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Residency Insight -- A PRESENT Podiatry eZine

New Beginnings

Robert Frykberg,
DPM, MPH
PRESENT Editor,
Diabetic Limb Salvage

As we near the end of one Academic Year and the beginning of another, I thought that it would be appropriate to focus not on ends, but beginnings — new beginnings. While many students are just glad to have gotten through another long, difficult year others are just entering into a new phase of their lives. Some are just entering Podiatry School and are anxious, yet excited about the prospect of embarking on a new academic venture and the pathway to Podiatric Medicine. Those in Podiatric Medical School are glad to be just one year closer to graduating with their doctoral degree. At the same time, they might be excited about actually seeing patients — putting all that didactic information to good use on living human beings. All are yet another step closer to becoming a doctor. I remember how exciting that was as a student moving from the classroom into the clinic and hospital. I also remember as a Clinical Dean how painful it was to teach new clinical students the art of medicine and podiatric medicine — clinical examination, biomechanics, developing a differential diagnosis, and then a treatment plan. It's always a little slow going to say the least in that first month (never mind treating patients)! You know what they say about getting sick in July.

Nonetheless, the overwhelming majority of students complete their requirements for graduation and receive the Gold Ring — the DPM degree.

And then You are a Resident

Then the real excitement begins with the start of a Residency Program in the Institution that was hoped for — the one you really wanted. If not first on your list, at least one that you like and think that will be a good fit for the next 3 years of advanced training. When I was a new graduate back in the late 70’s, there were not enough programs to go around for all the graduates — just as tragic today as it was back then. Thirty some years ago Residency training for podiatrists was not a requirement for licensure in most states. Podiatry Residencies were still in their developmental phase back then and most hospitals didn’t even have podiatrists on their attending staff).

Furthermore, most available programs were just one short year in duration. Only a handful provided two years of training, and only one that I can recall offered a second and third year. It’s hard to believe how far we’ve come since then.

Hit the Ground Running

The new graduate and PGY-1 resident enters the new setting with great expectations and hopes for the future. In a familiar setting such as a hospital where one has done a month or so of externship while a student, the new resident can find the transition rather comfortable. Familiar surroundings, familiar faces, even some familiar patients might make the going a little easier than entering an entirely new and unfamiliar setting. It can often be daunting, especially if you are unsure about your abilities and are not quite as confident about your medical knowledge as you think you should be. I was in a very similar situation – an unfamiliar hospital with attendings I really didn’t know and, worse yet, it was a major teaching hospital for Harvard Medical School. With only my 3 years of Podiatry School (remember, mine was the first class to graduate from the accelerated 3 year program rather than the traditional 4 year course) I was indeed somewhat unsure about my abilities to function in that environment. As all residents must do, I just dove in head first and was adamant that I would not embarrass myself or my program – at least not through a lack of trying. As you too will discover, constant reading, study, and showing an interest in what you are doing will pay off in the end – even in those required rotations that you really dislike (you know which ones I mean).

What I Learned as a Resident

...you must have a strong foundation in Medicine to become a competent podiatric physician

I learned that attendings really appreciate a resident who is tuned in to what they are doing. Not just by showing up as scheduled (an absolute necessity), but by doing some advance reading or reading up on a particularly interesting case that has come under your care. In this regard I am not just talking about surgical cases, but patients with interesting medical problems and conditions. Take advantage of the opportunity presented to you during your residency. Current requirements for the new Podiatric Medicine and Surgery Residency (PMSR) include 3 months of Medicine and medical subspecialty rotations, Behavioral Medicine, Emergency Medicine, and Pathology for a reason: to give you the breadth of knowledge you need to become a physician before becoming a podiatric surgeon. While every podiatry resident’s emphasis seems to be on podiatric surgery, you must have a strong foundation in Medicine to become a competent podiatric physician. Without that, how will you be able to assess a patient’s suitability for surgery? How will you be able to handle the medical complications that will invariably occur when you are on call over a holiday weekend? Can you recognize a patient with Serotonin Syndrome as a complication of linezolid therapy for that MRSA infection on your service? Do you feel confident that you can recognize the signs of HITT in a patient with repeated exposure to heparin on the 4th day of hospitalization (just before going into surgery)?

...it is the ability to diagnose and treat complications that separate doctors from technicians.

Thank God my Residents were able to make these potentially life-threatening diagnoses when they occurred. I attribute this not just to the quality of my residents, but to the quality and extent of their medical experiences during their training. Anyone can be taught to do a bunionectomy, but it is the ability to diagnose and treat complications that separate doctors from technicians.

RESIDENCY RECOMMENDATIONS
1. Find a mentor and allow yourselves to be taught

2. Ask questions and seek answers

3. Be inquisitive but not intrusive, engaging but not overbearing

Remember also to learn from your co-residents and those who have completed your program before you. Find a mentor and allow yourselves to be taught. Ask questions and seek answers. Be inquisitive but not intrusive, engaging but not overbearing. Your learning has just begun. Embrace it and constantly read — believe it or not, much of what you learned in school will be outdated or disproven within the next decade. You get the hint. They call it a practice for a reason: you never quite get it all right all the time. It takes a lot of time and effort, but then again, there’s no time like the present to start learning.

I believe I’ve used this quote from Thomas Huxley before, but it seems to fit our discussion nicely: “If a little knowledge is dangerous, where is the man with so much knowledge as to be out of danger?”

Good luck in your careers!

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