specialized sign-outs

[EAB]

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I believe at one time there was a thread on this topic but now I can't find it- I would have paid more attention if I had known how important it might be later.
Can somebody comment on pros and cons? My school does generalized sign-out and frankly, I never knew anything else existed until I started interviewing. It sounds terrific to me but I wanted to get other opinions.

 

[yaah]

See the bumped thread.

I like subspecialty, but the other way can be good as well, it all depends on the caliber of teaching and setup of the rotation.

 

[b&ierstiefel]

general and subspecialty...i think both work...probably not gonna factor in heavily on how I rank programs. I too thought subspecialty signout was intriguing when I first heard of it though.

 

[RyMcQ]

At the end of my residency, I have noticed that the subjects I learned best are those that I was exposed to on an ongoing basis, even if on a superficial level. There's so much information, it's like it just has to settle on me over time. Half the battle for me was to be able to formulate differential diagnoses.

The subjects that were taught in a shorter intense burst were more difficult to retain. Your mileage may vary.

On the other hand, I don't think my training in dermpath would have been sufficient if we just handled what came through a general surgpath practice.

So I guess I would advocate a mixture of specialty and general signout. What might be best is to have general surgpath signout with people who are subspecialists and mix in occasional consult cases.

 

[EAB]

Thanks- I found the old thread but I still have one more question. Does having specialized sign-out always mean you do specialized grossing? One school I interviewed with does this and it seemed pretty luxurious compared to the alternative.

 

[RyMcQ]

Thanks- I found the old thread but I still have one more question. Does having specialized sign-out always mean you do specialized grossing? One school I interviewed with does this and it seemed pretty luxurious compared to the alternative.

It is pretty low-impact while you are on specialty sign out. Other residents have to pick up the slack on general surgpath, though.

 

[Mindy]

MGH has specialty sign-out as well as specialty grossing. I think you can (and do) learn either way. As a PSF we had general sign-out. With general sign-out it can be easy to blow off the subjects that you have the most difficulty with: "Oh they are buried in the pile, no one will notice!" I do not think anyone will accuse GI large grossing at MGH of being cush. But other gross benches are easier. We have the 5 biggies: breast, ENT, GI large, GYN large, and Bone/Soft tissue. These can be crushing at there worst. This year is much better in that we have 4 or 5 PAs, a PA student and 3 techs (who only do biopsies). Last year we had 3 PAs and felt the strain at times.

Mindy

 

[b&ierstiefel]

MGH has specialty sign-out as well as specialty grossing. I think you can (and do) learn either way. As a PSF we had general sign-out. With general sign-out it can be easy to blow off the subjects that you have the most difficulty with: "Oh they are buried in the pile, no one will notice!" I do not think anyone will accuse GI large grossing at MGH of being cush. But other gross benches are easier. We have the 5 biggies: breast, ENT, GI large, GYN large, and Bone/Soft tissue. These can be crushing at there worst. This year is much better in that we have 4 or 5 PAs, a PA student and 3 techs (who only do biopsies). Last year we had 3 PAs and felt the strain at times.

Mindy

And I hear that they are hiring another PA this summer.

 

[stormjen]

I was really impressed by the Cleveland Clinic set-up: not just sub-specialty sign-outs, but each sub-specialty gets its own room with multi-headed scope!

 

[b&ierstiefel]

I was really impressed by the Cleveland Clinic set-up: not just sub-specialty sign-outs, but each sub-specialty gets its own room with multi-headed scope!

Although I haven't visited there, I hear the same thing about CC at other places...sounds like CC is either up and coming or already there!

 

[yaah]

I was really impressed by the Cleveland Clinic set-up: not just sub-specialty sign-outs, but each sub-specialty gets its own room with multi-headed scope!

We sort of have that too - the different services all sign out in different places and all have multihead scopes. I think most places that are big enough will have a similar arrangement, otherwise it's tough to do any real teaching. Some of the smaller services often have just one resident on anyway, so multihead scope is unecessary.

I can't comment on the clinic because I've never been there - just have heard it's a bit more private practice oriented and not as academic.

 

[Mindy]

And I hear that they are hiring another PA this summer.

True, true... Our PA situation seems quite stable right now. Furthermore, we have changed some of the grossing "rules" on hard services to match: Residents only gross 5 breast specimens per evening. And likewise, GI large is becoming more like that. I personally LOVE to gross, am a little obsessive about seeing my own specimens, and don't want to be told how many I can do. But we diligently follow the ACGME rules nowadays.

Mindy