Because an excellent resident in an excellent program—that is wrong for them—is not a good use of the strengths of either.
The One Question You Should Ask About a Pathology Residency
According to Dr. Richard Friedberg, former Chair of UMMS-Baystate's Pathology Department, this is the key question to ask of all residency programs in which you are interested:
"Knowing what you know now, what are the most important factors
to consider when choosing a residency?"
His Answer: Focus on Three Program Characteristics
"I make these comments not to guide you to select our program—which I believe is very good," says Dr. Friedberg, "But to help you assess for yourself which program is best for your individual wants, hopes and desires."
#1 Experience of the pathologists that actually train residents
Make sure you are going to be training to practice for the next 40 years, not the last 40 years.
For example, if a pathologist has so much experience in a specific malignancy that they can make a diagnosis by merely holding the H&E slide up to the light, that is little more than a parlor trick with little value to you. In addition, skills of pathologists in the department who are not involved in training may be of little use to you.
Focus on getting the experience needed for your future, not what someone needed for their future a generation or two ago.
#2 Breadth of diagnostic training
You cannot afford to be defined by your tools.
Make sure you will be training on the full complement of tools in the field of diagnostics, not just on a specific set of tools currently in favor. A care provider is concerned about the patient in front of them and typically just wants your help in making a diagnosis. They don't care whether you used formalin, immunohistochemistry, hematoxylin or impedance waves to make your diagnosis.
You are entering a world of medicine that needs diagnosticians who will readily embrace any tool that improves their diagnostic product. You need to have multiple tools in your skill set and the intellectual plasticity to add tools as needed.
#3 Economic model that drives the program
How faculty are incentivized will affect many aspects of your training.
All departments are driven by some economic engine—RVUs, grants, publications, outreach, etc. What is considered the coin of the realm will color your training—how much time is spent on interdepartmental meetings, multidisciplinary consultations, "Part A" activities, research endeavors, quality assurance programs, LEAN projects, CAP inspections, etc.
A trainee in an environment focused on the third decimal place of a sodium assay is simply not going to appreciate the true value of a point-of-care test to the bedside clinician. Likewise, a program that seeks to maximize RVU generation may not properly encourage quality improvement activities.