I’m feeling blurbish today, so I’m just going to write a series of poignant pointers, except instead of being poignant, they’ll just be fine.
Moving. As with med school, get all the stuff taken care of that you can before residency starts – register your car, get your SSRI’s and methylphenidate transferred to a local pharmacy, join a local rec center team but tell them you’ll never be there. Expect to spend a lot of money moving and getting settled into your new place.
Responsibility. Programs differ in their philosophy of how much responsibility they give to new residents, but regardless of how much or how little they give, it feels weird to be at the helm of it. It’s uncomfortable and frustrating and you can feel somewhat abandoned, at times. The best advice I can offer is to find the senior residents that are willing to answer questions and ask A LOT of questions. I think there’s a tendency to want to be uninvasive, but also to say “sure, I can handle that” but not realize what questions you need to ask until you’re by yourself and it’s “after hours.” So you have to learn to anticipate things and ask about the “what ifs” beforehand. And know that sometimes it just sucks, but it sucks for everyone at times, not just you.
Surgical Pathology. We have a cutting manual at our program, but I think Susan Lester’s Manual of Surgical Pathology is a pretty tremendous book for people starting in Surg Path. The only advice I can offer is to look at the OR schedule the day before your gross day and read up on how to gross/sample the big stuff that’s coming. As for previewing for sign-out, Diane Molavi’s The Practice of Surgical Pathology is a fantastic primer on the majority of big and small stuff, without going into the details you may want to delve into after you get your feet wet.
Step 3. I was told, “pick a light rotation month (even better if you have two in a row) like autopsy or blood bank fairly early in first year, to study for and take Step 3, because the farther out you get from med school, the less you’ll remember the clinical stuff that’s tested on the exam.” Of course autopsy (and probably all rotations) can be quite variable in terms of workload, just don’t plan on getting your studying done on Surg Path, if avoidable. As a reference point for other pathology residents who won’t have the clinical background of the majority of our intern peers, here’s my performance. I got a 246 and 249 on Steps 1 and 2. To prepare for Step 3, I did about 60% of the Qbank on UWorld and averaged about 60%. I got a 214 on the real thing with 222 being average with a 16 SD. Obviously not a score to brag about, but my goal was to pass and I had 3 weeks’ worth of evenings to study, so I’m fine with that. There may be some fellowships out there that put stock into Step 3, but I’ve been told by several reliable people that no one cares about your Step 3 score (in Pathology).
Futility: Step 3, Part 2: First Blood. As an aside, what a complete racket the Step exams are. They are proffered under the guise of standardization, but the LCME is already setting standards for US Med schools. MOST students/graduates pass the exams. A scenario where a student passes 4 years of medical training but can’t pass a multiple choice exam in one day should not exist – either the med school has a problem (and should be caught by the LCME) or the test is not a true measure of physicianship, WHICH IT ISN’T. Having a standardized exam for students/graduates of non-US med schools who want to practice in the US makes sense, as they may have very different standards for passing, but adding more and more expensive means of double, triple, and quadruple checking that a physician can pass a MCQ (regardless of the fact that they are succeeding in a standardized medical school curriculum) makes one’s eyebrow raise up so high that it departs from your face and takes a night shift at McDonald’s to help pay for these computer-based spinal injuries. Or maybe I’m just bitter that I have actual job-specific skills to learn, but had to spend a month preparing for an exam that will never have significant relevance to my career.
Anyways. I’m about 6 months into residency and those are the points I’ll offer to next years’ first-years when they inevitably ask, “what the hell?” Except that I’ll probably gripe longer and even more futilely about standardized exams.