The Questions Today’s Externs Can’t Always Answer

If you have been in the profession for 20-plus years, you most likely experienced being quizzed during rounds, in the clinic or in the operating room. Depending on the person doing the quizzing, the experience could have been not very pleasant to say the least. Now you may be the one posing the questions.

Fast forward to the 21st century. The old way to quiz has evolved into a friendlier approach. Here, on day one of an externship, we tell externs questions will be asked and if you don’t know the response, then it is “homework.” An additional parameter is that only subject matter from school is fair game. Asking someone who was the 10th president would be inappropriate. We state all questions in a collegial manner. I would call it more of a touchy-feely approach. I think that’s the way this question wants to be approached. Anything too harsh and externs may complain to the higher-ups. Then I could be working in some chain box store.

So you ask a question, the extern doesn’t know and now it is homework. However, in this era of instant information via the iPhone, the extern will come back with the answer in 10 minutes. That’s all well and good but it is likely he or she didn’t read the paragraph above or below the answer, or the chapter on the topic in question. You illustrate this by expanding on the original question and tell the extern that the smartphone, although good, is nothing like the chapter of a book or articles in a journal. Of course, you are hoping the extern has a book and knows what a journal is. He or she scurries away for a time and has the answer ready at a later time.

Is this the way to learn or am I showing my age? What is the externs’ retention using smartphones? Externs seldom reference books or journals.

The externs we have on a monthly basis come from all of the schools. They are in their fourth year and our clerkship coordinator, a DPM, selects the externs with a minimal grade point average as a requirement.   

I kid you not that externs had to look up answers to the following questions after either a wrong answer or the “I don’t know” response. I started keeping the list below, not knowing that one day these questions would be part of an article.  

• What is an ID reaction?
• What is a skew foot?
• What does NPO stand for?
• A “clump” of verrucae are called what?
• What would T. rubrum look like on the plantar surface of the foot?
• What is a Penrose drain?
• What’s a seroma?
• Define preaxial and postaxial.
• How long after an osteotomy would a bone scan be positive?
• What is post inflammatory hyperpigmentation called?
• What is a tyloma?
• What is the maximum dose of gabapentin?
• What is orthopnea?
• What are fibroids?
• What is the optimum rearfoot position of a subtalar fusion?
• Where would one use a split-thickness skin graft?
• What is a carbuncle?
• What is tuberous sclerosis?
• What is a flat top talus?

These questions originated from the clinic, during rounds or in the OR. Therefore, it was never just sitting around thinking up questions for the sake of just asking them.

Granted, some of the externs’ confusion at being asked the above questions may be due to being nervous but the questions do appear to be basic information that externs should know. My harshest response a few years back was “You should get a refund from your school.” Believe it or not, the extern I said that to buckled down and knew every question from then on, and actually read something about the topic.

You get the drift. There are many more unanswered questions I have jotted down over the years.

In the good old days, not knowing any of the above would lead to some crude remarks. Hazing? You bet. Am I grateful I got this treatment as an extern? At the time of my own training, I didn’t appreciate it but now I can see how my attendings instructed us. But that was the 20th century and this is now ...

Dr. Wallace is the Director of the Podiatry Service and the Medical Director of Ambulatory Care Services at University Hospital in Newark, N.J.

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