Defining Expectations During Each Year Of Residency Training

Seasoned residency directors discuss time management challenges and essential communication skills for first-year residents, a shift toward elective reconstruction and trauma procedures in the second year, and the progression of technical skills and management of junior residents in the third year of residency training. 

Q: What do you think are the most important skills for a first-year podiatric resident to develop and why?

A:

David Bernstein, DPM, FACFAS shares that in the first year of training, the resident should learn injection techniques, suturing and bandaging. Additionally, a comprehensive knowledge of surgical equipment and surgical procedures are necessary to show confidence and competency during cases. 

“(Residents should master these skills) as soon as possible if they want to do more than just retract,” says Dr. Bernstein.

Alan MacGill, DPM, FACFAS stresses time management and communication as key skills for first-year residents. 

“The transition from podiatric medical student to the first-year resident is daunting and can sometimes be ‘sink or swim’ at the beginning. There is a barrage of new protocols and responsibilities to learn in addition to rotation and emergency call schedules to follow,” notes Dr. MacGill. “It is very easy to get ‘in the weeds’ with the heavy workload that seems to grow by the hour each day. Learning time management at this stage is crucial for success and a quality that will carry the resident through training, and into his or her career.”

Dr. MacGill emphasizes that time management and communication often go hand in hand.  

“Every day, the first-year resident must effectively communicate with patients, co-residents, attendings and hospital staff. Hospital patient care demands diligent oversight and the resident must be able to track updates throughout the day, and notify the team promptly,” adds Dr. MacGill.

Michael Piccarelli, DPM, FACFAS agrees with the other panelists that working as part of an interdisciplinary team and growing academically are important cornerstones of first-year residency training. He also cites improving one’s dexterity to be a key skill and emphasizes decision making.

“Having confidence in your decisions comes from asking the right questions, learning from mistakes and reviewing and practicing the teaching points from your attendings and senior residents,” says Dr. Piccarelli. “This skill will form a foundation for one’s upcoming career.”

Q: When residents are in their second year of training, what skills and proficiencies do you expect them to display and master? What makes this unique to the second year?

A:

Dr. Piccarelli says that he expects second-year residents to gain a firm grasp on basic skills and exhibit a willingness to continue to learn. 

“At our program, the second year is when residents will show the most growth as they become the first assistant on most cases,” shares Dr. Piccarelli.

Dr. Bernstein agrees that confidence in key skills must emerge in the second year of training, including comfort in the operating room and having all equipment and products on hand for a case. He also expects second-year residents to explore and understand alternative treatments by reviewing radiographic images with their first- and third-year co-residents. 

“They should have the confidence and knowledge of what they know, and when to reach out for advice and assistance,” asserts Dr. Bernstein.

Dr. MacGill feels that in the second year of podiatric residency, there is a shift of focus away from common inpatient procedures and toward elective reconstruction and trauma. He cites the importance of the technical skills necessary for creating osteotomies, dialing in deformity correction, anatomic reduction of fractures, careful placement of internal fixation using spatial positioning and meticulous handling and closure of the soft tissue. 

“The resident who does the research and appropriate study before the case is likely to spend a great deal of time not only learning the nuances of the procedure from the attending surgeon but also doing the majority of the case. This is unique to the second-year resident because there is greater time in the schedule to focus on these types of cases,” says Dr. MacGill.

Q: What benchmarks do you feel third-year podiatric residents should achieve during their last year of training? Why are these important to take place specifically in this year? Are there specific goals or pathways residents are expected to follow in order to maximize chances of becoming board-qualified and eventually board-certified by their podiatric board of choice?

A:

Comfort in evaluating more complex pathologies, including appropriate conservative and surgical treatment options, is a crucial skill to develop as a third-year resident, explains Dr. MacGill. He adds that he expects progression in technical skill and execution of major forefoot, midfoot, hindfoot and ankle procedures in comparison to the second year of training. 

A sound understanding of research methodology is also a third-year benchmark, according to Dr. MacGill, who expects residents to complete a research project started earlier in training. He also feels a resident at that level should be able to effectively manage the junior residents and maintain a cohesive team environment. 

“The earlier years of training are what ‘molds the metal’ into the appropriate shape but it is the last year of training that truly ‘sharpens the blade,’” says Dr. MacGill. ”We direct great attention to the academic curriculum and the annual American Board of Foot and Ankle Surgery (ABFAS) In-Training Examination. I expect all of the residents to vigorously prepare for it. However, there is more gravitas for the third-year resident since a passing score will be accepted for board qualification status.” 

“We purchased an online board prep program last year and will do so this year,” says Dr. Bernstein. “In the post-residency job hunting process, passing all four parts of the exam makes the resident board qualified and more likely to obtain a much better position.” 

Dr. Bernstein adds that COVID-19 led to changing some plans for third-year residents that would otherwise involve travel. He relates his program set up an in-house arthroscopy seminar with the help of Stryker when resident travel to Chicago was not possible due to the pandemic.

Dr. Piccarelli feels that by the time a resident enters his or her third year, he or she should be capable of handling most cases and patients independently. 

“They should spend the final year of training refining technique and continuing to gain exposure in all areas,” notes Dr. Piccarelli. “I also expect them to act as teachers/mentors to the junior residents and students. I would say any specific goal or pathway is individualized as each resident will study and learn differently in regard to board prep. I do find, however, that residents who have higher expectation for themselves tend to do the best.”

Dr. Bernstein is the Director of the Podiatric Residency Program at Bryn Mawr Hospital in Bryn Mawr, Pa. He is a Fellow of the American College of Foot and Ankle Surgeons.

Dr. MacGill is the Director of the Foot and Ankle Surgery Residency Program at Northwest Medical Center in Margate, Fla. He is on the Board of Directors of the American College of Foot and Ankle Surgeons.

Dr. Piccarelli is the Director of the Podiatric Residency Program at Richmond University Medical Center in Staten Island, NY. He is a Fellow of the American College of Foot and Ankle Surgeons.