Common Questions

How is the work/life balance?

• Definitely good balance
• It’s one of the best parts of the program. Every weekend (unless on call) is yours. The hours on every rotation are reasonable. You will have a life outside of work.

What types of housing is available to residents?

• University dorms on campus and apartment/house off campus dependent on personal preference.

Do residents have families and get to see them?

• Kami: The majority of residents have significant others and about half of the residents have children. Even on my busier surgical pathology rotations, I’m able to see my husband and daughter, nearly everyday. Several residents have had children during residency, and the program has worked to coordinate and accommodate them. Overall, the program has a great work-life balance.

What’s it like living in Madison?

• Alex: As a lifelong Madisonian, I may be biased, but I think Madison is a fantastic place to live! It is small enough of a city where you can get just about anywhere in a reasonable amount of time, and just large enough that there are always events or activities available. The winters can be tough, but a good pair of boots can go a very long way. The snow is usually plowed before you wake up in the morning, and the buses still run in snowy weather.
• Margarita: Madison is a great mid sized city with enough to do both city-wise and even outdoor activities. There’s always community events such as concerts, art fairs, and the lakes and nature areas provide both water and land recreation. The restaurant scene is also up and coming with quite a variety between the downtown/campus and suburban areas.

How’s the commute to UW? How much is parking? Do people ride bikes/walk or take the bus?

• Driving, bike or walking is all possible. Bus pass is free for UW employee including residents.
• Kami: I live about 30 minutes away from the hospital, and drive to work everyday. The traffic can be busy, but it’s never been an issue. You have the option to purchase a parking permit each year. An annual parking permit typically costs between $800-$1300, depending on which lot (surface lot vs parking garage) you chose.
• Ande: Super manageable, but I also only live ~10 minutes (by car) from the hospital. Parking permits are available for those that drive. UW gives free bus passes to all employees (including residents) and my apartment is right off a bus route. The bus runs less frequently at night. So if I know I will be working past a certain time, I drive, otherwise it is only a 25 minute bus ride. Bike culture is really big in Madison and there are bike lanes everywhere. The lanes are wide too, not narrow like many other cities I’ve been to.

What’s the average cost of an apartment?

• $1500-2000 for 2 bedroom
• $1000-1600 for a 1 bedroom mansion

Do you socialize together outside of work?

• We have wellness activities periodically such as movie night, walking in the park, BBQ, boating etc.

Give an example of a resident request to change something about the program and how (or if) the program implemented the change.

• A couple of years ago the residents requested a reorder to our lecture schedule from somewhat random distribution of lectures to themed lectures, it took a significant amount of effort to get faculty on board due to the fact that it was a major change in the lecture schedule format, but ultimately it resulted in a very cohesive learning experience for the residents. We now have approximately 6 week blocks of lectures that are focused on one topic, which includes hematopathology and blood bank; autopsy and infectious disease; gastrointestinal pathology; breast and gynecologic pathology, genitourinary and head and neck pathology; and bone soft tissue, thoracic and dermatopathology. Residents also requested more dermatopathology lectures and these were added to our lecture schedule. The program directors and faculty are all very supportive of changes that improve resident education and work very hard to optimize our experience.
• 3 DAY CYCLE has been a huge recent change in the program that residents have been working with faculty on for years!!!!

What kind of experience do residents get in inspections/QI projects?

• Residents complete the College of American Pathologists (CAP) Inspector training course and participate as CAP Inspectors for our biannual mock CAP Inspections. Residents are trained in root cause analysis (RCA) and can participate as resident members of UW Hospital Institutional RCA teams. Each resident completes at least one QI project under the mentorship of a faculty member while on their last CP Core rotation (though some residents complete more.)  Two of our residents participate as UWHC Quality & Safety Council Resident Representatives.  Finally, more senior pathology residents present at the majority of interdisciplinary tumor boards. Such conferences serve a vital Q&A function and help improve patient safety at our institution.

Is the residency AP/CP integrated (mixed yearly schedule)?

• Each year has an approximately even mix of AP and CP, in 4, 8, and 12 week blocks. It’s not split up in any way. I like this, because it lets us experience a breadth of areas in pathology early on, so we have a good idea about what fellowships we want to apply for.

Is there an autopsy rotation?

• We have four months of in-house autopsy rotations (i.e. we do not go to a medical examiner’s office). Our autopsy service includes medical cases from UW Hospital as well as other private medical autopsies from hospitals around the state. We also have an in-house forensic autopsy service that does autopsies for various counties in Wisconsin.
• Ande: Yes! The case volume is enough where residents are not fighting to meet quotas. The attendings teach you how to eviscerate and how to prosect. They are present for all of your cases or are just a short page away if you are a senior resident. Residents do all the prosecting (with guidance from the attending when needed). There are dedicated morgue techs that assist you in the evisceration process on all your cases too. Our program does a good job ensuring there is a more seasoned resident rotating with you, so you always have someone you can go to.

How much vacation time do you receive and when can you take it?

• We receive three weeks of vacation (i.e. 15 week days). You can take them whenever. Some people scatter the days out. Some take them in one-week increments. You just have to coordinate with the service you’re on and the other residents on that service to make sure there is appropriate coverage.

Does the program support travel to national conferences (e.g. USCAP/CAP)? Are you funded to go?

• It does! And you are allotted educational days to attend conferences if you are presenting. If you’re presenting, they also pay for your hotel, registration, meals, and transportation! There’s a big push in our department to help us generate interesting research or cases that will be accepted at national conferences, so many of us attend the conferences each year.  Also, we have funding for residents to attend one large national conference during our time here even if they don’t present research. We have a departmental IRB that is a short two page form that can easily be filled out and applications for projects and funding have been approved in less than 24 hours. Residents frequently present their research at USCAP, CAP, NAME – among other conferences.

Is there a book fund?

• We get a $850/year fund to spend freely on books, online materials, technology (tablet, computer), and anything that is considered related to our residency education. The only stipulation is that we attend at least 85% of our morning educational didactic conferences, which is easily done by most all residents.

What is call like?  What is the back-up system for call (i.e. whom do you call if you need help?)

• We cover both AP and CP call from 7 PM to 8 AM the following morning starting on a Friday. It’s Friday to Friday. We have a group text/chat where we can all reach out to each other as help and the chief residents have all agreed to help with calls as well. In addition, each resident is paired with faculty in each subspeciality who are available for the entire week. There is a culture of helping out each other and residents are encouraged to call to ask questions of our faculty. We take call from home and only go into the hospital to cover frozen sections and rapids in surgical pathology as well as apheresis procedures on our transfusion medicine service. In general 2nd years take 6-7 weeks of call/year, 3rd years take 3-4 weeks/year and 4th years take 1 week/year. Call volume can be quite variable, but on average residents receive one or two pages/day and then spend a few hours each day over the weekend triaging surgical specimens and covering after hours frozen sections and transplant biopsies.

How easy is it to get clinical information?  What is the electronic medical record like?

• It is generally pretty easy with few exceptions. We use a centralized EPIC system for all UW Hospital and Clinics activities, which makes it simple for “UW” patients. When we have patients from other local hospitals or the VA hospital, their information can often be accessed under the EPIC ‘Care Everywhere’ tab. The VA has a separate EHR that all matriculating residents are granted access to; so if the clinical history on a VA patient is not found on EPIC it can be directly accessed through the VA system. For autopsy cases from remote outside hospitals, faxed reports are sent for our review. Overall it works well.

What pathology software does the program use?

• Our department uses both AP and CP Beaker, which is the laboratory information system associated with our hospital’s EHR from Epic Systems.

What is the lecture schedule?  How do they schedule lectures? (i.e. are you going to see the same immunology lecture every 6 months?)

• We have 8am didact every morning in addition to a few scope sessions in the afternoon.
• Ande: Our program has themed morning didacts where a stretch of lectures are all related to topics in one subspecialty. The morning lectures are currently on a 2 year rotation cycle, so you see each lecture twice. All of our lectures are recorded too. So if you had to miss or want to brush up on a topic before it comes around again, they are easily accessible. My senior co-residents have said many residents revisit these lectures when prepping for boards.

How does your program prepare you for boards?

• We have book funds to pay for study questions, as well as a number of board-specific lectures towards the end of the year. Additionally some of our faculty members have put together slide sessions for seniors preparing for board exams. We have numerous slide sets for general learning and very specific goals and objectives for each rotation that help prepare us to pass boards and more importantly independent practice when we graduate.

Where do residents go after the program?  What do they do?

• Byron: The short answer is they go wherever they want and do whatever they want. Graduates have gotten their #1 choice for fellowship in a variety of specialties (Dermpath, hematopathology, forensics, CDC, microbiology, blood bank, clinical informatics and many different surgical pathology fellowships).  About half of our residents in recent years have gone into community medicine and half into academic medicine after their fellowships, our faculty have connections all over the US and we are able to form close bonds with many of them as we work together over the years. They all get to know us well and are more than willing to reach out to colleagues and put in a good word for us.

Do your residents pass boards?

• Under the current residency program directorship team (i.e. over the course of the last 5-6 years) every single resident has passed their pathology board certification exam on the first attempt.  Most of our residents take the combined AP/CP examination.

Have there been recent changes in the pathology chair? Program director? Faculty?

• Andreas Friedl just finished his tenure as chair in 2022 and was the chair for 11 years. Drs. Cook and Connor took over as our residency program directorship in 2021, both of whom were prior residents in our program. We have recruited a number of new and enthusiastic teaching and research faculty who have joined our department in the last few years; our program and service volume has grown significantly in the past few years and we’ve been able to attract a number of well-trained faculty from around the country.

What does the program do with RISE scores?

• RISE scores are primarily used as a means of identifying areas in which residents may want to focus their reading/study efforts – particularly when approaching the time of board preparation. Scores are also helpful in providing feedback to faculty who have implemented novel curriculum or teaching modalities whether these interventions are having the desired effect.

What kind of leadership experience is available for residents?

• Residents are encouraged to accept positions of leadership and representation, at the local as well as national level. In addition to our Chief Residents (who bear significant leadership responsibilities), we also select residents to act as our residency program’s CAP Resident Forum delegates, ASCP representatives, UW House Staff Association representative, and EPIC SuperUser–among other leadership positions.

What support does the program give for residents interested in research?

• There are lots of opportunities for research from our outstanding faculties. We have the option to do projects in different area.
• Wenjing: The department provides strong support for the residents with an interest in research. There are research-dedicated rotations for single-track residents and research electives for AP/CP combined residents. Residents will be paired with mentors/supervisors (both clinical faculty and research faculty) in the field of their interest. The department readily funds residents with research proposals. If the project involves human specimens, the departmental basket IRB expedites the application process and the TRIP lab helps residents carry out the experiments. The department also supports residents to go to conferences, e.g., covers all conference-related expenses if residents have a poster or oral presentation.

What about options to teach?

• Monica: There are many opportunities to get teaching experience. The degree in which you are involved in these activities depends on your interest. Medical students rotate in our department, so you can always get the chance to mentor a medical student. We also teach each other. For example, senior residents usually sit with us and help us prepare for the unknowns every Monday or they help us when we are previewing cases. Additionally, during surgical pathology training month every junior resident has a full-time senior resident teaching him/her how to gross. There are also other more formal opportunities for teaching, which I haven’t experienced yet because I am a junior resident.

Do medical students rotate in the department? What is their role?

• Monica: We have medical students rotating in the department much of the time. Medical students are present during our morning conference and they sit next to us during working hours. They are always willing to help and participate so they seem happy when you invite them to review the medical history of a case or the slides that you need to preview. In autopsy, for example, we usually discuss the case with them before talking to the attending and they can help with the external examination of the body. They are curious students with an interest in pathology or other specialties such as radiology or surgery and they always seem to want to take the most from our pathology rotations.

Have there been any major changes in your program/department recently?

• Margarita: Switching from 1 day cycle to 3 day cycle in surgical pathology has allowed for more one on one attending time and previewing biopsies and big cases, with less hours spent in the gross room.
• Our program has been recruiting multiple new faculty members from different subspecialty services to better regulate workload and optimize teaching of residents. Other initiatives over the past academic year would include instituting a new dedicated Pediatric Pathology rotation (previously peds was integrated into autopsy/SP), a new CP Leadership rotation, being approved to recruit a single-track AP or CP-only resident per year (increasing our total resident numbers from 20–>23), instituting a new (and more popular!) format for Monday Morning Unknowns, and devising a new more ‘hands-on’ surgical pathology training month structure. In order to augment resident ability to prepare/review for didactics, we have purchased a new virtual education tool this year, i.e. ExpertPath (https://www.expertpath.com/.)  We are continually tinkering, trying to optimize our residency training experience.

How did your program adapt to COVID-19 to implement a safe learning environment?

• Monica: COVID-19 pandemic has changed the way we work a bit but we still have many opportunities to work as a group. Our morning lectures are now online, but attendings make these lectures very interactive so that everyone can ask questions or participate in the discussion. Our multi-headed microscopes now have plexiglass shields so we have a transparent barrier to separate each other when we are viewing slides together. If you only have paperwork, it is easy to work from home (i.e. telecommmute.) Finally, we always use our barrier face masks.

How does your program help graduates get fellowships?

• Almost all residents from our program complete fellowship training prior to seeking jobs. The residency program directors (i.e. PD/APD) meet with each resident individually twice a year to review performance and discuss career goals.  Once the resident expresses an interest in a particular area of pathology, the directors can begin to make suggestions about helpful electives, awards to apply for, and/or organizations to join that will help make the resident as competitive as possible in attaining the fellowship of his/her choice.  The residency program director and faculty write supportive letters of recommendation detailing the resident’s accomplishments.  As our program faculty themselves trained at a wide array of institutions, they are able to offer helpful input into a resident’s fellowship program selection (or even perhaps put in a good word directly for the candidate!)

How many AP specimens do you have per year?

• We have a large volume and diversity of surgical specimens each year with more than 50,000 surgical specimens (biopsies and resection specimens) currently.
• Our autopsy service performs around 500-550 cases annually. In 2019 our cytopathology service specimens included 21,308 gyns, 4,192 body fluids, and over 2,100 FNAs.  Our hematopathology service has ample case volume with over ~1,500 bone marrows processed annually.

What is the surgical pathology schedule (i.e. rotation cycle schedule)?

• Surgical pathology is our most rigorous rotation and most residents work 60 hours/week. We have a one-day surgical pathology cycle. We preview biopsies and write up cases in the morning, then sign-out mid-morning to mid-afternoon. At 3:30 we start grossing until we finish our allotted specimens, then we preview our big cases afterwards which can take a couple of hours. In the gross room we are allocated a certain number of specimens corresponding to our PG year, junior residents have less specimens than senior residents. One day a week we cover frozen sections from 9 am-3:30 pm (PAs take over when we gross). Although surgical pathology is the most rigorous rotation time-wise, we only work Monday-Friday and we don’t gross on the weekends (with rare late breast cases that come in late Friday night, which are completed by the on-call resident).
• Ande: We recently switched from a 1 day cycle to a 3 day cycle, meaning we now have one day to gross specimens, one day to preview/sign out biopsies with your attending, and another day to preview/sign out big cases. This has been welcomed change and has improved the work-life balance when rotating on surgical pathology, which has historically been one of the more rigorous rotations. With 5 residents rotating at a time, you are only responsible for frozen sections one day a week from 9 am – 7 pm. There can be days when you are scheduled to gross and are also on call for frozens. Program leadership and the grossing PAs are very supportive if you have a busy day on frozens. There is a process being developed by program leadership in collaboration with residents and grossing PAs to ensure adequate grossing time for residents even during busy frozen days. You rotate for 2 weeks on a designated subspecialty then switch to another subspecialty for the remaining 2 weeks of the rotation.

Is there surgical subspecialty sign-out?

• We have subspecialty sign-out as well as subspecialty grossing. We’re divided into five major surgical pathology rotations: Hepatobiliary/Pancreas, Tube Gut, GU/ENT/Endocrine, Breast/Gyn and BST/Thoracic/Derm. Residents rotate to a different service every 2 weeks and will gross those specimens for their service. In general we see everything we gross, with some exceptions if the disease process involves a different service (i.e. if for some reason a gastrectomy is performed and there is a lymphoma arising in it, it will then be signed out by the hematopathology service, not the tubular gut service).

Do you follow up on complex cases that require ancillary studies and immunohistochemistry?

• Yes, that is the expectation of every resident on service to take their cases seriously and carry the responsibility of the case as though they are the attending signing it out.

Do you present at tumor boards and communicate results with clinicians?

• Each resident rotates for 2-3 months on an interdisciplinary pathology (IP) rotation where they cover the majority of tumor boards; this is an opportunity for the residents to learn the treatment implications for our biopsies and resection specimens and to interact with a large number of clinicians and answer their questions. Residents also spend their last month of surgical pathology covering frozen sections and calling the results into the OR. Prior to the IP rotation, residents have opportunities to present at M&M conferences, pediatric tumor board, and autopsy or neuropathology gross conferences. There are always faculty present to back residents up for any questions, but residents are encouraged to take responsibility for the cases being presented.

What is the staffing like for the gross room? Are there PAs? Are there dieners in the morgue?

• We have four morgue assistants (similar to dieners), one of whom is always assigned to work with the resident on their autopsy case. In the gross room we have six PAs and one grossing technician.

What kind of orientation is there for new residents in surgical pathology?

• We have a solid month of surgical pathology orientation that was recently implemented after resident feedback. Essentially a new PGY1 is paired with a senior resident and the junior grosses under their supervision for a month. This has gone well so far, but we’re looking for feedback to best serve both the trainee and trainer.

What are the hours like on surgical pathology?

• It varies by subspeciality and the specimen load, but I estimate on average 65 hrs/week
• Ande: This has drastically changed recently with the implementation of a 3 day cycle. I’ve noticed most residents are gone by 6pm. It also varies depending on subspecialty as some services have a higher specimen volume than others. With the 3 day cycle, I would guesstimate an average of 45-55 hrs/wk (not including studying).

 What cytology specimens do they see?  What non-gyn cytology do you see?

• We see very few (if any) breast cytology, but every other location is quite common (e.g. thyroid, pancreas, lymph node, bladder, lung)

Do you perform FNAs?

• We do not perform FNAs as residents. Cytopathology fellows do get to perform FNAs.

Is there a gross/autopsy conference?

• We typically have autopsy gross conference 1 day per week and brain-cutting conference 2 days a week when we are on autopsy service.

What is your molecular experience like?

• Molecular pathology is included as a key component of our CP Core rotation. This unique rotation combines multiple other key CP areas (i.e. chemistry, immunology, microbiology, cytogenetics, and coagulation) into a three-month rotation.  The idea is to allow for focus on high-impact learning opportunities and to provide a more longitudinal experience that gives residents the chance to become involved in and follow-through on QA projects, lab management issues, etc.  CP Core Residents rotate in molecular pathology while on this rotation and are integrally involved in the Molecular Tumor Board.  Residents may additionally elect to perform dedicated molecular pathology rotations.  Also, molecular topics are integrated into our 8 AM residency didactic series.

Do you perform bone marrow biopsies?

• While residents have practiced bone marrow biopsy technique at autopsy, they are not responsible for performing bone marrow biopsies on living patients at our hospital. That said, the clinical team would no doubt be quite willing to involve a resident in biopsy performance if he/she expressed interest.

How do the blood bank, chemistry, microbiology rotations integrate residents into activities for the month?

• We attend daily and weekly one-on-one meetings with faculty as well as team meetings and laboratory management meetings during all of these rotations. We have opportunities to follow up on questions raised during these meetings and also get to present and debrief after meetings with our laboratory team and vendors.

Do you see lymph node and bone marrow pathology?

• Yes, several bone marrows a day while on hematopathology, and lymph nodes, while less frequent, are still a common occurrence. Additionally, attendings have excellent study sets that they use to teach residents during slide sessions.

What kind of blood bank responsibilities do you have?

• Wenjing: Under faculty supervision, residents interact with clinicians and technologists to ensure that blood components are used appropriately balancing risk, benefit, and availability; evaluate and approve special transfusion requests (i.e., washed or irradiated RBCs, crossmatched or HLA-matched platelets, etc.); interpret antibody screen panels, and manage transfusion reaction.

What is the resident role in blood bank and with apheresis?

• Aysenur: Residents see the patients undergoing plasma/ RBC exchange at the infusion center and also a few patients from inpatient units. Residents write progress notes with fellows and medical students, and are actively involved in the management of transfusion reactions and interpretation of antibody identification panels. We sign out these reports on Tuesdays and Fridays after discussing our findings and diagnoses with our attendings. We usually have at least three apheresis/infusion center patients/day.