How to Choose a Pathology Residency
Written by Clarissa Jordan, MD and Philip Hurst, MD
Having matched as anatomic and clinical pathology residents two years ago, we’re really passionate about helping medical students interested in pathology and wanted to share what we learned in the hopes that it might be useful. First, a couple of disclaimers: these are our personal opinions and experiences, and may not be representative of all students or residents. The views expressed herein are our own and do not reflect the views of our employer.
Congratulations on choosing pathology! Below you’ll find a collection of topics and questions that were useful to us on the interview trail (plus others we’ve added with the benefit of hindsight).
Grossing schedules
Different programs have different “cycles” where the residents spend different amounts of time split between grossing specimens, previewing them on their own, and then signing them out with an attending. The most common variations are 1-day and 3-day cycles. A 1-day cycle means you may do all of these things in a single day, e.g. grossing in the morning, signing out in the afternoon, and perhaps previewing your next day’s slides in the later afternoon/evening.
3-day cycles are a little more intuitive: the first day is for grossing, the second is for previewing, and the third is for signing out. Despite the differences, it’s probably not helpful to dwell on this too much. Once you start residency, you will likely assimilate to whatever schedule your institution has.
Resident workrooms
Most programs should have a space where you can sit at a desk for the various rotations you will be on and have your own microscope, etc. We feel it’s nice to have a space of your own, regardless of rotation, so you always have a “home base.” (And a place to keep snacks!)
Resources
Many programs will pay for educational resources, such as ExpertPath (think Wikipedia for Pathology). Almost all of them provide book funds (though there may be different restrictions on how you can use these funds). Also, ask about financial assistance to attend conferences to present research. It may be that these aren’t the make-or-break point for ranking programs, but still are something to consider, nonetheless.
Fellowships
Pathology is a small world and programs generally like to keep their residents for fellowships, so if you’re thinking about a specific fellowship, check to see if the program has it. If you don’t have a fellowship in mind, you could consider a program with a diverse selection of options. It also may be informative to ask about where graduates of the residency go for fellowship and/or end up practicing - some programs will have this information on their website.
Along the same lines, consider the division of cases between fellows and residents. If an institution gives more priority to their fellows, you may not see as many cases as you hope during residency, especially if the volume of the institution is not so high. Feel free to ask about this in your interview.
Call
Call schedules can vary from program to program. The most important differences are whether the call is mixed (AP and CP) or service-specific, and when you take a call (throughout the academic year or only when you are on those rotations). Also ask about support while on call, i.e. do residents feel comfortable calling the fellow or attending if they’re unsure about something.
Curriculum
Most programs are combined anatomic and clinical pathology, but many differ in how their curriculum is set up. Some programs will have a mix of AP and CP throughout all four years, while others will keep them separated into different years. Especially if you are interested in a CP fellowship, ask about the strength of the CP curriculum (which we found varies more widely across programs than the AP curriculum).
Something else to ask about is general vs. subspecialty sign-out (i.e. do you gross/preview/sign-out a mix of cases or only one organ system at a time). There are pros and cons to both, and you’ll likely get used to whichever you end up in.
Every program should have a (usually daily) didactic curriculum. Pathology has perhaps the steepest learning curve of any medical specialty because we get so little exposure in medical school, so that’s where having a strong didactic curriculum is important. Ask if the lectures are stored somewhere so you can review them again, if needed, and find out what other resources the program has for resident education.
Graduated responsibility and feedback
“Graduated responsibility” is a huge buzzword in pathology interviews, so you’ll likely hear a lot about how the program allows you to gain more responsibility and independence as you progress through training. A crucial part of this process is getting feedback from attendings.
Ask about attending feedback on your diagnoses and reports. What mechanisms are in place to facilitate this? Do you double scope with consultants? With fellows?
Electives
Find out when and how easy it is to get electives in which you’re interested. You’ll want some elective time at least in the second year, as you’ll have to soon thereafter start applying for fellowships! The earlier you know where your interests lie, the earlier the program may be able to start helping you plan your schedule.
Pathologists’ assistants and grossing rooms
Pathologists’ assistants are invaluable teachers at the grossing bench and beyond. Ask about how many PAs your program has to get a sense of how much grossing support you’ll have. Along those lines, ask about how the grossing rooms are set up — you want to make sure there are enough benches to allow for efficiency (you don’t want to have to wait for someone else to finish grossing!).
Work/life balance
Of course, your life is more than just being a pathology resident! While residency will always be busy, pathology is a specialty that lends itself pretty well to life outside the hospital. On your interviews, find out about the residents’ quality of life by asking about what they do on the weekends or what they do for fun outside of work. If they don’t have good answers or say they’re too busy, it may be something to note! We strongly encourage you to consider work/life balance in making your rank list — you are first and foremost a person!
People
Possibly the most important aspect of a program is its people. Are the attendings approachable and willing to teach? Are their offices located nearby so you can make connections or pop in and ask a question if you need to? Do the residents like each other?
Remember, you will spend so much time with these people, so it’s important to have a collegial and friendly environment, both inside and outside of work!
Hopefully, this is helpful to you as you’re coming up with questions to ask during your interview day, and considering how you’ll rank programs. As always, best of luck to you in the match!
