Guidelines for Pursuing a Residency in Pathology (AP/CP)

Transcription

1 Guidelines for Pursuing a Residency in Pathology (AP/CP) 1

2 WELCOME! The Field of Pathology: Welcome to the field of pathology! Falsely believed to be filled with kooky, sociallyinept pathologists, pathology is actually filled with extremely intelligent, competent, and compassionate physicians who are passionate about patient care at the level of the microscope or laboratory. However, generalizations are tough to make in this extremely diverse field: a pathologist can be a laboratory director, a medical examiner, an general diagnostician, a researcher, an educator, or even a hospital administrator, working in the setting of a large university hospital, a small private laboratory, a small community medical center, government agency, a medical school, or a biotech company. In general, pathologists experience a high degree of satisfaction with their work. According to Careers in Medicine, early in their career, pathologists can earn between $154,000 to $203,000; later in their careers, the range ups to between $239,000 to $331,842. Naturally, these values vary based on subspecialty field and setting of practice. Applying for a Pathology Residency: While pathology remains less competitive than many other fields of medicine, it is increasingly becoming more competitive because of exciting advances in medicine, the variety of career paths, lifestyle, and the earning potential. A well-informed and prepared applicant generally has the most success with the Match. We want to make you as well prepared as possible, so you match at the program that you want. Outline for this Packet: We would like to give you some information about the following: Pathology residency and the variations between programs Subspecialty options and different residency tracks General differences to look for in programs Time line for 3 rd and 4 th year 4 th year away rotations Suggestions for: CV, personal statement, and letters of recommendations Tips for interviewing and interview questions Thoughts on thank you notes, second looks, letter of intent, and ranking programs Faculty names and resources within the department Where other NYMC residents have matched Electronic Resources Good luck and enjoy! Please be in touch about any questions you have along the way! AN OVERVIEW OF PATHOLOGY RESIDENCY TRAINING: Programs Tracks: Anatomic Pathology (AP) 3 years Clinical Pathology (CP) - 3 years Combined Anatomic and Clinical Pathology (AP/CP) - 4 years Combined Anatomic Pathology and Neuropathology (AP/NP) - 4 years 2

3 Combined Anatomic Pathology and Dematopathology (AP/DP) 4 years AP/research or CP/research - Some programs also offer this 3 or 4 year track that is more research oriented By far, most applicants choose AP/CP. A commonly cited reason for this is to increase employment options after graduation from residency. However, applicants who know they are going into forensics may apply to AP only, while applicants who know they are going into blood banking may apply to CP only. It is possible to apply for one track and then switch into another depending on the flexibility of the program (but, be sure to ask the program director at your interviews!). It's more of a scheduling issue, for example, if you go from a 4yr to a 3 yr program. They now will have a year short one resident, but many programs are very, very flexible. Just ask! ACGME Pathology Residency Training Requirements: AP 24 months plus 12 additional months of education/electives CP 24 months plus 12 additional months of education/electives AP/CP 42 months with 6 months for elective time Call and Work Hour Regulations: The ACGME currently sets a work hour limit of 80 hours/week. Each shift cannot exceed 16 hour and an 8 hour break is required between all daily duty periods. According to the ACGME in-house call must occur no more frequently than every third night, averaged over a four-week period. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to 6 additional hours to participate in didactic activities, transfer care of patients, etc. However, most Pathology call is home call. The frequency of home call is not subject to the every third night, or 24+6 hour limitation. But, residents taking at-home call must be provided with one day in seven completely free from all educational and clinical responsibilities, averaged over a four-week period. Call frequency and responsibility vary between programs. Call duties may include reporting critical values, approving send out labs, performing autopsies, reading bone marrow biopsies, working up transfusion reactions, and cutting frozen sections. ACLS and BCLS Certification in ACLS (Advanced Cardiac Life Support) and/or BLS (Basic Life Support) may be required at the beginning residency. If so, ask your program coordinator if they will pay for and set aside orientation time for ACLS and/or BLS training. Board Certification: The American Board of Pathology (ABP) offers primary certification in AP, CP, and AP/CP. The ABP issues certificates in the following subspecialty areas of pathology: blood banking/transfusion medicine, chemical pathology, cytopathology, forensic pathology, hematology, medical microbiology, neuropathology, pediatric pathology, dermatopathology, and molecular genetic pathology. There are many other fellowships, but they are not officially board certified (ie. Not ACGME accredited) and there is no separate board exam. These fellowships include almost every organ system. Just because 3

4 they are not board certified does not make them worthless or viewed as weaker than other fellowships. Board certification is accomplished through the ABP usually during the final year of residency. Upon completing the on line application, the application is reviewed by your program director. Receipt of your medical license, medical school diploma, and Step 3 score are also required. The Credentials Committee then determines whether or not you are qualified to sit for the exam. Some general questions to think about: Which track would you choose (AP, CP, AP/CP, AP/NP, AP/research, CP/research) and how certain are you that you would stick to that track? Is there any area of interest within the track you choose that you might consider for a fellowship after residency training? Do you want a career in academia, private practice, or industry? Subspecialty options available: Historically, pathology residency was a 5-year AP/CP residency in which the first year was a general internship year on the floors, followed by four years of general AP/CP training. The push for subspecialty expertise in all fields especially surgery led the pathology curriculum to change to meet the demands of our clinical colleagues. Thus, the internship year was eliminated; the trainee thus completes four years of general AP/CP training, with the expectation that most graduates would then go on to complete a oneyear fellowship in a subspecialty field before seeking employment. It is the rare graduate who does not complete a fellowship; in fact, many graduates go on to do more than one fellowship. It is commonplace to complete two fellowships. Most fellowships are 1 year (with some 2-year fellowships as the exception). Most are ACGME-accredited (No board exam) but some are not. Unlike other fields, Pathology fellowships do NOT involve a Match Process. Thus, for now, personal connections, reputation of the institution and each institutions bias for its own residents play a role in fellowship placement. There is talk of pathology fellowships becoming a Match-based process, changing the traditional way fellowships are obtained. Website with the current specialties that have board certifications The following fellowships exist, although not all institutions offer all fellowships: Anatomic Pathology o Ob/Gyn (non-accredited; sometimes combined with breast as Women s Health Fellowship) o GI (non-accredited) o GU (non-accredited) o Renal (non-accredited) o Breast (non-accredited) 4

5 o Endocrine (non-accredited) o Bone & Soft Tissue (non-accredited) o General Surgical Pathology (all organ systems; non-accredited) o Cytology (accredited) o Forensics (accredited) o Pediatrics (accredited) o Hematopathology (accredited) o Clinical PathologyDermatopathology (accredited; can be two-years and open to dermatology residents) o Neuropathology (accredited; 2 years) Clinical Pathology o Microbiology (accredited;open to PhDs only) o Clinical Chemistry (accredited) o Blood Banking/Transfusion Medicine (accredited) o Molecular Genetic Pathology (accredited) o Clinical Informatics (accredited) Other career options/further educational opportunities include an MPH, international health, health policy, Community and Preventive Medicine residency or master in education. GENERAL DISTINGUISHING FEATURES OF RESIDENCY PROGRAMS Gathering as much information about how pathology residency works is the first step in being able to figure out what questions to ask on an interview; this explains why away rotations can be so helpful in allowing you to observe the way various programs structure their yearly curriculum as well as their daily schedule. Once you know this, you can start to get an idea of what questions to ask, keeping in mind that the information you gather on each program (ie, the answers to your questions) fall on a spectrum for each issue. For example, a reasonable question to ask is the program s research opportunities and expectations, which range from a single-case report during the entire residency program (light) to a full-on, original research project (heavy). Depending on your desire to be involved in research (are you an MD/PhD? Are you interested in an academic position one day?), each program will be a different fit for you. Thus, the key is knowing where you, the applicant, fall on the spectrum for various parameters and then determining where the programs fall on the spectrum for various parameters; where these align will be your best fit and where you ideally will match. BASICS: Geographic location o There are excellent programs throughout the country o Carefully consider: where do you want to live? City vs. suburb? Climate? Cost of living? Ease and comfort of life? Family and social support? o Where do you want to settle down and set up connections for fellowship and employment? 5

6 o How many hospital sites does the program operate on? How is transportation between the sites arranged? Large Academic Center vs. Private Practice o University hospital with medical hospital vs. for profit private hospital vs. physician group with outside contracts o Size of the program, number of hospitals, number of residents, fellows, and attendings o On the AP side: look at the surgical department, i.e. diversity and volume of surgeries and surgical specimens, ask if there is help grossing (pathology assistants) o On the CP side: look at the number of lab samples/year, if there is an onsite reference lab, if there is an on-site blood center, how many tests are sent out to larger labs Reputation of program and faculty o The reputation of the program and the faculty will help in obtaining a competitive fellowship (Dermatopathology, GI), but you must consider that your fellowship placement should be dictated by your ultimate career (i.e., if you intend to practice at a small community hospital, try to go for the best fellowship possible, but it need not be the most academic fellowship) o Do not choose an institution for a single faculty member because that faculty member may leave! Curriculum: o Balance, as well as timing and flexibility of AP and CP. AP and CP mixed throughout four years? Or alternating 2 years AP and then 2 years CP? Some say a mixture keeps topics fresh and more involved. Some argue that since CP tends to be lighter (depends on the program!) having it the final two years lets you study for boards more. Research o Research required? If so, are resources there? (i.e. dedicated lab help, equipment, training) o Expectations to be published Quantity of papers Nature of papers (i.e., case reports or original research) Realistic timeline: during first year or beginning in third year? o Are students presenting at national conferences? Post presentation or podium presentations? o Do they fund travel expenses to conferences? How many/much? Do you have to be first author? Teaching o Is teaching medical students optional/required? Is it protected time? Is preparatory material given out? o Are residents taught effective teaching methods? o Do medical students rotate in pathology? Does the program have a Post- Sophomore Fellow? Education 6

7 o Are there regularly scheduled didactic sessions? Are they effective? Are they well-attended? o Is conference participation funded? Airfare? Hotel? Dues? o Is there an online, accessible common drive where lectures are stored and accessible from any computer? o Electronic access to journals? o Range of teaching course topics: AP, CP, Lab management, Job search prep? o Is there a library with real books? o Is education time protected? Can only AP-residents go to AP-lectures or can CP-residents attend too? o Ask residents, is learning mostly reading on your own vs. At the scope with attendings AP Questions o Is AP teaching and signout done with subspecialists or with generalists? With attendings or fellows? o What is the structure and schedule of basic activities: preview, signout and grossing? How many days is the Cycle? o Realistically when do slides become available for preview? Are there problems with slides being late often? o Number of pathology assistants? Do they gross biopsies or surgicals? Do they help with frozen sections? o Do you get to do your own frozen sections? o Try to get a sense of how independent or intense surgical pathology rotations are and match them with how you learn o Is there a hot seat or junior attending rotation? If you like, it gives you a sense of being the attending signing out cases and making diagnoses. o With all the above into consideration, what is their AP board pass rate? CP Questions o How important is the quality of a program s CP department to you? (i.e., is a CP fellowship a real option or are you just AP/CP for the sake of better job opportunities?) o What are the divisions of the CP lab? (Many labs have more than the classic four areas of hematology, blood bank, microbiology and chemistry) o Is the CP learning active and on patient floors, or is it mostly textbook and lecture based? o How is CP integrated with AP? Are the departments completely separate? o Does CP run the apheresis services? o Do clinical teams perform rounds with CP residents? (i.e., ID rounds in Micro lab for part of their rounds) o Again, all things considered, what is their CP board pass rate? (normally a little lower, if not the same as AP) Cytopathology 7

8 o Time spent in cytopath (a large portion of Boards, but often only a month or two of residency) o Role of cytopath fellow (if there is one) o Do residents get to perform U/S guided FNAs and other procedures? o Gyn vs. non-gyn specimens Autopsy o Trouble meeting requirement of 50 autopsies? o Rotation at a ME s office and if so, can these post-mortems be applied to total autopsy count o Supervision in autopsy? Do you learn from a resident, attending, or diener? o Are there autopsy rounds? How it it integrated into the curriculum? o Are autopsy cases shared between residents? o How long does it take to complete one autopsy (Should be less than 60days)? o Is there a Diener? Do they teach? What method is used for organ evisceration and can you learn multiple? Post-Graduate Opportunities o Where do graduates go for fellowships? In what specialties do they do those fellowships? (Subspecialty is as important as location and don t hesitate to ask how many people are typically accepted into that fellowship) o What kind of jobs do they get after fellowships? o How many residents are accepted for in-house fellowships? o Which in-house fellowships are available? Who do they go to? LIFESTYLE/HAPPINESS: Resident Morale - Are residents happy? Is the environment competitive and about showing what you know? Do residents help one another? Do the residents socialize outside of the hospital? Cohesiveness Attending Resident Rapport Do attendings regularly chat with the residents about their experience? How often do Program directors/mentors/coaches meet with residents regarding their concerns and future plans? Flexibility, Adaptability and Change o Have residents been able to bring about change regarding their own curriculum? Family Friendliness Vacation LITTLE DETAILS: Amenities o Free meals at conferences, meal stipends when on call o Parking o Book/computer/review course stipend o Sponsored happy hours/social events 8

9 Salary, benefits, stipends, housing Call schedule: o For AP frozen sections? For Autopsy? For CP? Cross-coverage? o Home call or in-house call? How often? Resources o What is the dictation program? o Do they have a camera station for gross images? Do they have a computer dedicated to image optimization? (important for a program that encourages publishing) o How is the EMR? Is it full EMR yet? Think of having to leave the lab in order to get patient histories, if needed, from paper charts. o Do you get your own computer? Microscope? APPLICATION TIME LINE: Spring, 3 rd year of medical school While you are doing o Your third-year rotations Express interest in Pathology to Dr. Fallon, Chairman of Department of Pathology and other potential mentors (i.e., NYMC alums) During medicine/surgery rotations, if you have time, head down to the frozen or pathology lab and look at your patients' biopsies with a pathologist. You'll get some exposure and it will even show your clerkship team that you are taking that extra step to know more about your patients. Plus, you can give them a diagnosis well before the report comes out. You are planning o Your schedule for fourth year Choose when you want to take Step 2 CK/CS first and then when you want your away electives Since away electives in pathology are important, try to schedule them for as early in the year as possible. For example, July, August and September This allows you to audition early as well as obtain letters of recommendation from each rotation o Away Rotations Pick 2-3 reach schools and set up away rotations at those schools Go to VSAS or school s website (googling Medical School ABC Pathology away elective is often easier than navigating Medical School ABC s website) Call schools if the elective sounds competitive in case there is a waiting list Set up necessary doctor s appointments and health documents based on what that rotation requires 9

10 AP and CP are very different and it is a good idea to get a sense of both. Consider an AP rotation and a CP rotation; CP-only rotations are hard to come by so applying to a general Pathology elective and then asking to spend some time in the clinical lab is also a possibility. If CP is not of interest, doing a general AP rotation followed by a more specific rotation might be helpful. (e.g., 1 month surg path, 1 month of GI path). Rotations at a Medical Examiner s office also can be interesting for those interested in Forensics. Summer, 4 th year of medical school While you are doing o Step 2 CK or Away electives, impressing the institutions you re at (see section below on Audition Elective ) You are planning o Preparation of CV / Resume as pertains to ERAS (i.e., brief descriptions for each item) o Preparation of Personal statement and have multiple people read it o Obtain letters from the chair, program director, or professor/physician you worked closely with at your away rotations (ask them early so they can submit their letters by Sept 1) Programs will need a minimum of 3 letters and a max of 4. They do not need to be from only pathologists, but you should include at least one pathologist. July 1st While you are doing o ERAS application registration opens. Begin completing ERAS application o Step 2 CK or Away electives, impressing the institutions you re at (see section below on Audition Elective ) You are planning o Begin contacting alums in Pathology or other mentors to ask them for advice It is important to gather information regarding residency programs from these mentors July - August, 4 th year of medical school While you are doing o Step 2 CK or Away electives, impressing the institutions you re at (see section below on Audition Elective ) o NRMP registration opens. Register/pay fee early for Match. You are planning o Figure out what programs to apply to ( sure shots, safe, good back-ups, less likely, very competitive) based on class rank, Step 1 score, MD/PhD, research experience, publications, extracurricular activities, significant other/family considerations, geographic preferences 1

11 o Number of programs to apply to varies based on applicant s competitiveness and competitiveness of programs applying to, if couple s matching, geography, etc. o If you want to err on the EXTREMELY safe side, apply to 20 programs, interview at 15, rank 12 (but, only rank programs you will be happy attending) September - October While you are doing o Away rotations or Step 2 CK/CS or Required rotations o ERAS submission (opens first working day of September) Try to submit no later than 2-3 days after opens You do not need to upload all of your Letters of Recommendation, but do try to submit them as soon as possible. In other words, submit ERAS as soon as your application and personal statement are done do not wait to upload letters! You can upload letters as they come in. o Follow up with away rotations to make sure they have submitted grades to the Dean s Office. These grades will be included in your Dean s Letter. Since the Dean s Letter has all of your clinical grades, it is nice for Pathology programs to see how you did on your away rotations by seeing your away rotation grades. Together with your letters of recommendation from other clinicians and pathologists, the program will now have a complete picture of you as an applicant. You are planning o Consider a mock interview with friends or with your self: prepare answers to questions you might be asked (see below) as well as questions to ask October 1 st Dean s Letters released by all US Med Schools Mid-October thru last wk in January/ 1st wk in February While you are doing o Rotations through November o Interviewing as early as October In general, the order of interviews doesn t affect your rank on the program (ie, if you rock an interview in October or in January, you will probably get ranked the same). The only thing you should consider when interviewing is that you are less experienced with interviews initially and so 1-3 safety program interviews should be scheduled before your dream program interviews. If this can t be arranged don t worry and just make up the scheduling with extra practice. You are planning o Practicing your interviews o Analyzing the programs you visited o Considering which programs might deserve a second look 1

12 those programs by mid Dec (late Dec is better but program secretaries usually go on vacation) to see if they a) allow second looks and b) to schedule one They do not generally improve their rank of you, however, it will definitely help your ranking of the program Mid-January While you are doing o Winding down interviewing o Starting second looks You are planning o Make a preliminary Match List and certify it you can always change it (Note: You have to RECERTIFY the list each time you change it) o Considering to which programs to write letters of intent February ~ 3 rd week While you are doing o Starting rotations again You are planning o Submitting your final match list, due Feb. 20th Mid-March While you are doing o Rotations You are planning o Match Week Monday at noon, applicants find out if they matched or if they must SOAP o Match Day Friday at noon of that week 1

13 SUGGESTED SENIOR ELECTIVES for Students Interested in Pathology Electives at dream institutions: AUDITION ELECTIVE Choose electives where you get some exposure to AP and CP Choose electives at your dream schools, if you are interested in multiple geographic regions in the U.S. do an away in each area Direct opportunity to become familiar with another institution, and for them to become familiar with you for better or for worse! o Selection committees give considerable weight to first hand observations of students by their own faculty. It can be the kiss of death! o Offer to present a case or seek out opportunities for a project of some sort so that you can showcase your abilities o Ask to practice frozen sections on a small piece non important specimen. Ask to gross a placenta, gallbladder, or other simple specimen. Get involved! Show interest! Help out! No one expects you to know pathology at the scope when we have no 3 rd year rotations, but get involved and show that you are learning. o Regardless on how the rotation is going, ask someone (program director or a pathologist you worked closely with) if he/she would be willing to write you a Letter of Recommendation. If you apply to that program, that letter will have a lot of weight no matter who it's from o Ask for feedback from Chief Residents, from an attending you ve been working with half way through your rotation to see what you should work on for the last half of your rotation. It also shows you are proactive o Ask to speak to the program director. Showing your interest is a good thing if you like the program Some institutions will let you interview while there, however, this might be too early. I would recommend interviewing at this dream program when you have more experience interviewing. You will also have a better idea of what is important for you to know about programs. o Be a team player: help the residents, try to learn, try to show what you know, but most of all, be helpful, enthusiastic & curious, and proactive Helpful: have a marking pen, look up histories, print cassettes, help gross specimens/finding lymph nodes, remember details about special studies to follow up, offer to follow up on slides/stains/level Curious & Enthusiastic: be interested in signout, unknown conference etc. Come with a notebook to jot down notes. Ask questions, but know the appropriate times hour 4 of an endless signout when the service is very busy is not the time to ask what a giant cell looks like. Proactive: ask to present, ask for feedback; if things are slow go to histo lab or flow cytometry, introduce yourself and ask to observe 1

14 Team player: Go home when they say you should sometimes, residents can work faster without you around, and it s not an insult to have you leave o Items to have with you Little notebook Marking pens White coat Subinternship (acting internship): SubI can wait until after interview season When choosing, medicine or surgery subi's will probably be the most helpful GENERAL TIPS WHEN APPLYING You have received lots of information on this from Drs. Gladys Ayala, Elliot Perla, and Christopher Cimino. Here are some basic tips. Curriculum Vitae o Descriptions in ERAS can be bullet-pointed for brevity, but if you prefer sentences, that is fine, too o It should be concise, easy to read, and yet descriptive of what you have accomplished o Portray yourself honestly o Include interesting hobbies, extracurricular accomplishments. These might be a point of commonality with your interviewer. o Proofread your CV > 4 times and have your advisor review your CV before you submit it, for content, dates accuracy, spelling and grammar. Personal Statement o Topic options: Personal insight, understanding, accomplishment, or activity that could be elaborated upon in the interview. Very straight forward pattern: your background, why you went to medical school, why you want pathology, what you want in the future. But remember, this is a starting point for discussion and doesn t have to be all-inclusive. If you had an academic problem/interruption in your medical school, or some type of problem, this can be a good place to explain it. o Favor safe over bold, use humor very cautiously Do not try to be a pulitzer-winning novelist here, the personal statement just screens for crazy and maybe some topics of discussion. ie. It will not dramatically, if at all, move you up in rank, but it can hurt you. o Once again check carefully for errors and have friends and advisors read your statement before you submit it. 1

15 o Although the limit is one-page, it is not a goal. Shorter even as short as half a page is fine. Letters of Recommendation o As a general rule, 1 letter from the chairman of the department, 2 letters from other pathology faculty, and 1 non pathology letter o Always ask if someone would be willing to write you a letter; their reaction might be telling o Sign the waiver waiving your right to see the letter o o o o Do not solicit letters from residents or fellows great letters with no weight Provide recommendation writers with copies of your CV and personal statement. Some may request information regarding your grades from your clinical rotation, cumulative GPA and class rank. Some will want to meet with you prior to writing your letter to discuss your career plans, etc., in order to make the letter sound more personal Faculty members are VERY busy. Approach them AT LEAST 6 weeks before the letters are due You should provide for them a Letter of Recommendation Packet: a signed waiver form a copy of your CV a copy of your personal statement if available (usually not available in it s final form) a stamped envelope addressed to the Dean or address if they prefer instructions on any specific statements that need to be included in the Letter of Recommendation (i.e., The candidate has/has not waived his/her write to read this letter ) and how to submit the letter (e.g., include the letter and the waiver form in the stamped envelope and mail ) APPLYING TO PATHOLOGY RESIDENCY Some suggestions General rules: Always have a back up and always reach! You never know For Students in the top third of the class: Include a minimum of 8 university programs on your rank list Select 3-5 highly competitive programs Select 3-5 moderately competitive programs Select 1-2 less competitive programs For students in the middle third of the class: Include a minimum of 10 programs on your rank list Select 2-3 highly competitive programs Select 5-6 moderately competitive programs 1

16 Select 1-2 less competitive programs Again choose wisely! For students in the bottom third of the class: Include programs in your rank list Select maybe 1-2 highly competitive programs you never know! Select 5-6 moderately competitive programs Select 5-6 less competitive programs Again be careful if you have something glaring on your CV talk to someone who can help guide you If you have questions about how competitive a program is, please talk with Dr. Fallon. Occasionally we know programs that have been NYMC friendly in the past and can help point those institutions out to you. GUIDELINES FOR RESIDENCY INTERVIEWS Similar for most specialties The Interview: The invitation to schedule an interview is a clear indication that you are competitive for the residency program. However, most programs will interview 10 to 20 candidates for every available position. Therefore, prepare carefully for each interview. Use the interview as an opportunity to demonstrate you are a mature, articulate, and friendly individual. Pathology interviews generally range from 4-8 one-on-one interviews on a given interview day with anyone attendings, a chairman/chairwoman, chief resident, or fellow. Generally, they are very low key and involve questions that try to learn about your interest in pathology. Experiential based interviews are not very common: i.e., I was asked to give examples of when I worked in a team, or resolved a conflict, or faced a moral dilemma. Similarly, only one other interviewer asked me my opinion on challenges in the field of pathology. The most abstract questions I had were, If you were on a deserted island and you have all the texts needed and a microscope, could you be a patholgist? and Explain to me how one can be 100% positive, but still be wrong. A general structure to an interview day consists of: a morning conference, a morning introduction or information session, then interviews, lunch with residents, a tour, and more interviews, following by a closing session. They generally start anywhere between 8-9am and end anywhere between 2-5pm. Sometimes, you will be invited to a dinner the night before the interview with the residents. These dinners are informal ways to meet the residents and ask them questions related to the program. You should go to these because they can be helpful to you for two reasons: 1) you get to meet the residents, see if you click with them and gather information and 2) the residents get to see you and your shining personality. In general, you are being judged though perhaps not officially on your personality and 1

17 appropriateness. Should you not be grossly inappropriate, or rude, or strange, you should be fine. Dress is loose business casual khakis/gray pants and shirt for men, khakis/black pants and sweater or shirt for girls. The best interviews are the ones where you show how your decisions are wellconsidered in other words, what aspects of pathology are especially a good fit for you. For example, you might declare your fascination with technology in medicine: you might describe how pathology provides you with the opportunity to explore that passion and by telling this to an interviewer using specific examples; you showcase your knowledge of the field of pathology as well as your knowledge of yourself. Thus, the best interviewee knows as much about pathology as a field (not necessarily how to read slides yet) as possible, drawing on away rotation experience or reading (see resources section, at end). General Suggestions: Think about when you time your interviews. If possible, don t schedule the program you want most for your first interview. You will get better at this with time and your story will emerge as you interview more. That being said, there is now rolling ranking so it doesn t mean you have to interview at the end to be fresh in the committee s mind. Be respectful and courteous to everyone you meet on your interview day from interviewers, to residents, to staff and assistants Do not make disparaging remarks about any person or any program or NYMC. These comments make you not the place or person you re commenting on look bad Do not no-show. Call and cancel at least 3 days in advance. It is better to call than , and if you , you must follow up with a call if you don t hear back in 24 hours. In your call, always apologize, give a reason if possible, thank the program for the offer to interview and wish them the best of luck with their interview process. Arrive early. Leave early enough to be prepared for bad weather rain, snow, traffic. Bring o ID o Some cash o A portfolio with your most recent CV, personal statement, ERAS application, papers that you have published, presentations that you have given, a blank note pad, a pen Be engaged during the interview. Listen. Ask questions. Smile. o On many occasions the interviewed with, So, what do you want to know? This can be tough, so be prepared with questions! Questions to ask: Prepare in advance by reading the one-page program overviews at the Intersociety Council for Pathology Information, reviewing the program s website, and reviewing the materials that the program provides for you (many will send you information in the mail). If you know a resident at the program (see last section of this 1

18 packet), them when you are offered an interview to see if they can provide any insight on the process. You will be expected to ask questions in your interview days, both during an interview and during tours or lunches etc. Generally speaking, you can ask anything of the residents that will be eating lunch with you and giving you your tours; the questions you ask your interviewers will be different. Resident Questions o These can be information-gathering type, both factual and insider facts Factual questions can be asked even if they are already answered on the website or informational packet. Residents understand that interviewees forget and that programs start to run together Insider questions are best asked indirectly: rather than asking, Is there good camaraderie among the residents? ask, Do you hang out together outside of work? ; rather than asking, Do you have time to read outside of work?, ask, What is your Board pass rate? (this says it all); rather than asking, Is the program intense and competitive?, ask Has anyone left the program before finishing? o Some Sample Questions: Will there be any construction or other possible disruptions during training? How much reading time do you have? What is the call schedule like for AP and CP as well as the nature of call? How is the autopsy service run(especially weekends)? Board pass rate? Perks? Food (if on call), housing, meal cards, cafeteria? Stipends? For books, conference (if present vs. if go)? Histology review before starting? How many sites do you train at? Salary? Copath or Powerpath? Teaching resources: lectures, online portal of ppts, slide sets? Consensus conferences? Lectures & quality of lectures? Do residents go to conferences? Do they present? Presentations given by residents? Financial state of path dept? And what they spend money on? Each resident with own microscope or desk or computer? Research required or encouraged? Elective time? Time to audition for other fellowships through away electives? Order of AP & CP vs. integrated or one after the other? How is transition between services managed? 1

19 Do you have adequate help? This can be from administrative assistants, pathology assistants, or even the residency coordinator. Do they feel like gross monkeys or tissue technicians without having enough time to preview and making their own diagnoses before sign-out? Interviewer Questions o Generally, you should divide interviewers into three categories: Program Director, Chairman, and general attending For the Program Director, you should ask questions about the structure and rationale behind the structure of the program Do not just ask what are the strengths and weaknesses of the program? Instead, ask, What are the weaknesses in the program, and what is the department doing to improve these areas? Ask about how the program guides the residents towards their career: is there an advising system? Is there a mentoring system? How often do they meet? How does the program help placement for fellowship or jobs? Any major changes in residency structure of curriculum planned for the near future? Is there a research, advocacy, medical school teaching opportunities/requirement? Are there opportunities to pursue either of these areas with good faculty support? Is time set aside for that? Is there an evaluation system? 360-evals? Are there feedback sessions? When? One-on-one? Is there a mentoring system? Informal mentoring? How are careers guided? What s the percent pass rate of the Pathology boards? Check FRIEDA for latest numbers if available. What do residents do when they graduate? Split of private practice vs. fellowship? Where do they do fellowships? Do they take off time? For the Chairman, you should ask about the Department and where it is going What are the areas the Department is focusing its efforts and resources on? How are AP and CP integrated? Separate? Are there new hires or areas that are being started/expanded? What do you think are some of the changes in the field of pathology and can you describe any recent changes to your program that have tried to better prepare the residents for those changes? New fellowships being started? 1

20 Any other major changes to the program? Any physical expansion or moving planned? For the attending, you should ask anything else about his/her field, about his teaching interactions with students, etc For a CP Attending: o Self-study or part of clinical team? o Presentations routinely? o Papers on quality assurance of new lab tests? o Business plan writing? o Clinical lab lead by PhDs or MDs? o Do CP residents cover AP call? o CP board pass rate? o Are there CP call review meetings? o CP lecture series? For the AP Attending: o Ask about signout: If generalized, is there any move to make it specialized? If specialized, do they feel residents get enough exposure to bread-and-butter cases? Is signout regularly scheduled? How long do you stay with one attending? Generally: o What are your best electives? o What is the role of fellows in teaching and supervision? Sharing vs. stealing cases? o How are residents supervised? Autonomy in decision making? Is responsibility graduated or sink-or-swim Relationship between faculty and residents? o What types of lectures are given? Is there a curriculum? Is the time protected? Is it coordinated with the various sites? o Are there multiple sites? How are they different in terms of support, responsibility, etc? You can always ask the same questions to multiple people you will get different answers. In general, if an attending is reluctant to answer your question or dismissive, it is not a good sign: an interviewer should be as honest about the programs strengths and weaknesses as a good applicant is about his or her interests and strengths and weaknesses. Questions you might be asked: 2

21 It is difficult to predict what kinds of questions an interviewer might ask, but it is safe to say that you will likely not be put in a clinical scenario or asked to describe histology or pathology. Interviewers probably want to see not only an interest for pathology, but also solid reasoning for why you are going into pathology. This entails being able to explain why items on your CV led you to Pathology or a specific area of Pathology. Other questions that you should be prepared to answer (not only for an interview, but for life in general ): Why are you choosing Pathology? (a favorite!!! so very common) Where do you see yourself in 10 years, ideally? (ignore events that might sidetrack you) Is research your cup of tea? Translational? Basic? Clinical? Why AP, AP/CP, CP, AP/NP? (depending on what you choose) Plans for fellowships and why? What was your experience like at away rotations? Why do you want to come here? Interviews might also ask you to draw on your experiences on the spot, so being prepared to give examples for these questions is not a bad idea: Describe a situation where you worked in a team to solve a problem. Describe a situation when you resolved a conflict. Describe a situation when you went above and beyond. Describe a situation where you made a quick decision. What are you most proud of? Don t just answer the question try to think of the situations that make you look best. Think about how you want to come across and then select the situation that best exemplifies that. Always be a nice, humble, mature, hard-working team-player. Above all, be honest. Things to mention: The interview is not just a Q&A session. Don t forget that this is a time to throw into conversation some of your accomplishments and other facts that the program would find impressive! For example, have you attended national pathology conferences or meetings? Would you really like to stay in the state that the program you re interviewing at happens to be located in? Have you already practiced frozen sections on your away rotations? These items are not on a resume or in a personal statement but can help you. Furthermore, compared to some other more stereotypically intense programs (eg. Surgery), Pathology interviews tend to be more conversational, informal. I got the impression that many interviewers, above all else, wanted to see that you actually have an interest in learning pathology. A definite plan is not necessary, but have an idea of what fellowship you MIGHT consider because of x, y, or z. INPUT ON SOME OTHER ITEMS 2

22 Second Looks: A second look is a fantastic way of seeing a program in a less conspicuous manner than the interview day. Programs are open to these and welcoming, but do not do it because you think it is expected. Generally, it does not help your odds by doing a second look. Also, be aware that this allows the programs to obtain additional data about you just like on visiting rotations. If you go on a second look, be prepared to work: come in business casual with a white coat, notebook and pen. You might or might not meet with people in an interview-like setting; more likely, you will attend signout, shadow residents, and observe activities. At the end of the day, you should ask to meet with the Program Director (if he/she has not offered already) just to give a quick recap of your day and reiterate your enthusiasm (if it is indeed the case). After your visit, it is important that you write thank you notes to the Program Director (describing how much you enjoyed your second look and ideally, how it will influence your rank), residents you met or ate lunch with (can them as a group), attendings you signed out with, and the assistant that helped you arrange your second look. Writing Thank You Notes: Write thank you s within 2-3 days of interviewing to every interviewer and the group of residents that took you to lunch. s are better than cards because they arrive faster and you have the possibility of receiving a quick response. Traditionally, some might complain that s can be more generic and form than cards, but you can make s as personal as hand written notes. Every thank you must contain: 1) Thanks for the time and opportunity to interview, 2) A description of why you enjoyed your day with specific examples of what you liked about the program (It also helps to write down 2-3 things you discussed an interview immediately after each interview and mention those things in this section of the thank you note) and 3) A sentiment that you were impressed and would be thrilled for the opportunity to train there. It is important that your note contains these components, but that each thank you note is unique. Some programs put thank you notes in your application file and yet others share thank you notes among attendings. No matter what form of thank you note you write (handwritten or ), be sure to obtain the contact information (i.e., address or ) before you leave your interview day (or else you will have to the program coordinator and your thank you notes will be delayed). Ultimately, thank you letters are not required. Some programs will make that clear. If nothing else, it lets them know you were attentive of the day and took advantage of the opportunity to visit their program. Writing a Letter of Intent: 2

23 messages to the Program Directors at your top five programs, but not at your safer programs at the end of January. In your be appreciative and courteous. Mention the people whom you met during your visits. Indicate your passion and enthusiasm for pathology in general and for their program in particular. Cite their specific program strengths and aspects of their academic vision that most appeal to you. Mention that they are a great fit or even the most perfect fit for you. Tell your first choice that you will rank them number one and you would consider yourself fortunate to be part of their team in July. Lastly, be as succinct as possible. DO NOT tell multiple programs they are #1. You are lying. They can find out if they rank you #1, or very high, and you match elsewhere. Pathology is a small, close knit niche. You do not want to start your career that way. A way to frame your interest to your #2-4 is at the top of my rank list or top 3, etc. Preparing your final match list: Be sure you have included a good number and mix of programs based on your qualifications and geographic/personal preference. Do not rank any program which you absolutely would not want to go to. Rank programs entirely according to your preferences. Do not attempt to outsmart the match or outright ask programs how they will rank you. Programs are not technically allowed to tell you this. Remember that the matching process is organized to be consistently in the applicant s favor. Trust in the essential fairness of the process. Trying to outguess a computer is not advised!! Where NYMC Medical Students Have Gone in the Past Consider contacting people at programs with general questions about the field or before and/or after you visit: NYMC 2006 Stacey Simons Residency: Brigham & Womens Hospital , University of Washington, , AP/CP Fellowship: Medical Examiner at Miami-Dade County Employment: Associate Medical Examiner in Jacksonville, Florida staceyasimons@yahoo.com NYMC 2008 Jay Stahl-Hertz Residency: NYU, , (AP/CP), Chief Resident Fellowship: NYC OCME Employment: N/A trenchcoatjedi@yahoo.com Nicole Masian Residency: Yale Fellowships: Pediatric pathology at Women and Infant's Hospital (Providence) , 2

24 Forensic pathology at OCME Norfolk, VA Employment: NA Shafinaz Hussein Residency: Columbia Fellowships: Hematopathology at Columbia Employment: NA NYMC 2009 David Li Residency: UCSD, AP/CP Fellowship: N/A (interest in Surg Path & Hemepath) Employment: N/A or NYMC 2010 Sue Chang STEP 1: 230s STEP 2: 230s Residency: UCLA, (AP/CP) Fellowship: Surgical Pathology & Cytopathology Employment: N/A NYMC 2011 Mark Booyasampant Residency: USC, Fellowship: N/A Employment: N/A Wen Lu STEP 1: 216 STEP 2: 230 Residency: UPenn, (AP/CP) Fellowship: N/A Employment: N/A Patricia Raciti STEP 1: 227 STEP 2: 213 Residency: Columbia, (AP/CP) Fellowship: N/A Employment: N/A 2