Embarking on a pathology residency marks a significant transition, filled with steep learning curves and demanding experiences. As I approach the culmination of my pathology residency, reflecting on the journey from an inexperienced PGY-1 to a more seasoned PGY-4 resident brings valuable insights. The transformation has been immense – acquiring a substantial body of knowledge, honing technical skills, and developing professional acumen. But what were the pivotal lessons learned along the way? To gather diverse perspectives, I surveyed fellow pathology residents, posing a simple yet profound question: “If you could offer just one piece of advice to a fellow resident, what would it be?” The responses from 27 pathology residents resonated deeply with my own experiences, confirming shared challenges and highlighting key strategies for navigating the demanding path of pathology residency. Here are the essential lessons gleaned from navigating pathology residency, year by year.
The Inevitable Burnout: Acknowledging and Addressing It
Burnout in pathology residency is not just a possibility; it’s a prevalent reality. Studies indicate burnout rates as high as 52.5% among pathology residents. Personal experience and the survey responses underscore this point – every resident will likely encounter stress and fatigue at some point during their training. Factors contributing to burnout are multifaceted, including long hours, mastering new skills, research pressures, and the often-underappreciated role of pathologists within the broader medical field. Therefore, learning to effectively manage burnout is a crucial survival skill for pathology residents.
Strategies for mitigating burnout are diverse and personal. Engaging in hobbies, regular exercise, dedicated relaxation time, and even volunteering can serve as effective buffers against stress. The key is self-awareness – recognizing the signs of burnout and proactively implementing coping mechanisms. For me, stepping away for a brief mental break, whether it’s a quick coffee run or a conversation with a trusted colleague or mentor about stressors, provides significant relief. Survey responses echoed this sentiment, with residents advising to “Breathe,” and “Get enough sleep and sun.” Prioritizing physical and mental well-being is paramount; it’s the foundation upon which all learning and professional development in residency are built. In situations of severe burnout, seeking professional counseling or employee assistance should be considered without hesitation.
Embrace Lifelong Learning: Maximize Every Educational Opportunity
The fundamental aim of residency is to learn, and pathology residency is structured to provide extensive exposure to a wide range of cases essential for becoming a competent pathologist. Unsurprisingly, survey responses overwhelmingly emphasized this core principle: “look at as many cases as you can,” “try to see as many cases as possible,” “review cases as much as possible,” “Read a lot. Look at slides,” and “look at as many cases as you can.” The takeaway extends beyond simply working hard; it’s about actively seizing every learning opportunity.
Under the pressures of residency, it’s easy to dismiss certain learning experiences, thinking they may not be directly relevant to future practice. However, every piece of knowledge and experience is valuable. Regret often stems from missed opportunities to learn something that could have been easily acquired earlier. Sometimes, the most valuable lessons come from unexpected avenues. For instance, accepting an invitation to present at a city-wide conference, despite a busy schedule, proved to be a remarkably rewarding experience, leading to unexpected recognition and gratitude. Embrace every learning opportunity, for you never know where it might lead you.
The Ocean of Knowledge: Accepting the Limits of Learning
While striving to learn as much as possible is crucial, it’s equally important to accept the inherent limitations of knowledge acquisition. The vastness of pathology is such that no single individual can master it all. Acknowledging this reality is vital to prevent unrealistic expectations and further burnout. As one survey respondent aptly stated, “It is only too easy to become overwhelmed with the wealth of things to know.”
A seasoned pathologist and mentor in my program, with nearly 40 years of experience, often emphasizes that learning is a continuous journey. Even for highly respected and experienced pathologists, the learning process never truly ends. Focusing solely on knowledge gaps can be discouraging. Instead, shifting perspective to appreciate the knowledge already gained is essential. As another respondent advised, “Don’t stress about what you do and don’t know. Just always do your best and give 100%.” Visualizing the expanse of knowledge as a glass half-full, rather than half-empty, is a necessary and beneficial mindset.
Navigating Transitions: Recognizing the Difficulty and Seeking Support
Residency itself is a major professional and educational transition. Like any new experience, adapting to change takes time and can be challenging. My personal transition was compounded by moving from Lebanon to the United States at the start of residency, adding another layer of adjustment. Interestingly, survey responses were heavily weighted towards PGY-1 and PGY-4 residents, those at the beginning and end of major transition points in residency. This suggests that residents undergoing significant transitions are particularly attuned to seeking or offering advice.
Having progressed through over three years of residency, I can attest that each year brings increasing comfort and confidence. The initial challenges do subside, and adaptation occurs. Remember, the difficulty of transitions is temporary. It genuinely gets better with time, so maintain hope and persevere through challenging periods.
Embrace Mistakes as Learning Opportunities: Don’t Fear Imperfection
In medicine, and especially in a detail-oriented field like pathology, perfectionism is a common trait. However, this can make accepting criticism and acknowledging mistakes particularly difficult. Dr. Geoffrey Talmon aptly notes, “You’ll make mistakes (and always will).” This holds true even for experienced pathologists, and even more so for those still in training. Residency provides a safe environment to make mistakes, learn from them, and grow. The stakes are lower in training compared to independent practice. Learning from errors during residency is far preferable to making similar mistakes later when the ultimate responsibility rests solely on your shoulders.
Recently, I experienced a humbling learning moment when I misdiagnosed a benign biopsy as malignant. Initially, I was dismayed, questioning how such an error could occur so late in my training. However, discussions with colleagues revealed that this type of diagnostic pitfall can even trap seasoned pathologists. This realization was strangely comforting. It transformed my perspective on the mistake from a personal failure to a valuable learning experience, ensuring I would be far less likely to repeat it in independent practice. Mistakes are inevitable; it’s the learning and adaptation that truly matter.
Gradual Growth in Responsibility: Embrace Increasing Ownership
The safety net of not having your name on the final report in residency should not breed complacency or avoidance of responsibility. As one survey respondent wisely advised, “Treat every case as if it were your own.” Avoiding responsibility hinders learning and prevents recognition of potential errors. Deferring all responsibility to attendings deprives you of valuable learning experiences and can lead to future regrets when you are independently responsible. Active engagement and ownership of cases, even under supervision, are crucial for developing competence and confidence. You cannot master driving from the passenger seat; you must take the wheel.
Cultivating Professionalism: A Skill to be Honed
Survey responses emphasized the importance of interpersonal skills and professional conduct: “Treat your fellow residents with respect” and “Always keep a professional attitude and offer help to other residents.” Professionalism, akin to medical knowledge and technical skills, is a learned attribute. It requires conscious effort and development. I personally learned this through an experience where a seemingly trivial piece of information, not communicated to my attending, turned out to be significant. A simple email or phone call could have averted complications. Effective communication is just one facet of professionalism. Learning from such missteps in professionalism is as critical as learning from diagnostic errors. Employers highly value interpersonal communication skills and professionalism in newly trained pathologists, often on par with diagnostic acumen.
Pride in Pathology: Recognizing Your Unique Contribution
Pathologists possess a unique and vital skill set, essential for patient care and relied upon by other physicians. However, the behind-the-scenes nature of pathology can lead to overlooking its importance. It’s crucial to recognize and celebrate your achievements as a pathologist. Take pride in making a rare diagnosis, reflect on your learning journey, and acknowledge your progress. Find enjoyment in the residency experience whenever possible. Dr. Jae Ro, a respected pathologist and mentor, encapsulates this with his “BeST” philosophy: Basic knowledge, Enjoyment, Study, and Think. He emphasizes the often-understated importance of “enjoyment” as integral to success.
The Power of Networking: Building Connections and Community
Professional organizations offer invaluable platforms for residents to network with peers and established pathologists. Membership in organizations like the CAP provides opportunities to attend meetings, collaborate on projects, expand professional networks, enhance communication skills, and stay abreast of advancements in pathology. My involvement with the CAP directly led to the opportunity to write this article. Networking extends beyond in-person meetings. Social media platforms like Twitter, Instagram, and Facebook facilitate virtual networking, connecting pathologists globally. Meeting online contacts in person at conferences, epitomized by the hashtag #mottirl (met on Twitter then in real life), highlights the tangible value of online professional communities. Even limited engagement in networking can open doors to unique opportunities and collaborations.
Ultimately, no single piece of advice guarantees success in residency. There will be periods of ease and reward, and times of significant challenge. Perhaps the most crucial advice is to seek support from colleagues and remember that you are not alone. Residency is a shared journey with common struggles. Survival is the first step towards success and excellence. Persevere, seek support, and you will indeed find yourself on the path to a fulfilling career in pathology.
References:
- Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90:1600–1613.
- Richey, Justin. “Pathology Resident Burnout”. August 2017.
- Talmon, Geoffrey. “Cautionary Tales of the New in Practice”. September 2017.
- Miriam D. Post, Kristen Johnson, Mark D. Brissette, Richard Michael Conran, Ronald E. Domen, Robert D. Hoffman, Cindy B. McCloskey, Patricia M. Raciti, Cory Anthony Roberts, Amyn M. Rojiani, J. Allan Tucker, and Suzanne Z. Powell (2017) Employer Expectations for Newly Trained Pathologists: Report of a Survey From the Graduate Medical Education Committee of the College of American Pathologists. Archives of Pathology & Laboratory Medicine: February 2017, Vol. 141, No. 2, pp. 193-202.
