What to Expect When You Start Signing Cases Out On Your Own

• Resources for New-in-Practice Pathologists

Julie McDowell:

When pathologists train, they're often monitored every step of the way and don't have the opportunity to sign out cases on their own. It's nerve-wracking to sign out your first cases. Some of the common questions that go through the minds of newly boarded pathologists include when to ask for help. When do you get a review? How many questions are too many questions? And do you look like you don't even have a clue about what you're doing? Explains Dr. Buu Duong in this CAPcast interview. Dr. Duong will discuss what pathologists need to know during this important transition and key tips to gain confidence when you first start out and practice.

Dr. Duong, what advice would you give to new and practiced pathologists who are unsure about when to ask for help out of fear that they appear needy? Or how do you know when to show a case to another pathologist in the practice?

Dr. Buu Duong:

Thank you for having me on here today Julie. First of all, what I would say is to take a deep breath, rely on your training and know that you would not be where you are if you were not capable enough. Given that, of course, you always know that there are things that you don't know or that you have to learn, and some institutions even require you to show a certain number of cases or even review the first X number of cases before you can sign out on your own, which is actually a very good practice. Distinguishing between these two ends of the spectrum can be very difficult. It can be a fine line in the beginning, but it's going to be different for everybody, and it's going to change as you're in practice.

Julie McDowell:

So Dr. Duong, what about addressing changes in guidelines such as when there's an update from the WHO?

Dr. Buu Duong:

Yeah, so I think for everybody, it's going to depend on the culture that you're in, but you're definitely going to want to give it some time so you can feel out what is appropriate for your specific group. One tip that I've heard is that if you do see updates, then you should include them in your reports, but maybe continue to include the old terminology in parentheses just so that the clinicians that you're dealing with understand the reports and they understand what you're talking about.

Julie McDowell:

So let's talk more about reports. Any advice to share in writing reports?

Dr. Buu Duong:

Yeah, a great idea that I've heard is that you should look at the previous reports in the group that you're in to see how they've done it so that you're not recreating the will, but at the same time, you want to incorporate those reports into your own style. Somebody else has told me that when they started, that they made templates. And templates are a great idea as long as you know when to use them and when not to use them. I did a combination of both, and honestly, it's still a work in progress. I'm constantly working on it.

Julie McDowell:

What about signing off a mixed service load in private practice? What advice do you have for pathologists who might confront this situation?

Dr. Buu Duong:

Yeah, so again, for everybody, this is very different. In my personal practice we have, it's a single specialty, but at the same time, there are lots of different levels of complexity for the different cases. So with that regard, what I do is I triage the cases. And what I mean by that is I like to very early on in the day, if possible, get a look at all the cases and go on and get my re-cuts ordered, go on and get my special stains, my immuno stains ordered. And then while the lab is working on those things, I can start signing everything else out. And then by the time those special stains come out, I'm probably at the point through the day where I can actually look at those really difficult or complicated cases. And also that's a good time to showcase this to a partner too or to another colleague.

Julie McDowell:

Finally, Dr. Duong, are there any resources or publications that you recommend to pathologists just starting out?

Dr. Buu Duong:

Yes. So CAP's New In Practice Committee has a variety of articles addressing the challenges that new pathologists face. Few with tips on signing out include Cautionary Tales of the New In Practice. If you haven't read that yet, there are helpful hints for new and practice pathologists. Reducing malpractice risk and pathology onboarding. To-do lists make life easier. Another one called Setting the New In Practice Pathologists Up for Success. And of course, we've been doing these webinars which are focused on both new in practice and the newly boarded. And these webinars are interactive, so you can always be looking out in your emails for invitations to those. But all these resources are available on the CAP website.

Julie McDowell:

Thank you, Dr. Duong. As Dr. Duong mentioned, please visit the New In Practice section under member resources on cap.org. There you can find additional resources on navigating challenges during the early stages of your pathology career.

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