What is a typical day like?
A typical day begins at 7:30 am or 8:00 am with morning conference. Lunchtime is frequently coupled with didactics or conferences. Residents typically stay until 5:00 PM but some rotations may require longer hours. Resident work hours are well within ACGME limits. The balance between service and education varies with the nature of the scheduled rotation. Surgical Pathology is the busiest service; however, mechanisms are in place to maintain balance between service work and education, as well as, adequate home life.
How is the grossing schedule organized?
The grossing schedule for Surgical Pathology rotations is based on a three day cycle. Grossing takes place on Day #1 which is also the team’s frozen section day, with residents, SP fellows and PAs working as a 3-member team that leaves together at day’s end after all the required grossing is done. Cases requiring additional fixation are held over to gross on Day #2. Biopsies are signed out the morning of Day #2; slide material grossed by the resident on Day #1 is previewed on the afternoon of Day #2 with provisional diagnoses prepared for sign-out on Day #3. Slide material for held over cases is available on Day #3 for preview and sign-out that same day.
Does the high volume Surgical Pathology service allow for adequate preview time prior to sign-out?
Yes, because the Surgical Pathology division divides the service volume among faculty, residents and SP fellows in a manner that allows residents adequate preview time and quality faculty teaching at the multi-headed scope at sign-out. Turnaround time pressures are far greater on diagnostic biopsy material than they are on definitive surgical procedures. The faculty balances these pressures with resident learning by doing a portion of the case material independently while residents preview slides and read about selected cases. Initial concerns about seeing “too few cases” are relieved by the faculty’s commitment to share all interesting, unique case material with the residents.
What is the clinical pathology training like at Hartford Hospital?
The clinical pathology core curriculum includes scheduled rotation that blend bench rotations, one-on-one discussions with Division directors, assigned reading material, computer-based learning activities, sign-out responsibilities, clinical rounds and consultative activities. The emphasis in CP is diagnostic interpretation of laboratory tests, interaction with clinical colleagues, and understanding of technical methods, instrumentation, information systems, quality assurance and laboratory management. Although the majority CP rotations are not scheduled until PGY-2, weekly didactics begin immediately as part of our comprehensive Clinical Pathology core lecture series; to reinforce learning, this series is scheduled as 5-6 weekly lectures on one CP topic followed by a summarizing quiz. Approximately twice monthly, a Clinical Pathology Case Conference is scheduled; residents on CP rotations present current, interesting cases for group discussion with key CP faculty. Second and third year residents will complete at least one Clinical Pathology Project each year; projects typical involve new laboratory test development or identifying system errors. Residents receive extensive exposure to laboratory management by attending administrative meetings with lab directors including monthly Departmental Quality Assurance meeting and hospital committees. PGY-4 residents are given direct management responsibility in a self-selected subdivision of the laboratory. The resident works with the Medical Director and the section manager/supervisor for 6-8 months, becomes involved in all management activities and serves in lieu of the medical director on issues when possible. Activities include attending laboratory management meetings, undertaking a Quality Improvement project/activity, performing a CAP mock-inspection and ultimately completing a 4-week Laboratory Management and Informatics rotation.
Are their Book Fund Monies?
Every year, the Office of Academic Affairs disburses money from the Mead Fund for residents travel/book purchase expenses. The Mead Fund Committee meets annually and determines what each department will receive for each fiscal year, in past years the funds per resident ranged from $1000 to $1200. Participation in scholarly activities in the Department is encouraged; therefore, funding beyond the allotted Book Fund will be available for travel if the resident is presenting the results of research activities at a regional or national meeting.
What are Call responsibilities?
Call is scheduled as a 3-day weekend block (Friday PM to Monday AM) and a 4-day weekday block (Monday PM to Friday AM). Call mirrors the Surgical Pathology attending schedule, who are on-call from Friday PM to the following Friday AM). Call is scheduled as a fixed in-house duty shift (which can be assigned to PGY-1 residents) and/or at-home (pager) call. The duty shift hours are Monday through Friday 4:45 PM to 10:00 PM and Saturday 7:30 AM to 6:00 PM. On-call responsibilities include:
- After-hours intraoperative frozen sections with SP attending on-call, typically occurring weekdays between 5 PM to 9 PM and randomly on Saturday and Sunday;
- Assist the Day #1 team gross/process SP specimens after 4:45 PM, if an exceptionally heavy caseload;
- Grossing of SP specimens accessioned on Saturday;
- Saturday and Sunday autopsies are generally deferred to Monday; however, in the event that an emergency autopsy has to be done on the weekend, the PGY1 resident on the autopsy service will perform the procedure.
- CP and AP pager call for the clinical laboratory
The call schedule is put out for the entire year so you can plan your life, but since the unexpected can happen, most residents end up switching call with other residents. Call assignments are made in a manner that ensures equal numbers of call blocks per PGY level.
How do recent graduates perform on AP/CP Boards?
Since 2009, residents who took the AP/CP Boards late in their PGY4 have had a 100% pass rate.
Are residents required to pass USMLE step III during training?
Yes. As of July 1, 2014, Hartford Hospital Graduate Medical Education Step III policy states that all residents must have taken the USMLE3/COMLEX3 before the end of their PGY1 year. Successful completion of the USMLE 3/COMLEX 3 is a requirement to be promoted or appointed the PGY3 or above training level. If a resident enters Hartford Hospital residency program as a PGY2 and has not taken or passed USMLE 3/COMLEX 3, the resident must take the USMLE 3/COMLEX 3 within the first six (6) months of the PGY2 year. Failure to meet the requirements outlined in this policy will result in a formal meeting with the program director and a designee from the Medical Education Office.
Are graduates able to obtain desired fellowships?
Yes. Our graduates are highly successful in obtaining desirable fellowships in well known academic centers. Within the past three years, Hartford Hospital graduates have either completed or been accepted to fellowships at Memorial Sloan Kettering (SP, Cytopathology, GU), M.D. Anderson Cancer Center (SP, Hematopathology), University of Pennsylvania (Hematopathology), Emory University (Soft Tissue), Mount Sinai Medical Center, NY (GI) and Brown University (Neuropathology). Graduates are performing well in these fellowships; their feedback is that Hartford Hospital fully prepared them for their fellowship and for the practice of Pathology.
Hartford Hospital also sponsors Surgical Pathology, Cytopathology and Hematopathology fellowship programs. Preference is usually given to internal candidates for consideration of early acceptance.
Are residents involved in Teaching?
Yes, however, our residents and faculty are not involved in teaching at the University of Connecticut medical school. Interdisciplinary Conferences are major venues to develop teaching skills. Residents must present pathologic findings to non-pathology clinical colleagues (surgeon, radiologists, oncologists) and discuss the implications and clinical outcomes of these findings. Residents highlight key diagnostic elements, and field questions about both diagnostic differential and clinical concerns. Medical-Pathology CPC Grand Rounds is one of the first interdisciplinary conference PGY-1 residents present, but their presentations receive significant one-on-one mentoring by the faculty. Each year, residents prepare a Resident Topic Presentation; in this venue, residents develop and demonstrate the skills to teach pathology to other pathologists. Another important teaching venue is in the collegial environment at Hartford Hospital. Senior residents are actively involved in training junior residents while on service. In addition, we have rotating medical students and clinical observers on month-long clerkships in the department.
Are resident Involved in Scholarly activities?
Yes, poster presentations were given at national meetings, and several publications were produced by our residents in the 2014 academic year. A variety of QI Projects within the department were also performed by the residents. Pathology Education funds are available for residents to attend conferences if they are an author on poster/platform presentation at national meeting.
How are the resident concerns addressed?
There are multiple venues to address problems within the program. The easiest and most direct means is discussing individual concerns with the program director. However, some issues are better addressed with consensus and support from fellow residents. The Chief Resident is important in addressing more complex, collective problems. Resident Meetings are held with the program director on alternating months; quarterly, resident meet with the Hartford Hospital director of GME. Hartford Hospital also sponsors a Resident Counsel that includes representing residents from all Hartford Hospital sponsored residencies. The multiple venues ensure that concerns are addressed in a timely fashion. In addition, Hartford Hospital has a hotline for the Employees Assistance Program which will direct the individual to the service/person that would give the best help for any personal or work-related issues.
Do residents have their own workspace?
Yes, residents are each assigned their own desk, computer and microscope in the Resident Room; assignments change yearly. Additional desk space with microscopes and computers are available in the departmental library (VJ office).