Supervising and Teaching Pathology Residents

“Teaching is fun! I am so energized by working with learners! Working with residents will keep me up to date on current practice!” I’ve always been an enthusiastic person and had all the “right” answers for why academics was the right choice for me. But, as I jumped into my faculty role, all these self-affirmations disappeared. Suddenly, an eager first-year resident needing my guidance was exhausting, while the upper-level needing to stretch his wings was anxiety-inducing. How had all my mentors mastered this teaching skill? How would I ever get my work done, much less lead other human beings through the minefields of daily practice?

I’m definitely still developing in my role as a teacher (and will continue to do so, well, forever…), but I have learned a few things in these first years that may help other new-in-practice pathologists supervise and teach pathology residents.

You may be joining a team with a great curriculum, or you might be independently teaching residents on a brand-new service, either way, spend some time early on clearly defining what YOU expect from the resident: 

• What time will you meet?
• What reading should they do?
• What cases should they finish first, or concentrate on? 

I spent too long being frustrated with a resident who wasn’t picking up the daily smears; had I told him that smear review was his job, then when the duty wasn’t fulfilled, I would have had recourse.

After staying way too late several times, I came to the realization that I could dictate what time I met with my residents, and how the daily work flowed.  While this is going to be different for each pathologist (and may even vary from service to service), I found for most complex cases, I needed to sign-out without an audience (i.e. by myself). I arranged daily meetings with the residents to review cases and edit reports but saved my detail-oriented time for the early mornings or quiet afternoons when I’m at my peak.  If a report needs to be delayed to the next morning to get my full attention, I can have the resident call a prelim, “looks like a low-grade B-cell lymphoma and the subtype will be completed tomorrow,” which is a good exercise for them, too.  Others may do best at signing out directly when sitting with the resident—try both ways and figure out your own rhythm.  

This mantra is repeated in many aspects of life, but in medical education, it rings especially true and plays directly into the various levels of supervision engaged in our role.  During early call shifts with a resident, I allow them to face the questions and situations, but then come in as direct back-up.  With most residents, you will soon discern where their strengths and comfort levels are, and you may be able to dial back your involvement in some areas while maintaining an open ear for any questions they have (reminding them that I WANT to be called and keeping a helpful attitude when they do so).

This is admittedly easier if you join a department you have never trained in but can be somewhat tricky if you stay at (or even return) to your training organization.  Encourage support staff, other faculty, and residents to use the same honorifics they do for other faculty (i.e. if all faculty are “Dr. So-and-so” don’t be the only one on a first-name basis).  This can be delicate ground to tread, but kindly explaining to others what you’re trying to do should help.  Also, get involved in faculty-specific discussions and decisions; sometimes a junior voice can be valuable, so don’t be afraid to (politely) offer suggestions on service, schedules, or troubleshooting. 

Finally, YOU KNOW ENOUGH TO DO THIS. Let that sink in. In your first few years, you may feel inadequate with some cases - don’t let this deter you from teaching! Even in a department of experts, YOU will undoubtedly contribute some morsel of learning to a resident that previously hadn’t “clicked,” based on your own ideas, timing, or personality. When you aren’t sure about a diagnosis, let your learners see you consult a colleague or pull out the textbooks. When you make a mistake, have your learner walk through the correction steps with you - and show them how you messed up.

Day to day, teaching and supervising residents can lead you to great joy (and occasionally some frustration). Throughout it all, you are shaping your future colleagues and our profession. Keep your head up and keep trying!

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