The Perfect Residency

[jonwill]

What is your idea of a perfect residency program?

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[krabmas]

as much as I do not enjoy clinic as much as surgery I think it is very important to be able to see post-op of patients to know what is normal and what is not post-op. It is also very important to see the pre-op of patients, to learn at what point surgical intervention is appropriate.

Unless you are willing to work 24-7 either end high surgical or high clinic takes away from the other.

I externed at both types of programs and it is hard to get bored at a balanced program.

I think at the high surgical programs the resident has the potential to loose compation and patient care ideals. They have not seen the patient before the surgery, councilled the patient on options or seen the patient through conservative care. Nor will they see the patient through post-op course either. It is important as a resident to start to make conections with patients to matain being a physician/doctor and not just a surgeon.

As much as residency is for practicing surgical skills it is also about learning and practicing ethical patient care.

It is just like practicing a sport. It is much easier to learn good techniques at the beginning then break bad habbits later.

 

[Dr_Feelgood]

as much as I do not enjoy clinic as much as surgery I think it is very important to be able to see post-op of patients to know what is normal and what is not post-op. It is also very important to see the pre-op of patients, to learn at what point surgical intervention is appropriate.

Unless you are willing to work 24-7 either end high surgical or high clinic takes away from the other.

I externed at both types of programs and it is hard to get bored at a balanced program.

I think at the high surgical programs the resident has the potential to loose compation and patient care ideals. They have not seen the patient before the surgery, councilled the patient on options or seen the patient through conservative care. Nor will they see the patient through post-op course either. It is important as a resident to start to make conections with patients to matain being a physician/doctor and not just a surgeon.

As much as residency is for practicing surgical skills it is also about learning and practicing ethical patient care.

It is just like practicing a sport. It is much easier to learn good techniques at the beginning then break bad habbits later.

I agree but I would like a 2/3 surgical to 1/3 clinical. Enough to understand why you are cutting into these people and how to follow up.

I operate under the priniciple that you only learn surgery once, residency. But that being said, if you don't know how or why to chose a procedure then your surgical skills are useless.

 

[IlizaRob]

as much as I do not enjoy clinic as much as surgery I think it is very important to be able to see post-op of patients to know what is normal and what is not post-op. It is also very important to see the pre-op of patients, to learn at what point surgical intervention is appropriate.

Unless you are willing to work 24-7 either end high surgical or high clinic takes away from the other.

I externed at both types of programs and it is hard to get bored at a balanced program.

I think at the high surgical programs the resident has the potential to loose compation and patient care ideals. They have not seen the patient before the surgery, councilled the patient on options or seen the patient through conservative care. Nor will they see the patient through post-op course either. It is important as a resident to start to make conections with patients to matain being a physician/doctor and not just a surgeon.

As much as residency is for practicing surgical skills it is also about learning and practicing ethical patient care.

It is just like practicing a sport. It is much easier to learn good techniques at the beginning then break bad habbits later.

I agree with both of you. If you are only doing surgery then you are basically being trained as a technician. It is important to recognize complication and be able to treat it postoperatively as well as know the indications and contraindications of any procedure before it is done.

 

[Dr_Feelgood]

The tough thing is I still had to vote for heavy surgery b/c I think that a 50-50 mix it too low.

 

[IlizaRob]

The tough thing is I still had to vote for heavy surgery b/c I think that a 50-50 mix it too low.

Yeah but who is to say that "balanced" refers to a 50/50 distribution? Its Jonwill's fault for not being more specific. I call for a mutiny and strip his "advisor" status from him.

 

[Podman]

The tough thing is I still had to vote for heavy surgery b/c I think that a 50-50 mix it too low.

i agree...

but at the same token, i would also consider a program or rather prefer a program that provides a solid foundation of medicine rotations to complement a "heavy" surgical load. This goes back to what was said earlier regarding pre-and post-op management.

By the way feelgood, when do you guys get started with externships?

 

[jonwill]

i agree...

but at the same token, i would also consider a program or rather prefer a program that provides a solid foundation of medicine rotations to complement a "heavy" surgical load. This goes back to what was said earlier regarding pre-and post-op management.

By the way feelgood, when do you guys get started with externships?

DMU'ers start clerkships in June.

 

[defboy]

Which residency do the best job off combining the surgery and clinic? Which have the heavy surgery? I vote surgery just because it is something I have been getting very excited for and think will help raise the bar for DPMs but I agree that DPMs must be more human than other specialties are required to be. I read in an article today for a 2001 that some MD programs have taken the "humaness" out of medicine and that we need more patient contact. 2 cents from a hillbilly.

 

[jonwill]

I'm not too suprised by these responses. But only 25 votes? Come on people!

 

[Ski Bum]

unfortunately not enough programs are balanced. i do not agree that you only learn surgery once...your life and career you should be learning - "practice medicine". there are many doctors/surgeons that change their techniques etc all the time and are learning new skills. residency to me is your platform to build upon. Too heavy of clinic would also be horrible because there is so much to learn in the OR and the hospital system.

...just my 2 cents

-tim

 

[Feli]

I agree that many residencies are a lot different and some students would prefer much different programs than others. One pod student might be planning to try to get into an ortho multispecialty group like Marque Allen while another might want to do research and teach like David Armstrong...

It'd be really helpful if any of the upperclassmen students or residents would maybe do a rough categorical breakdown based on what they've read/heard/seen instead of just an overall "top 10."

I know most of the elite programs train you well across the board, but how about top diabetic limb salvage programs? Top ortho/trauma surg programs? Top didactic/research programs? Etc?

 

[jonwill]

I agree that many residencies are a lot different and some students would prefer much different programs than others. One pod student might be planning to try to get into an ortho multispecialty group like Marque Allen while another might want to do research and teach like David Armstrong...

It'd be really helpful if any of the upperclassmen students or residents would maybe do a rough categorical breakdown based on what they've read/heard/seen instead of just an overall "top 10."

I know most of the elite programs train you well across the board, but how about top diabetic limb salvage programs? Top ortho/trauma surg programs? Top didactic/research programs? Etc?

Off the top of my head-
Diabetic Limb Salvage: U of Texas - San Antonio, VA-Phoenix
Ortho/Trauma: Detroit Medical Center, John Peter Smith (Ft. Worth), Grant Medical Center (Columbus, Ohio)

Anybody else?

 

[krabmas]

I agree with Jonwill so far.

I'll add...


UMDNJ - trauma, clinic, hospital protocol and working with other specialties, careful oversight by attendings who are employed by the hospital and some other attendings that have private practices.

INOVA - external rotations are superb - 3 month blocks at: Georgetown with Dr. Steinberg DPM and Attinger MD doing wound care from a plastic surgery prospective, Indian reservation, Africa (if you want), Kaiser, and many more.

PSL (denver) - Academics, diabetes wound care, surgery of private patients and some clinic

Florida East orlando - academics, there are no ortho residents so all the foot and ankle trauma goes to pods and it is the busiest non-level 1 trauma center in Florida. 3rd year is up to you - fellowship with AO in Europe, Diabetes clinic, private office,

an aside comment about other residents - it is good to not have ortho so you can get the trauma, but without ortho unless the ortho attendings want to teach you may not learn as much as you should from the ortho guys, they have lots to teach us in ortho principles and technique. other residents from other specialties may be how you get patients when you start to practice (networking)

I truely believe that the best programs are at big academic institutions where the first priority is education and the whole environment revolves around teaching. For the most part people do not take jobs at university hospitals if they do not want to teach or do research.

 

[SportPOD]

Just wanted to say "hi" to everyone as I'm a new poster.

I feel that a good balance is essential to the residency training. Surgery is important and you should get as much training as you can get (practice makes perfect). Also try to do alot of non-podiatry treatments (such as chest tubes, central lines, etc.). As it has been alluded to before, it's important to have a good clinical experience since you want to be able to work up the entire peri-operative time frame in order to know what to look for once you're out on your own.

 

[Feli]

Just wanted to say "hi" to everyone as I'm a new poster.

I feel that a good balance is essential to the residency training. Surgery is important and you should get as much training as you can get (practice makes perfect). Also try to do alot of non-podiatry treatments (such as chest tubes, central lines, etc.). As it has been alluded to before, it's important to have a good clinical experience since you want to be able to work up the entire peri-operative time frame in order to know what to look for once you're out on your own.

Welcome to SDN forum and thanks for the advice

It's always helpful to hear from people who have recently been through the process

 

[SportPOD]

Off the top of my head-
Diabetic Limb Salvage: U of Texas - San Antonio, VA-Phoenix
Ortho/Trauma: Detroit Medical Center, John Peter Smith (Ft. Worth), Grant Medical Center (Columbus, Ohio)

Anybody else?

Another good diabetic program is Beth Israel Deaconess which is affiliated with the Joslin Diabetes Center in Boston.

VA Phoenix has a good diabetic program and has a dedicated clinic day for high risk diabetic patients.

 

[jonwill]

Anymore voters?

 

[Dr_Feelgood]

Anymore voters?

Can I vote again?