins as their ideal model. Medical education went from for-profit apprenticeships, varying in quality, to an academic model of basic science study followed by practical hands-on training in patient care. Eventually with standardized accreditation requirements, most medical school curricula, despite their differences in implementation, had their core foundation in common: didactic years to learn and clinical years to apply (under supervision).

Like the proprietary “medical” training institutions of yesteryear that existed prior to the Flexner report, do our pathology training programs need a global re-evaluation and an overhaul? Despite the existence of ACGME accreditation criteria and visits, do we have programs that need serious reform or termination to meet an ideal? Do our accreditation standards need to change to create a new ideal? And must we come together now to adapt our expectations and training objectives to meet the challenges of our rapidly evolving health care landscape? What is and should be the role of the pathologist on the interdisciplinary clinical health care team? And so the core question becomes, what are the most important things that we need to teach our trainees and how do we go best about it? I’d love to hear your thoughts…

And to encourage scholarship in the Flexner tradition that also emphasized the role of research in our education…for those who would like to submit an abstract for resident poster and platform presentations, submission periods for these conferences are currently open (except for CAP) with the following deadlines (I’ll try to update with more later but these are the most immediate in terms of deadlines in the next quarter):

Chung

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

Selective Pathology Fellowships

So, what are selective pathology fellowships? They are 12 month fellowships that originally provided advanced competency training in subspecialty areas but would not result in ABP certification at their completion (eg – surgical pathology subspecialties). There are 3 tracks of these types of fellowships encompassing 80 currently ACGME accredited programs with 155 available positions as of the writing of this blog post (12/17/14): A) selective pathology-surgical pathology, B) selective pathology-focused AP, and C) selective pathology-focused CP. These programs can either be non-accredited programs (NAPs) or ACGME-accredited programs (AAPs) and the ACGME requirements for such fellowships can be found here.

These fellowships can be a stand-alone 12 months, as many of the surgical pathology selective pathology fellowships tend to be, or can include an extra year. Examples of extra year selective pathology fellowships include the New York City’s Office of the Medical Examiner and University of New Mexico’s forensic neuropathology/cardiovascular pathology fellowships and the Houston Methodist Hospital’s hematopathology fellowship (http://www.houstonmethodist.org/SelectivePathologyHematopathology), both of which require a second year beyond the traditional fellowship in these subspecialty areas. Methodist’s hematopathology selective pathology fellowship can be completed alone but will not lead to eligibility for ABP board certification in hematology, so it is preferable to combine it with the traditional hematopathology fellowship.

These fellowships either provide additional focused diagnostic training in areas important for these fields and/or opportunities for research. If there is a second year, funding is provided by the institution and not the Centers for Medicare and Medicaid Services (CMS) like it is for residency, and so this limits the numbers of these types of fellowships. Traditional AAPs are eligible for funding from CMS while NAPs are not. Some institutions instead of selective fellowships provide a second “junior faculty” or “clinical instructor” year.

Reference:

  1. JC Iezzone, A Ewton, P Chévez-Barrios, S Moore, LA Thorsen. Selective Pathology Fellowships: Diverse, Innovative, and Valuable Subspecialty Training. Arch Pathol Lab Med, April 2014; 138: 518-525. http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2013-0454-SA

Chung

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

The Importance of Relationships and Elective Rotations for the Fellowship Application Process

I know that I’ve said this before, but it is important to cultivate relationships, especially in a small professional community such as pathology. In medical school, it was fine to focus on learning from our lectures, doing well on boards, and performing competently on the wards. This triad was enough then to secure us good letters of recommendation for our residency applications. And most programs invited candidates supposedly based on a magic number calculated from these aspects of our applications. Additionally, most programs, since we have a match and so as not to have to scramble via the SOAP, would invite about 10 candidates per position available.

However, for the fellowship application process, it’s a different ball game. We do not have grades for rotations and most of us have not taken our boards before we apply. So it is no longer as heavily numbers-oriented. Most of our personal statements will not be that different from each other, I would guess. So, the two things that stand out in my mind as having the most impact on receiving an interview invite (at least in my experience), are our letters of recommendation and our CV’s. I know that at every interview, aspects from one or both of these were discussed. Since I was a non-traditional medical student, most often what was brought up from my CV was my extensive research background (I was originally going to be a PhD molecular neuroscientist), long path to residency (I have 4 degrees), and reasons for getting an MPH (two of my main foci were molecular and infectious disease epi because I thought that I’d be interviewing for MGP and clinical microbiology fellowships right now). I also had to explain any gaps in my training.

As far as the CV goes, I think it’s most important to show a consistent commitment to your area of interest through publications, abstracts/poster or platform presentations, and leadership positions with advocacy organizations in your desired subspecialty area. But remember to do things that you are passionate about and not just to put on your CV! Attending national/state/local meetings provides an outlet to meet the experts in your future field who not surprisingly, you may end up interviewing with during the fellowship application process. More weight is now placed on relationships. If you have great letters (or better yet, a phone call or personal email sent on your behalf) from a colleague that the fellowship director knows, you are more likely to be chosen for an interview. Also, if you are a well-liked internal candidate or external candidate who spent time rotating at your dream program, then you also have increased chances of being chosen for their fellowship. Some programs (or subspecialties like some forensics programs that I’ve heard of) either require an “audition” rotation or heavily favor candidates who did rotate with them. So I STRONGLY recommend figuring out what fellowship you want as early as possible and to do an elective rotation (if it is not your own program) at your dream program during your PGY-2.

I cannot emphasize enough that showing what you can bring to your future fellowship by doing an elective rotation before the application period (early PGY-3) and interacting with your future interviewers can only help you. I wish someone had told me this when I was a junior resident. If the program chooses to interview you after you’ve rotated there, it generally means that you’re more competitive than others who they may interview because they know and like you and feel that you meet their competency requirements. I have not had any elective rotations yet so I was surprised at one of my interviews to learn that all the current fellows had completed a 2-month rotation there before they had applied. I had been told just before I left for my interview that this program heavily prefers those who have rotated there but it wasn’t as obvious as when I was told this during the lunch with the fellows. Even though they interviewed only a few candidates, it will be difficult to tease out how much an elective rotation factors into the final decision. I will always wonder if I do not receive an offer.

At this point, the competition is much fiercer than it was for residency, often with only 2-3 candidates invited to interview for each available spot from what I was told at some of my interviews. But I’m not sure how this number varies based on the competitiveness or popularity of each program. I can tell you that the programs I interviewed at would fall under the ‘very competitive’ category so other programs may interview more. But you could always ask the program coordinator how many they plan to interview and how many positions are truly available. They often will let you know if a future position is already filled by an internal candidate. Sometimes, I was given only one day or a few days to choose for scheduling an interview and if I couldn’t on those days, the program moved on down their list. So make sure to ask for lighter rotations and no call during your anticipated interview months (Sept-Jan). This is especially important with small residency programs or those with multiple hospitals to cover where it may be difficult to find someone to switch call coverage with you.

Since applications are accepted and interviews are conducted earlier than in the past and positions may have already been (un)officially promised to internal candidates, research programs and apply early! I do so dislike the word ‘networking’ because to me, it sounds insincere and calculated, but whatever you do, make opportunities for yourself to build relationships with and show your interest to your future colleagues before you have to apply. If you need some financial help to do an external elective, apply for ASCP’s subspecialty grant by clicking here and applying before January 16, 2015!

 

Chung

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

 

 

The Importance of Continuing Medical Education, at Least in Theory…

Hello again residents. It’s the wee hours of the morning and I am in Chicago O’Hare International Airport waiting for my connecting flight to Columbus, Ohio, where I will serve as an ACCME/AMA monitor for the College of American Pathologists (CAP) at the Ohio Society of Pathologists (OSP) meeting. I wasn’t allowed on my flight because I was just beyond the cutoff time even though I had rushed out of the hospital, still in my scrubs. And so I got re-routed through Chicago and spent a couple hours at a hotel in order to sleep before catching an early flight the next day.

As the junior (trainee) member on CAP’s Council on Education (COE), I was given this opportunity to monitor this CME meeting for compliance to ACCME/AMA standards and CAP representation as a joint CME partner. I’ve served on the COE since January 2014. We have four meetings a year with two of them in Chicago. I was just approved for a second term that runs until December 2015. We oversee and approve proposed projects from all the educational committees of the CAP: publications, GME, CP education, and the curriculum committee as well as some of the educational aspects of the Annual Meeting.

Despite the airport snafus (which I’m pretty good at getting myself into), it was interesting to serve as a monitor. I met an attending from the Cleveland Clinic who I remembered from my residency interviews. I also met other residents and fellow who were in attendance. The OSP had taken great care to preclude commercial bias from their meeting. They did have a few exhibitors but they were in a separate room from the lecture sessions. I heard a very informative talk on the clinical oncology applications of next generation sequencing (NGS) as well as an engaging case-based session on dermatopathology cases.

The meeting was held in a hotel in Dublin, OH, which I strongly suspect must have Irish and German roots from the names of the town, streets, and types of restaurants (Irish pubs and German-Austrian) that are common here. The hotel restaurant which had an Irish name served a buffet of Irish food (no surprise) for the participants at a discounted rate. Overall, it was a good meeting with a good balance of germane topics covered. Having been a co-chair of a national medical conference when I was in medical school, I totally can appreciate all the pre-planning that goes on behind the scenes to organize meetings such as this. I was also able to have dinner with and catch up with a friend who is a non-pathology resident at the local Ohio State University.

I know that we, as doctors, would like to believe that once we’ve passed through the gauntlet of medical school and graduate medical education training, that we know everything that we need to know and shouldn’t necessarily have to be retested or do CME, but I believe that it only makes us better doctors if do. We should be life-long learners, especially in a technology-driven specialty such as pathology (that is, if we want to remain in control of lab testing). As a scientist in my life prior to medical school, I intimately understand how even dogmas can change (at one time, people thought that protein was the genetic material of the cell!). We can always learn something new and new disruptive technologies like NGS will always arise that will transform how we diagnose, prosnosticate, and treat our patients. We may not always see patients physically but must remain present within the process and that requires us to continue to test our knowledge base. Since I haven’t graduated yet, I don’t really have the experience to say whether the current mix of CME, SAM, and MOC requirements is the way to do it but in some form, we need regulations to help push us as a profession (not necessarily as an individual if we are self-directed and pro-active) in the right direction to be the best physicians for our patients.

 

Chung

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

 

Decisions That Will Impact the Direction of My Pathology Career

So, I’m in Midway Airport in Chicago with a 2.5 hour layover back to the East Coast from my West Coast tour of fellowship programs and interviews. I flew on 5 separate flights and interviewed at 5 programs in 4 cities in 3 states over the past week. Quite a whirlwind schedule to keep even if it wasn’t exacerbated by the fact that I’ve had a wicked flu the entire time (and still am sick as I type). But I look forward to getting at least one night’s comfortable sleep in my own bed and spending some time with my kitties before I start with my first East Coast interviews (2 in 1 day) on Monday. I’m very fortunate that my program director, program coordinator, and fellow co-residents have been supportive, especially when I’ve had to switch multiple days on-call.

On the left coast, I interviewed at 3 hematopathology and 2 molecular genetic pathology programs with overlap at one program where I interviewed for both hemepath and MGP. All of the people that I met at each program were people who I felt that I would like to become colleagues with (and who will be my colleagues in the future). But despite this fact, each program was vastly different from the other and I am reminded that these next decisions about where I’ll spend my fellowship years will probably impact the direction of my career more so than any other decision thus far. The people who will touch my life will help shape the pathologist I will be!

I thought that I had adequately prepared my list of questions that I carried around to each interview but I found that each interaction spurred additional new questions that I had not thought of prior to the interview. Many times, my interviewers had anticipated some of my questions and had answered them as we talked even before I asked. The current fellows I went to lunch with were very helpful in answering my questions and telling me about their lives within their fellowship programs. For me, the “fit” and culture of my working environment is important – finding colleagues who treat each other with respect and notice when others might be struggling and help each other out. I value a strong teamwork mentality as much as I appreciate a rigorous academic environment that will push me to be the best that I can be.

Having come from a graduate research training environment in what I might call some of my formative years, I also value an environment that spurs creativity. I enjoy being able to have open door policy discussions where we bounce ideas off each other and challenge each other in a positive manner to “think out of the box.” I know that research will be an integral part of my future career, hopefully along with hematopathology sign-out and molecular genetic lab directorship (even if it is not for the entire lab but possibly just the molecular hematopathology portion of it). The question for me is whether that research will be more basic science (which means I’d probably be committing to more like 80% research, 20% clinical in terms of my service duties) and on a K-R01 grant track as a physician scientist or will be more toward translational research where I can apply some of the knowledge and skills I gained during my graduate and MPH training. I was very flattered that at my first interview, the fellowship director told me that I could come back after my fellowships to do a post-doc with him and one of his mouse models of hematopoietic disease.

Mentorship for me is really big. I really want to find a program where the faculty take an interest in my career. I want mentors who look out for my future career and who will guide me toward opportunities that will enhance it. Mentors who will support me and make those all-so-important phone calls to help me get my first job, or better yet, offer me my first job. It is not far-fetched to think ahead that I might want to lay down roots where I complete my fellowships so that is an additional factor to consider when it comes time to make the final decisions.

Each program varied with respect to educational philosophy and resources. More so than I previously realized that they would even though I’ve been in two residency programs that I can compare. But right now, I compartmentalize everything I see and learn from each interview and just try to soak everything in like a sponge without assumptions or judgment. I’m placing those observations aside in my head until the time comes that I will need to think about them (which will probably be the end of this month or the very beginning of the next).

It has become very clear to me that being self-motivated and proactive to make opportunities for myself when they did not necessarily exist within the formal structure of my residency program has been a pivotal aspect of getting me this far in interviews. If your program does not have a resource available (eg – NGS for a MGP-minded person like me), then find one and gain access to it (eg – I will go to Rutgers for my last molecular pathology rotation to help with NGS clinical testing validation, and hopefully, a hematopathology elective rotation at an institution with a higher volume and diversity of cases than I can see at my own program)! If you are interested in a particular subspecialty, get involved in research, tumor board presentations, and sign-outs in that area (eg – look at hemepath cases on your free time or on the weekends if that’s what you like) from your first year as much as you can. Whining is not allowed nor is a quality that will help anyone so don’t waste time complaining about aspects of your programs you cannot change. Make your destiny happen rather than be a mere participant in it by accepting the status quo! Good luck to my fellow residents who are also on the interview trail! May we all find our future homes for the next phase of our careers very soon!

 

Chung

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

Educating the Doctors

If you had a chance to spend one day with a group of fourth year medical students who had already been accepted into residency programs, and you had the goal of providing them with the information any beginning doctor needs to know about the laboratory, where would you begin and what would you teach them?

I had this opportunity recently. The director of a medical school boot camp for Fourth-year medical students (MS4) who would start residency in two months approached me, wanting to know if I’d like this opportunity. Of course, I jumped at the chance. The hardest thing was deciding what information to leave out, to essentially focus the short course on the minimum information related to the lab that a doctor should know when they begin their career. I can honestly say that the opportunity was educational for me also – it showed me exactly how little a graduating doctor knows about the lab! Now in its third iteration, we learn and add and subtract as we go.

We do a brief introduction and overview of general lab structure and then start with phlebotomy. Most doctors (and I’m going to exclude everyone who entered medical school after being a medical technologist) have no idea that the tube top color indicates the type of anticoagulant, and for instance that every purple top tube everywhere in the world has EDTA anticoagulant in it.  We also covered basic phlebotomy technique. Then we rotated them in groups through the various sections of the lab, allowing each section to educate the group on the some of the items they considered the most important features of that section. Some of the topics that were covered include:

Client services/accessioning: some tests utilize a whole blood sample (CBC, blood gases), many, many samples require spinning and aliquotting while maintaining sample identity. Hemolyis, lipemia and icterus interfere with tests.

Chemistry: batch vs random access testing, main chemistry analyzer vs manual testing, pre-analytical affects on test results; reference intervals

Hematology: why clotted tubes can’t be used, how white cell differentials are performed (mostly manual in pediatric institutions)

Microbiology: blood culture bottles in the instrument vs plating and identification; how susceptibility testing works; likelihood of a false positive on a positive flu test run in the summer

Blood banking: what a type and crossmatch includes; how various blood products should be transported; uncrossmatched blood availability

Each section is also instructed to encourage questions and interaction with the MS4s as they tick off main points.

This is an educational opportunity I wish I were granted for all MS4s everywhere. Each year we run this program we refine it as we learn what they most need to know, as well as what they don’t know and what we don’t know. It’s a wonderful learning process.

 

???????????????????????????????????????????????????????????????????????????????????

-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.

 

 

The Road Less Traveled By Has Made All the Difference

Hello again residents, I hope that you enjoyed the recent posts from your colleagues about their experiences at the 2014 ASCP Annual Meeting. Hopefully, we’ll see you there next year in Long Beach, CA during October 28-31, 2015 and we can celebrate Halloween together! I’ll let you know in late winter/early spring 2015 when the abstract submission period opens for those interested in being chosen to present during the oral and poster sessions. And congratulations to those residents recently appointed to various ASCP subcommittees! As always, let me know if you’d like to get more involved and I’ll pass on your info.

So I’m writing this post from the air while flying from Newark to San Francisco via a layover in Phoenix. When I arrive at SFO, I would have spent 9.5 hours today traveling. In fact, I’ve flown every month since I moved home to NJ this past July either for conferences where I presented posters or meetings for national leadership positions I hold in organized medicine organizations.

I’m tired from all the travel but at the same time excited to finally start my fellowship interviews. I postponed them until November when I’d have a month free from most of responsibilities I’ve had the last few months. The only responsibility I have this month is to serve as the ACCME/AMA monitor at the Ohio Society of Pathologists meeting for CAP. But November is actually somewhat late for interviews. Some of my PGY-3 friends who interviewed early have already matched to their fellowships because they were given offers at or shortly after their interview at programs that have rolling admissions (which is quite common).

So if you’re a PGY-2, I suggest asking to have your letters of recommendations written and ready by end of July 2015 at the latest and send out your applications in July/August or as early as the application period opens at your programs of interest. Spend early 2015 researching programs and refining your personal statement and CV so that everything is ready early. But the bottleneck most likely will be your LoRs so make sure to follow up with your letter writers to make sure they are completed in a timely fashion. Also remember to follow up with programs to make sure your applications are complete because I had lost LoRs that delayed the process, and one program that I did eventually get an interview at, never received my initial application because the email address was incorrect on their website.

If you’re a PGY-1 and unsure of what you want to do for fellowship, make yourself opportunities in 2015 to help answer this question for yourself early. For 2014, concentrate on learning on your rotations, especially surgpath/grossing. Ask to have rotations of interest or electives in your chosen subspecialty completed by second year so that you can make this decision and so that you can get letters from attending physicians in your subspecialty area. PGY-2 is also your opportunity to shine during an external “audition” elective and possibly be considered almost as an internal candidate at your top program if you schedule one early before you apply. You can even apply for a subspecialty grant from ASCP (deadline is Jan 16, 2015) to help fund your external elective expenses.

Get involved in research in your area of interest, participate in and ask to present monthly at tumor boards for your area of interest (go above and beyond the minimum!), get involved in the lab validating tests (for CP oriented folks), and attend CME meetings in your area of interest (I used to attend Chicago Lymphoma Foundation Rounds even when not on the hemepath service) – anything to learn more about and show your interest in your chosen subspecialty. Also think about getting involved in a resident leadership position within the organization that represents your interests (eg – ASCP, CAP, USCAP, Association of Molecular Pathology, etc) and take your responsibilities seriously in this role because pathology is a small specialty. Word gets around if you do your job well (and also vice versa). The connections I’ve made in these positions not only allowed me to meet inspiring pathologists who will be my future colleagues but also helped me in terms of letters of recommendation.

Well, at least all that travel and the fact that I have a credit card from a major airline, saved me in terms of paying for interview travel as most of them were paid with frequent flyer points! During medical school, I got an airline credit card at least a year before residency interviews and paid for most of my interviews that way as well. Another way I saved money on interviews back then and again now, is to rent a private room in private residencies for a fraction of the cost of a hotel through the Airbnb app. Sometimes, the programs will give you a list of hotels – remember to ask about discounts for those interviewing at that specific program. Both during residency and for fellowship interviews, some programs are paying for all my expenses except for airfare! Another way to save money is to take rides using the Uber, Lyft, or Sidecar apps especially if you can find a promotion or coupon code. And remember to keep all your itineraries organized using apps such as Tripit or Kayak.

I’ll drive to most of the East Coast interviews. But this week, I have 5 West Coast interviews in 4 cities and pretty much jetting to the airport right after to catch a flight and get into the next state around midnight in time to sleep for my interview the next day. Since I have to use vacation days, I thought it best to interview every day instead of wasting a day for the bi-coastal flight. And lucky for me, I start in San Francisco and end in Seattle where I have friends to chillax with and can do the long cross-country flight back and forth on Saturdays so as not to lose a potential interview day.

I feel fortunate with respect to fellowship interviews. I’m grateful that I received invitations at most programs that I applied to unless they took internal candidates or candidates that they interviewed who submitted applications earlier than I did. I applied for two consecutive fellowships (hematopathology and molecular genetic pathology) and upfront informed programs of my intention in my cover letter. I left it up to the programs to choose in which order I’d complete the fellowships if they were interested in interviewing me for both. I’ve found that most programs were open to my proposal. Three of them even coordinated the interview so that I either had both on the same day or over two consecutive days. Among other residents that I’ve met, the popular combo this year seems to be cytopathology then molecular genetic pathology. Makes it more competitive to get a MGP fellowship as there are currently only 52 ACGME accredited positions and that does not account for those which will go to internal candidates out of that number.

I’ve never been traditional. I graduated college as a super senior (took >4 years and time off working in a biotech company), went to grad school (I have a masters in pharmacology and experimental therapeutics with a focus on transcriptional regulation and signal transduction with respect to molecular neuroscience), worked as a research scientist in molecular and cell biology and transgenics, went to med school in my 30’s, and then completed my MPH (focusing on molecular and ID epidemiology along with minority/urban health and domestic and global health policy and development) before I went to residency.

But just like Robert Frost’s poem, I think that having taken the ‘road less traveled’ has made me into the person I am today and I wouldn’t trade in my experiences for a more traditional path. Along the way, I’ve gained knowledge and skills that I think have helped me to get interviews at great programs and that hopefully will help me develop into the triple threat I aspire to be (hematopathologist, molecular pathologist, and researcher). If this is possible or too naïve a dream, time will only tell. I blog to hopefully share helpful advice or to pass on advice from practicing pathologists that I’ve met in terms of those areas of which I yet do not have experience (eg – job market). As for me, and also for you, advice is only meant to be a trigger to thought. You will need to decide what works for you and work diligently to make your personal goals a reality. As Robin Williams said in one of my favorite movies, “Carpe diem…live EXTRA-ordinary lives.” I believe that he was telling us to aspire beyond mediocrity, to push to change and not merely accept the status quo, and to create our own destiny while not dwelling on those things that we cannot change. When my fellowship interviews are complete, I’ll let you know how the journey went.

 

Chung

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

 

Reminiscing Tampa

ASCP 2014 at Tampa provided the perfect getaway for a New Yorker forced to wear fleece early October. The same attire seemed to be mocking me the moment I stepped out of the Tampa International Airport on Wednesday night. It was a pleasant surprise and I gleefully tucked it right into my suitcase.

At the hotel, I took a quick glance at the lecture schedule. Having already missed the first day, I was eager to extract the best out of the next two days. I was thrilled to see an array of topics specially aimed at residents. Also, many lectures focusing on novel or state-of-the-art techniques, including molecular methods, virtual microscopy, digital pathology, informatics, etc. It seemed to me like “The future beckons!!” Being a hard-core morphologist, it was a tough call for me, as I would have to forego a host of other good lectures. But I decided to focus on the resident review courses and ancillary techniques.

Keeping with my agenda, I set the ball rolling on day two by attending the lecture on “Automating Anatomic Pathology.” It was an eye opener for me, dealing with the scope and future of automation in anatomic pathology lab. “Anatomic Pathologist’s Role in Patient Safety” was the next. Dr. Silverman cited studies revealing that soft tissue lesions, with an error rate of 20-30%, led the list of organ specific error rates. He deliberated on the importance of second opinions in error reduction. He aptly concluded his lecture with the remark, “the pathologist is the Final Quality Assurance Officer or ‘the buck stops here.’” It was a huge wake up call for me.

I moved on to my first lecture on Molecular Pathology, “Welcome to the Beginning: Molecular Pathology for the General Pathologist and Molecular Pathologist.” It was just the right one for me and helped me firm up basic concepts. In the evening I attended “Molecular Diagnostic Methods in Oncology: an update on practical aspects.” Dr. Larissa Furtado and Dr. Yue Wang from University of Chicago were simply brilliant in elucidating the role of molecular techniques in oncologic practice. The prior morning session, helped me understand the deliberations in this talk much better.

I made it a point to attend most of the Resident Review courses. Though my Board Exams are two years away, I took it as a perfect platform to acquaint myself with the “hot” topics. I spent almost the entirety of day three attending the courses. A packed audience was testimony to these sessions’ popularity. Most of the speakers were brilliant. The case based presentations followed by an interactive voting format helped keep us all fully involved. However, the lab administration and last day hematology section could have been better.

In between, I found some time to listen to one of my all time favorites: Dr. Goldblum’s trademark lecture on soft tissue pathology. He quipped in his inimitable style “Don’t hunt for lipoblasts to diagnose a liposarcoma” and warned us of the vast plethora of “pseudolipoblasts” lurking around. Rather, he stressed the importance of analyzing the entire histology in the correct clinical context.

Let’s wander into the poster sessions! We had a total of twelve posters from our program itself, probably the largest representation from a single center. I had four posters and one of them was selected as a finalist in the Best Resident Poster section. It was an entirely new experience for me. However, I did some homework to prepare myself for the judging session. The judges on both the days were very pleasant and spent a significant amount of time discussing the work with me. It was disappointing not to get the award, though I knew the competition was tough.

The evening Mixology Lab was the perfect concluding session in the backdrop of the setting sun across the scenic Hillsborough river. There was delicious food and wine as Dr. Baloch announced the various poster award winners. It was special for me for another reason, as my very good friend Shree Sharma was one of the “top 5 under 40” award winners.

Mixology Lab attendees soaking up the sun.
Mixology Lab attendees soaking up the sun

It would be so improper if there were all work and no play. Friday evening provided the perfect opportunity to explore the city. I went out with friends to the Ybor City, taking the streetcars, which surprisingly provided 50% discount to conference attendees. Ybor City was such a happening place, full of fun. While strolling along the 7th avenue, we took pictures with people celebrating Gasparilla festival, dressed as pirates. A glass of sangria at the historic Columbia Restaurant provided the perfect toast to end the day.

My trip was not to end here as I had already registered for the TRIG Genomic Pathology Workshop for Saturday. This was my first exposure to such a session in molecular technology. We were divided into small groups. In a case based approach, the workshop deliberated on teaching principles related to the development of genomic assays and result interpretation. There were four cases pertaining to single gene testing, prognostic gene panel testing, how to design a cancer gene panel and whole genome sequencing, respectively. Both Richard Haspel and Andrew Beck were simply brilliant and they took special care to approach each group separately and clarify their doubts. It was a highly stimulating experience for me and I learned a whole new facet of pathology. The utilization of online genomic pathology tools for result interpretation appealed to me. It also gave me the opportunity to work with fellow residents from other programs in a very close and interactive manner. Though the warm sun outside beckoned, I believe this was the perfect finale for three full days of extensive learning activities.

A trip to Tampa would be incomplete without a visit to the Florida Aquarium. I took a relaxed tour of the aquarium after the workshop, visiting the lovely marine friends. When I boarded the flight back to New York on Sunday afternoon, I felt very content. It was also reassuring to see that ASCP indeed cares about resident education and needs. The meeting opened my eyes towards the new horizons in pathology and how many options lie before us for shaping our careers.

 

rifatpassportpic

-Rifat Mannan, MD is a second year Pathology resident at Mt Sinai St.-Luke’s Roosevelt Hospital Center, New York.