Are We Ensuring An Optimal Educational Experience For Residents?

After entering my 13th year in practice, I have had the opportunity to spend time with many residents from different residency programs. In my first year of practice, I spent time with residents from the same program that I graduated from. It was gratifying to give back and teach in the same operating rooms and clinic where I once learned. Relocating and beginning a practice in a new geographic area allowed me to work with residency programs that were much different from the program in which I was trained and also served as an attending physician.

Over the years, I have observed what is important and valuable to podiatry residents who are preparing to become physicians in this awesome profession. One of the positive attributes I have seen is the parallelism with residents from other specialties. Podiatric residents interact with their co-residents from other specialties as if they have no difference in education or background. I increasingly see podiatry being called on by other members of the healthcare team such as internal medicine, infectious disease, vascular surgery and even orthopedics. The residents’ interactions with physicians from these specialties continue to increase the awareness of what our profession does and the importance we play as healthcare professionals, especially in the hospital setting.

One of the negative aspects that needs to be refined is the focus of the training. Despite the interaction of our residents with residents in other disciplines, podiatry has still segregated itself and continues to do so by having some residents graduate who are not qualified from a surgical standpoint on a parallel level with other professions. In some of the programs I am involved with, I see training vary according to resident rotation and what assignments they have received. It is my belief that we need to refine this so all residents exit residency with equal training.

Another issue we need to address is that residents are not receiving adequate training in surgery. I have too frequently seen residents’ sole focus on which case they are scrubbing in on. It seems that as more and more surgeons perform cases at many different surgery centers and hospitals, residents have to spend more time driving between hospitals to get the surgical case numbers required of them. This leads residents to have less time spent rounding on hospital patients.

This time lost seeing hospital inpatients is crucial. I have been involved with residents who are allowed to scrub in on surgeries with me in the hospital but cannot do patient rounds afterward. Not only is this straying from the classic educational approach set in place for residents, it reduces the experience these residents are getting in their training. They need to see post-op patients in the hospital and do consults on new patients to learn how to work up an inpatient. We need to address spending time focusing on which case to scrub next as opposed to learning the entire process of managing a patient. I realize it may involve more driving between facilities and better time management to see these patients, but it is a crucial part of learning.

Remember, the day you leave your residency, you leave the opportunity to see countless examples and exposure to pathology that you may never have the opportunity to be exposed to again. As programs evolve and collaborate with more institutions to allow residents to meet their numbers, it makes it harder to spend time in the hospital.

As a surgeon who has been on both ends of the spectrum, I now realize how valuable my time was spent in the hospital and not just in operating rooms. Learning how to do surgery is one aspect of our training but learning when to operate and how to manage these cases postoperatively is equally important. I would encourage all residents as well as residency directors to work together with affiliated hospitals to enable residents to have full privileges at these facilities. Having the ability to work up a foot infection, participate in the surgical management and then following that patient postoperatively is an invaluable experience.

I have worked with many residents who have very limited experience dealing with infections and amputations in postoperative patients with infections and amputations. They must develop a knowledge of what the surgical site should look like and the stages it goes through in order to be able to make decisions as to whether the foot is improving or whether the patient needs to go back to the operating room.

In other specialties such as general surgery and even internal medicine, the residents play a vital role in the management of patients’ day-to-day progress, and I feel that podiatry should parallel these roles as well.