I wish I knew...
I’ve seen recent Instagram posts going around about surviving intern year, which is when I have to confess my imposter syndrome. I’m not a real doctor, I’m just a pathologist. I never experienced the traditional intern year - no patients, no rounding, no codes.
But I recently messaged with a pathology resident at the end of her first year --- and also at the end of her rope. It brought back the sheer awful terror of pathology residency. Don’t get me wrong - I get through life by siloing off all the disparate parts of my identity and minimizing any difficulties I have. Everyone’s life is hard, I am no one special. This is especially true of my pathology training - medical and surgical interns have it far worse than pathology residents in many ways.
And yet and yet and yet… just contemplating my residency brings up a million mixed emotions that I never confronted or examine today. Is despondency the right way to describe how it feels to be on the receiving end of contempt? During my training, I can think of about 3 moments of pride I took for the job I was doing. My training took 6 years.
Even though we don’t have that ‘intern’ designation, being a pathology resident grinds you up and makes you question your self worth. I hope it's different now, and I’m sure all of you are much better than I ever was. But in case there’s any pathology residents out there who might relate to this, here are some things I wish I’d known.
-Revel in your ignorance, especially at first. No one expects you to know stuff your first year, or even so much into your second. I remember being awed by the audacity of a resident who just replied flippantly, ‘looks like lots of pink and purple to me’. It got a big laugh and no one cared. Meanwhile I was sitting in the back, rending my clothing over my ignorance.
-There will always be someone in the program better than you. They’re better at grossing. Maybe they did a post sophomore fellowship. They’re happy to come in on Saturday and prep for unknown conferences. They get along with the attendings who make your skin crawl. It turns out, they’re working on a research project that you never heard of and don’t understand. They’re presenting that research at a conference in California during a blizzard while you are running the bowel for a hepatitis positive autopsy.
-Pathology academicians are not known for their people skills. Sorry to reinforce this stereotype but it's true. I know it's true because there are exceptions, and they stand out because they’re exceptions. For the most part, they’re research medical scientists who need to publish. They don’t remember how they learned to gross and they just want you to make their lives easier. You can learn things from them, but not until your later years, when you’ve started to learn their language.
-Some people are jerks. You might have to sit in a room with said jerk, often a subspeciality fellow, for a month solid, looking at cases as they preach and condescend to you, and you’re supposed to learn the material from them. Some attendings believe that yelling at you across a busy frozen section room is the way to get you to remember some things (I remember them!). Sometimes you will get yelled at by a surgeon, for sport or for a legitimate reason. These things are going to scar little parts of you inside that no one will see at your autopsy.
-Pathology work is physically hard, and they give that part to you all up front. It is also precise and dangerous, and the combination of these three things makes it almost impossible to get it right. Even the most mundane of tasks, like pinning out an esophagus, could kill you. The most important thing you can learn is to protect yourself from an exposure or infection even if no one else seems to value that in the moment. Just because your program doesn’t value you, it doesn’t mean you don’t matter.
-You also have to protect your knowledge. Although you are there to provide diagnoses for patients in real time, the real goal of a pathology residency is for you to accumulate applicable knowledge. You are investing in your own personal treasure trove of patterns, situations and rules you have to rely on to earn a living in the future and do right by future patients and doctors. It doesn’t matter how you compare to the people in your program - your knowledge investment matters. You matter.
-You have to do a lot of learning on your own, and that’s just the truth. It is medical school all over again, except in depth and from the other side of the mirror. You have to resign yourself to not knowing stuff and to remain motivated to keep learning. It is hard to feel motivated to learn when you feel ignorant. You will have more compassion for people who struggled in school than ever before.
-Creating things helps me remember material. Write down diagnoses in a book. For me, even the write ups for cases were mysterious when I started. I didn’t know that colon cancer was always grade 2. Sure, I read manuals. But I simply didn’t know how to format the cases, what information mattered. Outlines in Pathology, by John Sinard, was surprisingly the best resource. My best advice? Make your own hard copy version of that textbook, a notebook for yourself. You can carry it around, write down all the important phone numbers you need, and keep busy when the favored resident is preening.
-I made flash cards. I took the photos from each Archives of Laboratory Medicine journal case reports (free for residents) and turned them into flash cards. I found old textbooks in the recycle bin and cut them up into flash cards. I got glue sticks and decompressed on the weekends doing this.
Finally, each year gets better. Sadly, the only way to get through it is through it.