The Symphony Orchestra of Medicine

By Jack Maggiore, PhD, MT(ASCP) - April 28, 2021

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Interviewing candidates for pathology residency programs is a time-consuming process in which participating faculty are encouraged to ask open-ended questions that allow candidates to expand upon the highlights of their Curricula Vitae and personal statements. This investment of time could be quite demanding on the participating faculty, and a realized return on the investment may not manifest for many months or many years, if ever. Formulating a series of creative and thought-provoking questions is critical to the success of the interview process, and could transform an otherwise mundane task into a true recruitment opportunity and help to accomplish your objective in identifying the best matches for your program.


Asking engaging and open-ended questions

All pathology residency interviews this past year at our institution occurred remotely via live videoconferencing applications to permit one-on-one interactions. In an attempt to make the 20-minute session feel more conversational and less like a job interview, I sought to create a set of unique questions that could have the outcome of an icebreaker while providing an opportunity to gain important insights about the perceptions of the candidates. One particular question that I created this year as a faculty member of our residency recruitment committee was, "In the symphony orchestra of medicine, what instrument does pathology play?"

I asked this question to all candidates who indicated in their application a skill of playing a musical instrument, hobby of listening to music, attending live concerts, or simply expressing a love for music.  This past year, of the candidates we interviewed for our residency positions we sought to match, 20 percent indicated music in their applications and were asked this question.

Four candidates were initially taken aback by the question and asked me to rephrase it. In my rephrasing, I indicated that I was attempting to create an analogy of the field of medicine to a symphony orchestra, and was seeking their perspective as to which instrument the specialty of pathology plays in this "orchestra" that is medicine.

Most candidates were intrigued by this unique question, for which one could not have rehearsed a reply. Many were downright excited to be able to provide their perspectives on the medical specialty for which they were committing to call their own.

The intent of my question was multifaceted in that I was attempting to gain their perception of the field of pathology and its contribution in the overall care of patients. In doing so, I was allowing the more creative candidates to think quickly in formulating a clever and insightful response. This question was always the highlight of my interview sessions. Below are a few of my favorite responses that demonstrate just how varied the perceptions are about the role that pathology plays in the symphony orchestra of medicine. These are all direct quotes from residency candidates, with identity withheld to preserve the anonymity of our process.

Drums and Percussion

"Pathology represents the percussion section, setting the beat and cadence for all other disciplines to follow. Not just one instrument, but an entire class of instruments that fills the void and silence with soundbites and makes all the parts of the music fit together."

"Pathology is most like a percussion instrument. Without percussion, the music would play without direction; much like medicine would proceed without its strongest diagnostic partner."

"Pathology plays the drums, keeping all other areas synchronized so that they don't drift into another song. The beat guides the music like pathology guides patient care."

"Pathology represents the tabla, which is a Hindustani hand drum that may be played on its own, as an accompaniment with vocals or other instruments, or as part of a larger ensemble. The tabla provides an unmistakable, very distinct sound, just like pathology does in the diagnostic world."



"Pathology plays the same role as the string section. It doesn't set the melody, but rather plays the harmony. It takes the original musical score and provides the accompaniment to make the piece seem balanced."

"Pathology would be the bass. Unless you're looking for the bass, you don't immediately recognize it, but you would recognize it if it weren't there. The bass is the background music. That's pathology in the symphony of medicine."

"Pathology is definitely the bass in medicine's orchestra.  Not everyone is quick to hear it, but it is unmistakably there working in the background to carry the music, maintain a smooth rhythm, and deliver a successful outcome." 

"Pathology would be in the string section, most likely the bass. The bass provides the glue that holds the song together; its pitch is low, very much behind the scenes, but if it were gone, you would definitely know it wasn't there."

"Pathology is like an acoustic guitar, very versatile and able to play many different musical sounds. While it could play solo, it is best as an accompaniment with other musical sounds and voices."



"Pathology most reminds me of a piano concerto, playing the crux of the musical piece, the part of the song that everyone anticipates and remembers. Pathology provides the diagnostic information that all other disciplines of medicine anticipate and act upon, just like a concert pianist."



"I don't think pathology represents an instrument or section, but rather is the conductor.  Pathology's role is not to make the music, but instead assures that the rest of the orchestra is on the same sheet of music and is playing the song in a coordinated fashion."

"Pathology is the maestro. The maestro of the orchestra makes sure that there is good balance between the sections and that each section is guided by an expert who knows about each musician and makes the orchestra play as a united group. That's what pathology does for medicine."


Closing thoughts

What may be obvious to many readers are the instruments that are NOT represented in these responses. We see no representation from the woodwinds—no flutes or clarinets. We also see no representation from the brass section—no trumpets or trombones or tubas. This indicates that among pathology residency candidates, pathology is not perceived to 'toot its own horn' nor strives to be in the limelight of medicine.

These responses serve as indicators as to how these candidates view the role of pathology in the medical community. Some are very distinct in identifying with behind-the-scenes player, while others describe a collaborative process by walking in step with the medical team, while still others are emphatic about the need to take charge and conduct the orchestrated process. Responses may provide insight as to whether candidates are likely to be collaborative team players awaiting requests for consultation, versus those who prefer embracing the attention and taking charge where opportunities present. Regardless of the responses, we learned that the information could be used to assemble a well-balanced professional team.

I wish to thank our candidates for their creativity and openness. Many whom I interviewed sent me follow-up notes of gratitude to express their thanks for me asking this question and indicating that it made their experience memorable and reflective.

If you would like to include this question in your pathology residency interview process, please do so, as I have no desire to claim copyright or otherwise obstruct your ability to actively engage in a meaningful dialogue with your candidates. If you would like to share with me your favorite answers to this question in your interview experience, I would welcome the correspondence.

Let the music of our symphony play!

Jack Maggiore, PhD, MT(ASCP)

Associate Director, Core Laboratory and Point of Care Testing, and Assistant Professor, Pathology and Laboratory Medicine, at Loyola University Medical Center in Maywood, Ill.