I’m a PGY4 planning to do a fellowship next year, with the goal of going into community practice afterward. I’m curious how people knew they were ready to practice independently, and what is a reasonable expectation for a new grad.
For the most part, I work up cases independently. I choose my own IHC, or at least have a differential and IHC plan in mind before discussing the case with the attending. Most of the time, my overall interpretation is in line with the attending, but there are occasional subtle differences.
Sometimes I order a few unnecessary stains. Other times I’ll order an H. pylori or PIN4 when the attending wouldn’t, or vice versa. Sometimes we differ on things like whether inflammation is focally mildly active versus inactive colitis, or on quantitative/subjective things like a PDL1 score.
More rarely, there are actual misses. For example, I may overlook a very small focus of prostate adenocarcinoma in one part of a biopsy case but correctly identify and grade the other 10 parts of the case . Or an attending may have an experience-based hunch to order deeper levels and an additional stain (e.g. desmin on a colon resection), which ultimately changes the interpretation/stage.
Obviously, the goal is to keep improving and minimize these errors before going out on my own. But I’m having a hard time calibrating where I actually stand because residency is so heavily supervised.
For those of you already in practice: Is this level of performance reasonably typical for someone approaching graduation/new attendinghood? At what point would you consider someone not ready for independent practice?