How to be a great extern

[hematosis]

Folks. Ive been seeing attending post their guidelines on how to be a superstar podiatry student / great externs on instagram and other social medial and how to basically kiss ass on both cheeks. Get there early, leave late, carry 20 wound care supplies, mop the floor, do everyones notes, etc etc.

I know some of this applies to every other specialty and i've personally seen this ass kissing during my vascular, medicine rotations but just like everything else in podiatry we take it way too far. Student, resident, fellow and associate abuse in podiatry is a big problem and nobody is going to talk about it. Other non podiatry attending for the most part do a great job teaching, showing up some weekends to round, doing their own work, etc. Most podiatry attending are the worse. During my residency, we pretty much did everything. Two of the older podiatrist didn't even know how to use the EMR system and would dump it all on us. We would joke and say if the residents called in sick, the department would close for the day.

As an attending, i made it a point to myself to never abuse a student or resident. I don't use them to see my post ops so i can see billable patients (what 90% of fellowships do). I don't use them to write my note and send it to me. I don't use them as a scrub or a free PA to assist in cases. I don't use them to round on my patients for me. They're there because i simply love to teach. thats it.

I encourage you to report these scumbags to APMA, your hospital administration, ACFAS ( these guys are worthless though). Do it anonymously. Youre not there to slave away and make their job easier. you're there to learn and they are getting paid to teach you. I'm sick of this "make their life easy mentality." If they're not teaching you report them. If theyre billing patients for your work, report them to Medicare. you ave a lot of power. and this **** needs to stop.

If you're in a situation and need help, private msg me for advice. I can help you.

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[CutsWithFury]

Folks. Ive been seeing attending post their guidelines on how to be a superstar podiatry student / great externs on instagram and other social medial and how to basically kiss ass on both cheeks. Get there early, leave late, carry 20 wound care supplies, mop the floor, do everyones notes, etc etc.

I know some of this applies to every other specialty and i've personally seen this ass kissing during my vascular, medicine rotations but just like everything else in podiatry we take it way too far. Student, resident, fellow and associate abuse in podiatry is a big problem and nobody is going to talk about it. Other non podiatry attending for the most part do a great job teaching, showing up some weekends to round, doing their own work, etc. Most podiatry attending are the worse. During my residency, we pretty much did everything. Two of the older podiatrist didn't even know how to use the EMR system and would dump it all on us. We would joke and say if the residents called in sick, the department would close for the day.

As an attending, i made it a point to myself to never abuse a student or resident. I don't use them to see my post ops so i can see billable patients (what 90% of fellowships do). I don't use them to write my note and send it to me. I don't use them as a scrub or a free PA to assist in cases. I don't use them to round on my patients for me. They're there because i simply love to teach. thats it.

I encourage you to report these scumbags to APMA, your hospital administration, ACFAS ( these guys are worthless though). Do it anonymously. Youre not there to slave away and make their job easier. you're there to learn and they are getting paid to teach you. I'm sick of this "make their life easy mentality." If they're not teaching you report them. If theyre billing patients for your work, report them to Medicare. you ave a lot of power. and this **** needs to stop.

If you're in a situation and need help, private msg me for advice. I can help you.

I don't have residents or students but if I did I would definitely teach them and not abuse them like I was abused as student extern. Residency was a joke as well. Everything hematosis said about his residency experience was similar to mine and I graduated from a well known residency program.

This is your time to learn to be the best podiatrist you can be. Why do you think there are so many fellowships? It is because residents are not getting trained.

 

[Sweatshirt]

Preach. Most of my externships were good, but this one externship I was at was unreal. The EXTERNS were expected to run the clinic. We saw patients, did the treatment, and wrote the notes. The residents checked our work and the doctors just sat there until they were needed. It was the worst rotation ever. If the STUDENTS were not there the clinic would have had to shut down because nobody would know how to do anything.

I skipped the interview and did not rank them

 

[Weirdy]

Preach. Most of my externships were good, but this one externship I was at was unreal. The EXTERNS were expected to run the clinic. We saw patients, did the treatment, and wrote the notes. The residents checked our work and the doctors just sat there until they were needed. It was the worst rotation ever. If the STUDENTS were not there the clinic would have had to shut down because nobody would know how to do anything.

I skipped the interview and did not rank them

......name and shame? Or region in the US at least?

 

[de Ribas]

Preach. Most of my externships were good, but this one externship I was at was unreal. The EXTERNS were expected to run the clinic. We saw patients, did the treatment, and wrote the notes. The residents checked our work and the doctors just sat there until they were needed. It was the worst rotation ever. If the STUDENTS were not there the clinic would have had to shut down because nobody would know how to do anything.

I skipped the interview and did not rank them

I think what you described here is not necessarily bad unless there are more details. I am sure some found it to be a good thing. Some learn better when they do everything, some need more guidance. It depends a lot on personality.

I have seen when people negatively comment of rotations that do not let you do much on your own and negatively comment when you are allowed to run the clinic on your own. I have seen both praise and complaints for same programs based on that. I guess these various programs need to exist to match what people prefer. I would much prefer to run clinic by minimal oversight than being micromanaged.

 

[CutsWithFury]

I think what you described here is not necessarily bad unless there are more details. I am sure some found it to be a good thing. Some learn better when they do everything, some need more guidance. It depends a lot on personality.

I have seen when people negatively comment of rotations that do not let you do much on your own and negatively comment when you are allowed to run the clinic on your own. I have seen both praise and complaints for same programs based on that. I guess these various programs need to exist to match what people prefer. I would much prefer to run clinic by minimal oversight than being micromanaged.

Depends on what kind of clinic you are running. I had a similar experience as a student during my 4th year. I had to do a required local podiatry rotation through a VA in between my extern months. Myself and my classmates ran the clinic but it was all toenails and basic wound care. No post op follow ups or new MSK problems. Students ran the clinic with residents waiting for us to present to them. Attendings were either in the OR or in the hospital but not actively present. This kind of experience was interesting for like a week but then it got old real fast.

If students are seeing a lot of post ops or are given opportunities to work up new MSK complaints this would be a better experience

 

[Sweatshirt]

......name and shame? Or region in the US at least?

It was a VA on the east coast

I think what you described here is not necessarily bad unless there are more details. I am sure some found it to be a good thing. Some learn better when they do everything, some need more guidance. It depends a lot on personality.

I have seen when people negatively comment of rotations that do not let you do much on your own and negatively comment when you are allowed to run the clinic on your own. I have seen both praise and complaints for same programs based on that. I guess these various programs need to exist to match what people prefer. I would much prefer to run clinic by minimal oversight than being micromanaged.

It was pretty bad. It's my personal belief that externships should not rely on visiting students just to be able to survive. School clinics, yes that should be run by students. But externships? No way, they are just 1 month visitors. Everything was on our shoulders to keep patients moving, get supplies, do notes, present, and treatment. I don't think it's appropriate to have 1 month visitors running the whole operation. I'm not saying externs should not contribute to clinic work, but the residents and doctors should be taking the bulk of the work.

 

[Sartorius P.O.D.]

I once did a six week ortho rotation during 3rd year at a hospital where the department was pretty vocal about hating podiatry and had a foot & ankle orthopod actively trying to make life a living hell for the podiatrists on staff and the residents who worked at the hospital. I learned more, scrubbed more cases, was allowed to do more in those cases, and was treated with more respect than 4 of my 5 podiatry externships. These were well respected programs with multiple ACFAS lecture circuit attendings. I matched at the 5th one.

Other specialities have attendings that are full time employees of the hospital and are there because they want to teach. Many could get a better paying job in private practice or as a contractor. Podiatry is almost exclusively private practice docs who merely have privileges at institutions that sponsor residency programs. They were exploited when they trained and will feel next level entitled to free resident [PA] labor. I guess its time for the new generation to be the change we want to see as hematosis has done.

I think we all had a similar experience at a VA rotation. Most of the people that took those jobs in the past were only there because it was the easiest gig in the profession. That may be changing going forward as scope and salary parity increases.

 

[wakaflocka88]

Folks. Ive been seeing attending post their guidelines on how to be a superstar podiatry student / great externs on instagram and other social medial and how to basically kiss ass on both cheeks. Get there early, leave late, carry 20 wound care supplies, mop the floor, do everyones notes, etc etc.

I know some of this applies to every other specialty and i've personally seen this ass kissing during my vascular, medicine rotations but just like everything else in podiatry we take it way too far. Student, resident, fellow and associate abuse in podiatry is a big problem and nobody is going to talk about it. Other non podiatry attending for the most part do a great job teaching, showing up some weekends to round, doing their own work, etc. Most podiatry attending are the worse. During my residency, we pretty much did everything. Two of the older podiatrist didn't even know how to use the EMR system and would dump it all on us. We would joke and say if the residents called in sick, the department would close for the day.

As an attending, i made it a point to myself to never abuse a student or resident. I don't use them to see my post ops so i can see billable patients (what 90% of fellowships do). I don't use them to write my note and send it to me. I don't use them as a scrub or a free PA to assist in cases. I don't use them to round on my patients for me. They're there because i simply love to teach. thats it.

I encourage you to report these scumbags to APMA, your hospital administration, ACFAS ( these guys are worthless though). Do it anonymously. Youre not there to slave away and make their job easier. you're there to learn and they are getting paid to teach you. I'm sick of this "make their life easy mentality." If they're not teaching you report them. If theyre billing patients for your work, report them to Medicare. you ave a lot of power. and this **** needs to stop.

If you're in a situation and need help, private msg me for advice. I can help you.

100% agree with you. When I was in my final residency year, I made it a goal to teach each extern as much as possible and let them be hands on - to their comfort level. Even when I was slammed, I still did my own notes unless the student truly really wanted to do some. I was even teaching ED interns/residents/attendings and letting them do the ankle fracture reductions/ankle taps. They loved it.

 

[Feli]

You get what you allow. The vast majority of places aren't like that. Yes, nail consults and tinea clinic pts and such have little teaching value, but you will see that stuff post-residency and the world needs ditch diggers... some places use that as the way to earn the "good stuff." Just think of it as practice for your customer service and pt rapport skills.

Personally, I have always let my residents go skin-to-skin unless they fail the few easy anat/procedure questions and basic confidence check pre-op... or if they are clearly bumbling a reduction/pinning/etc (they typically ask for help at that point anyways). I will also take over if they are going snail pace or just one of those people with truly horrible coordination to the point that it will make me late for office or delay the next case in the room (mine or another surgeon's).
...time permitting, I have a habit of taking a stool in the corner or leaving the OR to talk to the patient's family once the meat and potatoes part of the operation is done and just the closure is left. That is mainly for the benefit of the resident(s) so that they can feel like it is their show. Most get it, some don't... I actually had a few tell me they felt uncomfortable and two over they years even formally complained about it to their director, etc. Just like any other surgical specialty, residents can work under indirect supervision (attending in building or able to come back to OR promptly... attendings just need to be there for the critical portion of the operation). I always remain scrubbed in or able to jump back in quickly... often I hang out by the scrub sink and make a phone call and watch them through the OR window

...From the title, I'd thought this was a thread with constructive extern tips, lol. Those would be to READ textbooks and journals (esp the ones the attendings wrote), show up early or stay late as appropriate, have a good attitude, have a calm confidence to just play past any nonsense cutthroat students from other schools, spend $5 to buy and read How To Be A Truly Excellent Junior Medical Student by Lederman (for MDs but most principles apply anywhere).

... Why do you think there are so many fellowships? It is because residents are not getting trained.

Hear hear! ^^^

 

[SouthPod7]

It was a VA on the east coast


It was pretty bad. It's my personal belief that externships should not rely on visiting students just to be able to survive. School clinics, yes that should be run by students. But externships? No way, they are just 1 month visitors. Everything was on our shoulders to keep patients moving, get supplies, do notes, present, and treatment. I don't think it's appropriate to have 1 month visitors running the whole operation. I'm not saying externs should not contribute to clinic work, but the residents and doctors should be taking the bulk of the work.

This is how almost all the Scholl Core Rotations were. Jesse Brown VA, Lovell VA, Stroger Cook County. Students doing 100% of the work while residents and attendings sat in computer chairs and were just shooting the **** with each other. I vividly remember how in December which was supposed to be our "study" month for Part 2 which was in January and so nobody had any formal rotations scheduled, all the Scholl Cores freaked out that they wouldn't be getting ANY students for the month and demanded that coverage be provided. So we ended up having to do these forced 2 week staggered "rotations" (NOT official clerkships) at these hospitals that then promised extra consideration for students during CASPR/CRIP for matching purposes.

 

[CutsWithFury]

This is how almost all the Scholl Core Rotations were. Jesse Brown VA, Lovell VA, Stroger Cook County. Students doing 100% of the work while residents and attendings sat in computer chairs and were just shooting the **** with each other. I vividly remember how in December which was supposed to be our "study" month for Part 2 which was in January and so nobody had any formal rotations scheduled, all the Scholl Cores freaked out that they wouldn't be getting ANY students for the month and demanded that coverage be provided. So we ended up having to do these forced 2 week staggered "rotations" (NOT official clerkships) at these hospitals that then promised extra consideration for students during CASPR/CRIP for matching purposes.

sounds about right. Had the same experiences. Those core rotations I didn't learn anything and the attendings would try to intimidate us and pimp on random podiometric knowledge that nobody cares about (orthotics and biomechanics). This was CLASSIC podiatry training and education.

Jesse Brown was hilarious. I enjoyed listening to Dr. G#$%^ talking about how awesome he was and how many fellowships he's done. Fellowships in internal fixation, external fixation and nerve surgery with Dr. Dellon. I kid you not. Those are words straight out of his mouth. I remember it like it was yesterday. He might have thrown in a couple more fellowships in there. Ahh the good old days where I was naive and believed everything fed to me...

 

[josebiwasabi]

My Jesse Brown CRIP interview case workup involved treating a smashed pilon fracture for a semipro athlete in their 20s.

I saw a grand total of 3 non limb salvage cases the entire month I rotated through there, and the youngest patient I saw was probably in their 50s.

 

[SouthPod7]

Jesse Brown was hilarious. I enjoyed listening to Dr. G#$%^ talking about how awesome he was and how many fellowships he's done. Fellowships in internal fixation, external fixation and nerve surgery with Dr. Dellon. I kid you not. Those are words straight out of his mouth. I remember it like it was yesterday. He might have thrown in a couple more fellowships in there. Ahh the good old days where I was naive and believed everything fed to me...

Didn't he get in massive trouble recently over some wound care products? I remember my month as an extern the reps were walking up and down the hallway of the clinic and into patient rooms and telling us (in front of patients) to throw Grafix on everything. Can't believe I thought that was completely normal.

 

[CutsWithFury]

My Jesse Brown CRIP interview case workup involved treating a smashed pilon fracture for a semipro athlete in their 20s.

I saw a grand total of 3 non limb salvage cases the entire month I rotated through there, and the youngest patient I saw was probably in their 50s.

You got fooled by the training quality there because you read their program description on the CASPR/CRIP website right? Anyone who has rotated there as student should read it and you will get a good chuckle.

 

[Feli]

You got fooled by the training quality there because you read their program description on the CASPR/CRIP website right? Anyone who has rotated there as student should read it and you will get a good chuckle.

Yeah, but what else do you really have to go off when trying to pick clerk/interview hospital if you aren't from those areas? It is hard to tell the good programs from the mediocre. Unless you choose one of the 25 or 50 "name" programs in our specialty, it is a very foggy crystal ball beyond that. Residents will usually talk their program up... attendings always will. You never know which up-and-comer programs are underrated and good... and which programs have fallen off or added spots or lost key attendings and diluted a once good thing. So yeah, you stick to the name programs if you can, but some students want a certain area with few/no name programs, and most students don't have the gpa chops to clerk (much less match) at all name programs.

Heck, even if you are local to a program, your classmates might bamboozle you... better to try for intel from the ethical and respected upperclassmen (4th years or residents... when you are 2nd/3rd year). The ones who clerked yet didn't match a program you are eyeing are probably your best shot at unbiased and helpful objective info. You might get the occasional salty clerk who didn't match trashing or the 1st year resident "recruiting" for the program, but you have to take the good with the bad. That was honestly my best resource when picking my clerkships and interviews

This thread Forum Members - PMSR/RRA Residency Reviews is really, really good. We had that sort of thing at Barry where the 4th years post-match would make a booklet up with their extern spot reviews for the 2nd years who were applying for clerkships. I think they asked $20 for the little booklet but it was worth $20k in hindsight. No joke... I was able to make my clerkships really count and match the best one for me. I wouldn't change a thing. Still, even with good info, it is pretty crazy how fast a program can take a cannonball to the broadside when a key attending/director leaves (Husain+CK from DMC, Mendo from West Penn, me from anywhere, etc... lol) or they lose a hospital affiliation, spin off a program into two, or add a residency spot or two. The program name will be the same but the training can get sketchy pretty fast (eg, the StJohn Detroit program I trained at lost its director and was on fairly shaky ground for a couple of years: interim director, good but not great numbers, bit of trouble matching good students due to questions about program direction, some other key attendings retired or started to take appreciable F&A cases to centers covered by other cross-town residency programs for various reasons, etc... but now they're back to being quite stable and legit). So, it goes in cycles - even at the name programs. The good thing about name programs is dozens of attendings and a much better "depth chart" to weather the stormy times.

Bottom line: it is always best to do your recon here/upperclassmen/etc for info on clerkships (take top 25-50 name programs whenever possible), and then try to pick from among those you clerked or visited for residency. You can pick just a certain city or state if you like, but if there are no good name programs there or you might have trouble matching them, you are risking the quality of the next 30+ years of your practice afterwards (and/or wasting a fellow year). You will be surprised how significantly a program/hospital/director can miss or exceed your expectations once you are there for a few weeks. GL