Pathology

Pathology Residency Questions

What advice would you give about getting letters of recommendation in your specialty?

• When applying for a general pathology residency program, it is best to have at least one letter from a pathologist who has directly observed your work in anatomic or clinical pathology (on an elective, on a research project, etc.). This allows them to refer to their experience with you in a meaningful manner. Obviously, don’t choose someone with whom you have had negative experiences.
• Since pathology involves interactions with clinicians, having a letter from a clinician who has direct knowledge of your work who can positively comment on your knowledge, skills and attitudes/behaviors in the clinical realm is very useful. This letter can be from a clinician in any specialty, but most commonly, we see letters from internists (or specialists in internal medicine) or surgery.

What is the value of doing audition rotations in your specialty?

• Any rotations in anatomic and/or clinical pathology are very helpful. The practice of pathology is unique from other clinical specialties, and most programs want to see that you “know what you are getting in to”. If you don’t have any rotations in pathology prior to interview season, you will likely answer a lot of interview questions about “do you know what a pathologist does; do you know what you are getting in to?”
• Generally, at least one 2- or 4-week rotation is helpful to have, prior to interview season. It’s okay if the rotation is at your home institution.
• If you want to go to a particular program, doing a 2- or 4-week audition rotation there is always helpful, as it gives faculty and residents an opportunity to get to know you and see if you will fit in with their program and group. It makes you a more memorable candidate and gives you an excellent head-start, since the faculty doesn’t have to choose based solely on your “paper information”.

To what extent does research, publications, or presentations affect one’s ability to match in your specialty?

• Having research experience definitely will help. Different programs weigh the degree and extent of research differently, depending upon the general goals of the program.
• Having at least one peer-reviewed publication shows that you understand research and have follow-through and dedication to complete a task.
• Having a presentation at a local, state or national meeting can also be very helpful. If the topic is very general or basic and presented at a local meeting, it’s not as impactful as a more sophisticated research presentation at a national meeting.

Is a Step 2CK score needed before you will invite someone for an interview?

• Programs vary in their approach as to which Step scores they require and/or weigh heavily. If a Step 1 score is really high, then an interview might be extended without a Step 2 CK score. If this occurs, then the program will likely be expecting you to take Step 2 CK in the fall and will ask you about your score when you come to interview. They may want to see the score before they enter their rank list.

What does the perfect applicant look like in your specialty?

• Strong Step scores indicate that someone has the intellectual capacity to perform well in residency and be successful on the American Board of Pathology (ABP) exam.
• Strong letters of recommendation indicate a candidate’s knowledge, skills and attitudes/behaviors relative to a good fund of clinical knowledge.
• Demonstration of excellent communication skills and an ability to work well with others (team) is integral to a pathology resident’s success.
• Foreknowledge of what the specialty is and what opportunities are available in the specialty show that a candidate has “done their research” and knows what they will be expected to do.
• Research experience shows attention to detail and a respect for a deliberate, evidence-based approach to patient-centered care.
• A strong work ethic and a genuine willingness to serve others and provide excellent patient care is key.

Does having a below average Step 1 score doom you in your specialty?

• Programs vary in their emphasis on Step 1 scores. Some have screening cut-offs based upon Step 1 scores.
• It may depend on comparison with other applicants that year.
• Having a score 1 point above passing vs. having a score a few points below the average are very different.
  • If you have a score just above passing, there are concerns that you will struggle with learning everything you need to know in pathology and may not pass your Board exam.
  • Having a few points below the average may still mean you can be successful in pathology, but you will need to demonstrate to a program that you have a strong work ethic, research experience, or some other uniquely defining characteristic/experience that will serve the team well.

Would you ever take someone with a Step 2CS failure?

• Programs vary in their emphasis on any USMLE failures.
• Some programs will not look at any candidates with any failures, regardless of the circumstances.
• Other programs may review the application and consider other attributes/experiences of the applicant before making a decision to offer an interview (or not).
• Some will look at extenuating circumstances, such as family health issues, if there is a failure.

Does a student need to Honor in your specialty in order to match?

• No. Grades are important, to the extent that failure of courses, remediation of courses and/or remediation of a year will be particularly scrutinized. Honors are not absolutely necessary.

The students have significant elective time during their 2^nd and 3^rd year for career exploration.

Is there anything else I haven’t asked that you feel an applicant to your specialty ought to know?

• Pathologists need to be excellent communicators and must work amicably with many different team members.
• Pathologists take call and have significant responsibilities within a hospital setting, particularly as it relates to integrated systems, quality assurance, and patient safety.
• Medical students frequently underestimate the high level of responsibility and accountability in rendering pathologic diagnoses. They are also unaware of the uncertainty and subjectivity involved in rendering pathologic diagnoses. These issues should be discussed with potential applicants if feasible.