Keys To Success In The First Year Of Residency: Reflections From Second-Year Residents

The panelists discuss the high and low points of their first-year experience, reveal lessons learned and share advice they have for incoming residents.

Q:

As you start your second year of residency what is the most important piece of advice you would give to the incoming PGY-1 residents?

A:

Matthew Lining, DPM stresses the importance of asking attendings the “why” for procedures, including the steps performed to execute the procedure and reasoning behind procedure election. 

“Often as residents, we show up, do the case and leave,” notes Dr. Lining. “Pre-procedure planning and post-op follow up are very important in determining what procedures you will lean toward when you are on your own.” 

Jacob Carmichael, DPM advises incoming residents to develop good habits now. 

“Be thorough and systematic with your workups. That way, you develop a rhythm for patients and it becomes second nature to you,” he explains.

Sandy Nguyen, DPM encourages first-year residents to maximize their rotations and learn as much as possible in their first year, both in podiatry and off-service. She feels these rotations make a resident more well-rounded and allows him or her to apply this important knowledge in future training years.

Q:

What areas of your first year of training could have, or should have, been improved? What are your thoughts on your experience with things like IT, lectures and hands-on procedures?

A: 

Dr. Nguyen relates she would have liked more structure in the academic portion of the program in her first year. She continues to say that this is improving due to resident-enacted additions of surgical case reviews, presentations of chapters from McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery (Lippincott, Williams and Wilkins) and board reviews that will hopefully contribute to preparedness for board exams at the end of residency.

Dr. Carmichael agrees that structure is important in the first year of training. He shares that his program was under a new sponsoring institution during his first year and many things had to be figured out as the year progressed. However, he relates the resultant structure in the program is strong. Dr. Carmichael echoes the importance of the format of academic programs within the residency, stressing the need to create interactive and engaging sessions. 

“Academics should be a discussion in which people are encouraged and motivated to participate, not just a series of lectures where everyone sits around silently unless they are called on,” explains Dr. Carmichael.

Academic weekly meetings were also an area targeted for improvement in Dr. Lining’s first year and he relates that these have significantly improved over the past six months. He goes on to say that making a connection to podiatric relevance on off-service rotations also could have been improved in his first-year experience.

Q:

What are your thoughts about the strengths and weaknesses of first-year residents. How do you support them? 

A:

Dr. Carmichael feels the incoming first-year residents all have great attitudes and work ethics that will take them far, but notes that they will need to build confidence over time and become more comfortable and efficient in seeing patients and writing notes. In his program, he notes that an upper-year resident is always present for podiatry-related duties in the first few months and is also available for questions at any time. 

“Our first years are very eager to learn and work as a team,” says Dr. Lining. “One area of improvement would be making decisions on lab, imaging or treatment options on their own, and then verifying these with the attendings.” 

However, he relates this takes time to cultivate and will likely come with experience. At Dr. Nguyen’s program, she relates this learning curve happens rather quickly. Her residency has one resident per training year.

“In my opinion, this was a strength of this program and why it was my number one choice, she shares. “As a first year, we learn very quickly since we have to work independently. We also have a very hands-on residency program and start surgery from week one, so I believe our first-year residents’ surgical skills will advance very quickly.” 

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. Carmichael is a second-year resident at the East Liverpool City Hospital podiatric residency program in East Liverpool, Ohio.

Dr. Lining is a second-year resident at the St. Vincent Hospital Podiatric Surgical Residency program in Indianapolis. 

Dr. Nguyen is a second-year resident with Christiana Care Health Services in Newark and Wilmington, Del.