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|Q:||How does the surgical pathology rotation work?|
The surgical pathology rotation here at Maryland operates on a three day cycle, with three residents on service at a time. On the first day, you will be in the grossing room “grossing in” specimens (dictating gross descriptions, orienting, and cutting the specimens into the sections that you want to examine histologically). This typically is an all day job, but there is time for lunch breaks, bathroom breaks, etc. As a resident, you are responsible for grossing all of the cancer cases. We currently have 2 pathologist assistants (PA) that gross biopsies and some non-cancer routine cases. The grossing room currently has three up-and-running grossing stations, with a fourth that should be operational soon. We also have a digital photography system in the gross room for photographic documentation.
On day two we are responsible for frozen section requests from the operating rooms and for signing out biopsies that were grossed on day one (usually grossed by the PA). This means you will spend most of your time on day 2 up in the frozen section room on the second floor. The resident on day 2 is responsible for getting the frozen section pager from the resident who was on call the night before (technically by 7:30AM, but it usually happens at 8AM) and is responsible for frozen sections from the main operating rooms until 5PM (at which time they can give the pager to the resident on call that night). Typically, you are done signing out biopsies by 4 or 5PM. Day 2 is also when we preview our cases for routine sign out on day 3. The histology lab usually has the slides ready by 3PM, so if you are done with biopsies and there are no frozens, you could get started as early as 3PM. Preview time is your own time, so you can manage it however you like. Some people like to get it all done that night while others like to split it up between that night and the next morning. This makes day 2 the longest of the three days on the surgical path rotation. There is usually adequate time to preview all of your cases as well as to read about a few of the bigger ones so you can impress your attending.
On day three we sign out the cancer and routine cases with an attending. Sign out usually begins by 10AM and lasts as long as it takes to sign all of the cases out. Typically you are done by 5PM or earlier and have some time to catch up on other lingering cases (these tend to build up).
A PGY-1 will typically do 4 to 6 months of surgical pathology during the first year. Transitioning into surgical pathology can be challenging, especially if you have had no prior surgical pathology experience (which is fine), so in the first month of surgicals a first year resident is paired up with a senior resident who helps them get adjusted to the rotation and shows them the ropes. This is in contrast to some other programs where you may only get a day or two of training and then you’re on your own.
|Q:||So, I have to go to the VA (aka "the SPA") for surgical path?|
You will rotate at the VA for surgical path approximately 4-6 months during your 4 years. The number of specimens they receive each year is ~4000 which is about 1/3 the number of specimens at Maryland. The cases at the VA are different than at UMMS which is a good thing for your education. For example, you will sign out multiple skin biopsies daily which is a specimen we lack at Maryland. Instead of the 3 day cutting cycle, you do all 3 phases everyday (don’t worry, sounds worse than it is). The typical day lasts from 8AM to 5-6 PM (faster you are, sooner you’ll leave). The mornings are relatively quiet because your biopsy slides don’t come out until 1PM or so. You can use that time to gross large specimens you put off, I mean didn’t have time to get to, the previous day or to read. After you finish signing out the biopsies (around 2-3 PM) you start grossing that day’s specimens.
The VA is biopsy heavy, so the late grossing start time isn’t too much of a problem. You load the processor yourself and it has to start by 6PM. There are only a few frozen sections (1-4) per week which you are responsible for and you’re not required to do after hours frozens. Routines are signed out by the attendings themselves and they’ll show you any interesting cases they may have.
|Q:||What is the call schedule like and what does being on-call involve?|
One of the nice things about being a pathology resident is that being on-call doesn't have to ruin your life. There are 3 types of call you will take during your time at Maryland: surgical, autopsy, and clinical. Your duties on call will consist of a mixture of "in-house" and "from-home" learning opportunities.
Surgical call begins only after you have had at least one month of surgical pathology. For the most part, being on surgical call means that you will be responsible for any after hour frozen sections and for transplant biopsies (we do all kinds of transplants here, but the majority of transplant biopsies you will see on call are kidneys). It is really 50/50 on whether you will get called on any given night. Typically, if you get called, you will pick up the kidney biopsies from the blood bank, cut frozen sections of them and load them into Aperio (our online microscopic digital imaging system) so the attending can access it from home. As you advance through the program, you are given more responsibility for reading biopsies on your own without having to consult the attending in the middle of the night. First year residents do not take overnight call, however, they do cover intraoperative consultations after hours on a limited basis.
Clinical call involves being available to answer questions that clinicians may have about any of the clinical laboratories as well as blood banking issues. Most often this involves approving or denying platelet requests and working up suspected transfusion reactions. You begin taking clinical call only after you have been on the blood bank rotation, and this is typically sometime during your second year. Generally, as you progress through the years of residency, you will take more clinical call and less surgical/autopsy call.
Autopsy call is taken a week at a time (Monday - Friday) and involves being available to perform off hours autopsies for both UMMS and the VA hospital. During the week it is an extreme rarity to get called for an off hours autopsy (unless there are some incredibly rare extenuating circumstances involved). Residents do not take autopsy call until they have completed at least one month of an autopsy rotation.
|Q:||Where do the residents live? Is the area safe?|
The residents that are currently in the program at Maryland live both in the city and in the surrounding suburban areas. There are options to live as close as a block away from the hospital to as far out as you want to be. The commute into the city, if you choose to live outside of the city, is not bad if you’re coming from south of the city because most of the traffic is heading south toward Washington D.C. in the morning. There are also affordable housing options in the city of Baltimore itself, some of which are within walking distance from the hospital. Downtown, Federal Hill, Fell’s Point, Canton, and Mount Vernon are all reasonably priced areas to look for housing options.
The area surrounding the hospital and professional school complex has more than adequate security. As in any city, there are nice areas and not-so-nice areas that are in close proximity to each other, but the medical campus is as secure as it gets around here. That being said, I wouldn’t recommend walking around at midnight alone with your gold watch and iPod. Residents have access to free parking in a covered garage that is also monitored and secure. There is no fee for parking, which is one of the nice perks of this residency.
|Q:||What kind of teaching opportunities will I get at Maryland?|
There are several opportunities for teaching that you will be offered while at Maryland. Opportunities to teach medical students, medical technologist students, pathologist assistant students, and fellow residents are available throughout the year. The PA student pathology course along with one resident lecture are the only required teaching; the rest is on a volunteer basis, and there are almost always enough residents who like to teach and will volunteer that those who do not want to teach don’t have to. Most of the teaching is done in a small group setting. Along with giving PA student didactics, we also help them with learning how to gross specimens in the grossing room while we are on surgicals.
|Q:||How much research is done and are there any research requirements for residents?|
|A:||There is no requirement for research projects at Maryland. It is always encouraged to do research, as it is both helpful for the field of pathology overall and helpful for you as you will be applying for fellowships and jobs, but no one is going to force it on you here. Typically, residents that graduate from this program have written several case reports or done other projects. Case reports are the easiest opportunities to find, but if you are interested in more basic research there is also the opportunity for that.|
|Q:||What kinds of fellowships have recent residents gotten and where?|
|A:||Residents who graduate from the Maryland program go on to great fellowship programs. Many of our residents have done fellowships at Johns Hopkins, which is one of the major selling points for our program. We have had residents get fellowships in all different pathologic specialties, including dermatopathology, forensics, genitourinary, molecular, gynecologic, cytology, renal, etc. You name it, we've done it, and at well known, prestigious institutions. You will have no problem getting a great fellowship and a good job coming through the Maryland program.|
|Q:||Will I have to buy my own books and what other resources will I have access to?|
|A:||Each resident gets a $1000 book fund each year (does not roll over from year to year) that can be used to buy text books. Additionally, the book fund can be used to pay for board review courses (including the Osler review course for APCP boards and USMLE Qbank) and board exams. For instance, several residents have used the book fund in the first year to pay for step III of the boards. You can also use the book fund for travel, if you so desire, although we are also allowed $1000 per trip to a conference where you are presenting a poster or giving a presentation. The University of Maryland Health Sciences and Human Services Library (HSHL) is also available to residents and is considered to be one of the largest and best medical libraries in the country. There are lots of online journals and texts that are available through the HSHL for our use. The pathology department itself has a library of books that are available for referencing. Basically, if you need a book or a journal, you can easily get it.|
|Q:||Is there a local gym that the residents have access to?|
|A:||A brand new gym was recently built and opened right across the street from the hospital. It is equipped with a pool, rooms for exercise classes, two full-size basketball courts, two racquetball courts, several weight lifting areas, a cardio area, locker rooms with sauna, indoor running track, and more. Unfortunately it is not free for residents, but membership fees are reasonable if you are looking for an easily accessible and convenient place to work out. The city also offers several other options, including a Golds gym near the inner harbor. Many of the apartment buildings in the city have their own gyms as well.|
|Q:||What kind of social scene does Baltimore have to offer?|
|A:||Baltimore is a fun city to live in. There are a lot of unique dining options as well as a fair number of bar/night clubs for anyone who likes to party. The inner harbor also offers family friendly activities, such as the Maryland Science Center, Baltimore Aquarium, Harbor Place, and of course the Orioles and Ravens.|
|Q:||Tell me all about the clinical pathology rotations.|
|A:||Like most other pathology residency programs, you will find, CP is not as strong as AP, mostly because it is not resident driven. In other words, residents are not essential to the functioning of the CP lab in most cases. Accordingly, this is reflected by the pass rate for the CP boards across most pathology residency programs. At Maryland, residents are not essential for the labs to function; however, this does not mean that residents do not get involved in the laboratory setting. The rule is that you get out what you put into the CP rotations. There is a lot of time for reading during these rotations, and they offer a good opportunity to take on projects such as writing papers and taking step III of the USMLE boards. We have instituted pre and post-CP rotation examinations to help keep us on track for what we will need to know for the CP portion of the boards. Again, being assertive and willing to spend time in the laboratory is the most important key to really learning on these rotations. The CP rotations here at Maryland include immunology, cytogenetics, molecular, chemistry, microbiology and blood bank. These rotations are split between UMMS and the VA hospital.|
|Q:||Are there any scheduled learning opportunities for residents?|
|A:||We have scheduled conferences on most weekday mornings. Attendance to these conferences is not mandatory, but we do try to attend as many as possible. The conferences range from CP to AP topics and cover all of the subspecialty areas in pathology. Examples of the different types of conferences that we have can be found on our website (http://www.umm.edu/pathology/residency/res_info.htm). Thursday morning is considered "protected time" for residents, which basically guarantees at least 2 hours of didactic opportunities per week for every resident, regardless of what busy rotation they may be on at the time. Our PA's are essential in this process as they cover frozen sections during the conferences on Thursday mornings. Many of the conferences are resident driven, such as gross conference, where the residents currently on the surgical pathology rotation will show interesting cases they have grossed that week.|
|Q:||Do residents interact with other departments in the hospital?|
|A:||There are several weekly interdepartmental conferences that the residents are responsible for covering along with an attending throughout the year. You will be assigned to cover these conferences on a monthly basis. The conferences that we cover are Thoracic, Head and Neck, GI, Solid Tumor, and Endocrine. The clinicians will send us cases that they would like to review and we then scan the slides into Aperio (the microscopic digital imaging system) so we can talk about them at the conference. As a first year you will have a senior resident to help you with your first month of covering a conference. Occasionally we have autopsy correlation conference, where a patient's case is reviewed from the beginning of their presenting symptoms to the autopsy findings. This is a collaborative effort between the pathology department and whichever department was responsible for the patient. Autopsy correlation conference is not a regularly scheduled conference, however. We do interact with surgeons the most, especially when doing frozen sections. You will quickly become accustomed to speaking with surgeons, clinical oncologists, and many other specialists and primary care doctors.|
|Q:||How much vacation time do residents get and how can it be used?|
|A:||Residents at Maryland are allowed three paid weeks of vacation per year that can be taken during any off-service rotation. In addition, you get either the week of Christmas or new years off as well as the standard national holidays. You can take up to one week of vacation at a time. Of course, if you are on call during your vacation, you would still have to take it unless you can switch with another resident, which is usually pretty easy to do.|
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