When
I began the third year clinical clerkships, I didn't know what
I wanted to do for postgraduate training. The decision to go to
medical school had seemed so much easier than picking a specific
field in medicine in which to train and carve out a career. I thought
the best solution to the problem was to try and keep an open mind
as I rotated through the different specialties. My first rotation
was surgery. I thought it was very exciting; however, after standing
for hours in surgery, I found the part I liked best was taking
a specimen to the pathologist and viewing a frozen section of
the tissue we had just taken out. Even during other clerkships,
issues
in pathology seemed to interest me the most. I was fascinated by
the autopsy conferences held by the pathologists, and the teamwork
shown in multidisciplinary conferences with pathologists, radiologists,
and clinicians was inspiring.
Finding myself excited by these things, it seemed that pathology, which
I hadn't really considered before entering medical school, might be the
best choice for me. Originally, I had thought I would be a pediatrician
or perhaps a psychiatrist. All in all I think the choice of residency and
by extension a choice of a specific career in medicine is one of the most
difficult decisions in life. After all the questions, the research, the
weighing of the good and the bad, it all comes down to a gut feeling about
what will make you happy.
How
did you prepare yourself for application to your chosen specialty?
As I
have already mentioned, I was unsure at the beginning of third
year what part of medicine I wanted to focus on in residency. Although
I had had contact with pathologists in other rotations, my first
official rotation in Pathology wasn't until the beginning of fourth
year, well after most people had started the application process
to their chosen specialty. I did a rotation in Autopsy Pathology
at my medical school and asked to also get exposure to surgical
pathology during that rotation. I had a pretty good idea that I
wanted to go into pathology at that time, but it was the first
real experience in the field that I had had. It turned out that
I loved the work of a pathologist and did well in the rotation.
That rotation was the only pathology rotation that I completed
before the interview season and I didn't have any substantial research
background in the field. In hindsight these last two points may
not have helped my application to pathology, but I was still well
received at very good pathology programs in the country.
Who
wrote your letters of recommendation for your application?
During
my autopsy pathology elective I worked with several attendings
and asked the three that knew me the best to write letters of recommendation.
For me, I think it was very important to pick people that knew
me well as opposed to people in higher positions in the department
who really didn't know who I was. Those three letters were the
only ones I used in my application. I decided not to dilute their
impressions of me in pathology with other letters from clinicians
in other fields.
Which
programs did you apply to and why?
My final
list of programs to apply to included UCLA, Johns Hopkins, Washington
University, University of North Carolina Chapel Hill, Emory, University
of Washington, UCSF, and Stanford. In pathology, I think it is
important to train at a major academic institution because there
needs to be a large volume of material from a large area in order
to see some of the more unusual cases. In coming up with my list,
I also considered the livability of the cities where the programs
where located and practicality of travel to interviews.
What
kinds of questions did programs tend to ask you?
The
most common question was why did I want to be a pathologist. Another
common question was what kind of pathologist did I want to become
(i.e. clinical pathologist, surgical pathologist, academician,
community practice, etc.). Most of the time I felt that the programs
were trying to sell the merits of their programs. I found the best
way to get through the interview was to be as honest as possible
and try to learn more about the field of pathology from the many
interviewers.
What
would you have done differently in applying?
Ideally,
I would have liked to know that I was going to go into pathology
from the first day of medical school, and start developing research
interests, and connections in the field. Of course this probably
doesn't happen in most cases. Short of that I would have liked
to have had more exposure to pathology a little earlier in third
year before the application process was hanging over my head. Another
option that I did consider but then rejected was the post sophomore
fellowship in pathology. I think anyone considering pathology should
look into this option. The downside is that it takes an entire
year at low pay. The upside is that the year counts for one of
the five required years to be board certified in AP and CP and
you get an early taste of the life of a pathologist. I'm still
unsure about whether I would do the post sophomore year or not
if I had the whole process to do over again.
What
was the most difficult part of the application process?
Overall
it was a very easy application process. The hardest part was deciding
that I really wanted to pursue pathology as a career. There are
rumors floating around that there are no jobs for pathologists
and that this will not change by the time that our class is through
with training. This may or may not be true, but in the end I would
rather be trained in something I like and temporarily unemployed
than being employed in something I don't care for.
What
should I look for on my interview and tour day?
Most
of the places I saw were comparable to each other. Some were cleaner
and had better ventilation in the cutting rooms (this I would think
is a big plus). Find out about how much help there is in the cutting
room. Some places hire physicians assistants to help in the cutting
rooms. For me it was important to also get a feel for the living
situation in the different cities I visited.
What
questions should I ask of residents, faculty, and program directors?
Be open
about what you are interested in. If you are interested in surgical
pathology, ask about how many surgical specimens the department
handles and find out how referrals are handled (i.e. does the resident
get to see the referrals). If you are interested in research find
out about availability of funding for residents and the flexibility
of the program to work research into the schedule. It seems that
most programs have pretty much the same set up as far as call,
weekends, etc., but it doesn't hurt to ask.
How
did you form your rank list?
The
first thing I did was to eliminate the programs that were located
in cities to which I couldn't possibly relocate. I have a wife
and two children so location for me was very important. Then from
the programs that where left, after making lists of pros and cons
that I didn't find very helpful, I just chose the place that gave
me the best feeling and put that program first. I then pretended
that that program was out of the running and went through the same
process for the second place and so on until I listed the rest
of the programs.
What
other advice can you give seniors applying in your specialty?
I think
getting to know the pathologists in your medical school is a good
first step. From what I've seen, most pathologists are very open
to helping students find their way in the match process. It's also
good to get outside opinions about what programs strengths and
weaknesses are. I think pathology is an interesting and exciting
field and don't be afraid to pursue it.
