Pathology Residency Overview

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Pathology is the branch of Medicine that deals with the causes of disease and its very nature. It’s a diagnostic specialty, and pathologists will combine their clinical training with significant lab expertise in order to bring about optimal care. Pathologists are more likely to be research-focused than those working in many other fields, but today’s pathologists are able to add in clinical work to the typical mixture of research and laboratory investigation. Pathology includes both anatomic and clinical pathology, although many will focus in one area. An anatomic pathologist will investigate how disease affects the human body (through examining tissue and specimens), whilst a clinical pathologist will work in laboratories, undertaking testing procedures – thus covering diverse fields including immunology, molecular biology, chemistry and immunology. Pathologists are typically hospital-based and will very rarely work in the community outside of this. Salaries for pathologists are in the upper tiers, with the median clinical salary being $363,000.

Residency Core Requirements

A pathologist must complete four years of residency. The vast majority of residents will choose a combined program that offers training in both anatomic and clinical pathology (AP/CP). This is a four-year categorical program that has no requirement for a preliminary year. Equally, one can choose to complete a three year AP only or CP only program, although this is much rarer with only about 20% of the cohort choosing this route. There are around 150 programs that are accredited to provide training. Almost all pathology residents will go on to complete fellowships after their training, which are typically just one year in duration. The following are currently recognised by the American Board of Pathology: pediatric pathology, cytopathology, dermatopathology, forensic pathology, neuropathology, hematopathology, blood banking/transfusion medicine, chemical pathology, molecular genetic pathology, clinical informatics, and medical microbiology.

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Application Statistics & Competition

In the most recent available data, there were a total of 827 applicants for 631 spots, which works out as 1.31applicants per position. There were 230 US MD Seniors who applied, of whom only 6 failed to match. Meanwhile, 81 US DO Seniors applied, of whom 75 matched – a 93% success rate and one of the highest for DO applicants. Mean USMLE Step 1 scores for those who matched successfully were 233, whilst mean USMLE Step 2 scores were 245. The overall competition rate is therefore low, with a Step 1 Score of 200 resulting in an 86% probability of matching, and a Step 1 score of 240 resulting in a 99% chance of matching.

Sample Interview questions

How would you divide the field of pathology in two, if you had to?

Pathology is divided into anatomic and clinical pathology. The former involves investigating how disease affects the body through autopsy or the microscopic examination of tissues and cells, whilst the latter involves the supervision of testing, blending microbiology, haematology, chemistry, molecular biology and immunology. Some pathologists will combine both areas, but it is much more common to undertake fellowships and specialise in an area that fits within one of the two divisions, rather than that straddles the division.

Compare cytopathology and histopathology.

Histopathology focuses on the structure and architecture of cells, and requires biopsy – typically with a large needle and forceps. This is therefore an invasive procedure, and can take between 30 minutes to two hours. The time to diagnose is 24-48 hours. A basic h&e stain is used, with a paraffin block used rather than a slide. Cytopathology involves detached cells and a fine needle, which whilst an invasive procedure is much less so; the time for this is anything from 5 minutes to 2 hours, and diagnosis will take around 24 hours typically. A slide can be used, or a paraffin block.

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Important considerations

The most important consideration to make is whether one chooses a four year combined residency or the shorter three year single residency. However, most will choose the combined option – meaning that your next consideration is the choice of fellowships after. Remember that most pathologists will take on multiple fellowships, which means that you could be looking at 6 or 7 years further education including the four residency and two or three fellowships after completing it. Overall, pathology pays well and is relatively un-competitive, so is a great choice for those interested in a diagnostic specialty.

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