One of our second year Anatomical Pathology trainees, Henry Xie, tells us what a typical day is like for him as a resident in the Department of Laboratory Medicine & Pathobiology.
Henry Xie (PGY2)
Like many of our clinical patient-facing colleagues, pathology residents enjoy service that varies from day to day.
Similarly, we are drawn to the practice of medicine for its compassionate role in society, and the sense of challenge we experience everyday.
What I describe below can be considered a “typical” day on the surgical pathology service, but by no means is it routine.
The University of Toronto is uniquely positioned to train residents in multiple institutions and provide exposure to most subspecialty topics within pathology.
For example, one month you may be enjoying the complexity of soft tissue pathology, the next rotation you may be asked to perform a complex medical autopsy after a radical surgical procedure to find answers for clinicians and family.
As a learner, I find myself in a position of great privilege to learn and hone my pathology skills in Toronto, often directly from some of the leaders in the field.
A day in my life
As a junior in the Anatomical Pathology program, my typical service day would start around 8:00-8:30am. I would revisit my small stack of cases and edit my reports before checking in with my staff.
Generally, I would challenge myself to confidently arrive at a diagnosis. However, often as a junior trainee, I would prepare a differential diagnosis, a list of special stains that I would request, and a series of questions to ask during my case review. When I am ready, I set aside my cases and join my fellow residents for a coffee.
Around 9:30am, I would be sitting across from my staff for our routine sign outs. I organize my cases based on priority – typically cases with suspected cancer diagnoses go first.
In order to get the most out of my review, I strive to present a concise summary of findings so that I can focus on parts of the case where I would need guidance.
On the surface, our approach to diagnosis appears unique compared to our clinical resident colleagues. However, I think the process of gathering history, reviewing tests (slides and special stains), and presenting the case is something every medical trainee practices.
The difference is the setting – instead of working in a clinic room or by the patient’s bedside, pathologists and their learners work at a microscope and learn to describe patterns that would lead to a specific diagnosis.
One-on-one teaching is a large part of pathology training.
I take my seat at the multiheaded microscope and present the clinical context as my staff reviews the case.
During the process, we may arrive at an area on the slide I marked with ink, and here we would pause briefly, and I would bring up any significant findings in the area along with questions I have.
Often the pathologist would use these brief pauses in our session to provide key teaching moments and help us hone our eyes for subtle patterns of disease processes.
It is this one-on-one apprenticeship that many trainees like myself deeply appreciate.
Our session concludes around noon, and I return to my microscope with new cases to review.
As a brief break, my peers and I get lunch and catch up with each other’s day. We often have lectures, virtual slide sessions, and rounds for supplemental learning.
Often, these topics cover a practical approach to certain cases, and sometimes it would be a showcase of atypical and rare “zebras” diagnoses.
In the afternoon I review and write up reports, again highlighting areas where I would like guidance the next day.
Sometimes I may be scheduled for grossing of new specimens– a great way to learn anatomy, and to appreciate the complexity of surgical procedures and underlying disease process at the macroscopic level.
Other times, I would opt to use my afternoons to work on research.
At the end of the day, I take ten to fifteen minutes to complete my case logs and submit my evaluations. Time to go home.
After work, I would usually go to the gym for a quick workout. During the longer days of summer, I opt for a run as the heat of the day dissipates.
I use exercise as a mental reset so I can feel refreshed as I settle in for the evening.
After a homemade meal, I may try to catch up with friends and peers, typically over an evening desert. Ice cream being my go-to preference, and options are of course endless within the heart of Toronto.
For the rest of the evening, I commit a few hours for reading around cases from the day or settling in for a more in-depth review of topics and create study notes. It is also a good moment to reflect on the learning for the day, and perhaps raise relevant questions for my cases. My night often concludes with just one episode from the latest binge-worthy show on Netflix.
What a pathology residency can offer you
If you are a medical student considering pathology for CaRMS you certainly will be pleased by what pathology, specifically at University of Toronto, has to offer.
You could be a candidate who loves medicine because you are curious about disease development and progression and may want to be a teacher to future trainees.
Perhaps you are interested in research and want to help answer the many idiopathic processes still outstanding.
Maybe you’ve got a keen eye for patterns and want to hone your diagnostic and hands-on skills, all the while maintaining a good work-life balance.
How you decide to master the art of pathology is completely up to you, and our Anatomical Pathology program will have the tools to help you.
City of Toronto
In terms of life and living, I would argue that Toronto is one of the best cities to be a part of.
There’s something for everyone. The endless number of restaurants would test even the most seasoned foodies.
If your interests are in the arts, then you may be pleased to know that Toronto is a hub for theatre, music, and film with my favourite event being the Toronto International Film Festival every fall.
Rest assured, Toronto is a great city to in which to do your hobbies, discover new interests and learn pathology.
