Do you feel overtrained?

[Dermato Fight Club]

---

Members don't see this ad.

Just curious in this question. For those who have graduated residency within the last 20 years, how would you rate your training based on the bottom 95% (easiest pathology) of patients?

 

[MoostashPod]

We are definitely overtrained for the work that we do on a daily basis. From the diagnosis to treatment of common foot problems the patients have, we are confident and sufficient enough. Now, depending on the residency that we did individually, there will always be variability in the training and confidence level. I'd say for the DPMs that had a good/excellent residency training, they are overtrained and under utilized because there's not enough of complicated cases or surgeries to do.

 

[Hybrocure]

I think it depends on the person. You can be adequately trained and still feel anxiety over certain cases. Just like how gunners and super smarties think they failed every test they take when they pass w flying colors.

The largest change I’ve noticed is that my job post residency didn’t keep up with the case variety and surgical volume that I had during residency. When you aren’t cutting enough or cutting enough on certain cases over time your skills will suffer

 

[Homo sapien]

Oh

Clinical- overtrained
Surgically- adequate-to-undertrained

 

[Sweatshirt]

Podiatry - Overtrained (this profession is not hard at all)
Medicine - Undertrained (what is Sodium?)

 

[air bud]

Insert Feli rant about oversaturation. It's this simple. If you don't operate enough your skills and confidence suffer. Now that I am back to a busy job and operating 1-2 a week my confidence and ultimately outcomes continue to improve.

 

[footpainhealer]

Just graduated and we rotate with a few private practices as 3rd year residents in a variety of socioeconomic settings.
I would estimate that about 85 to 90% of a 30 day period has been clinical stuff that we are certainly overtrained for. I personally felt like I could run an entire clinic on my own by the end of first year of my training since we have a good clinic at our hospital where we do everything from every injection to every in office procedure like toe amps, tenotomies, etc.

The other 10 to 15% of these private practices were the surgeries and I would say about 80% of those surgeries are your bread and butter, podiatry stuff like bunions, hammer toes, EPF, etc. The remaining 20% of the surgeries would be more involved, but still relatively simple if you had decent training like lateral ankle ligament reconstruction, flat foot reconstructions, the occasional IM nail for end stage arthritis. During my private practice rotations, we only had two more-complicated full Charcot recons that I can think of where we had to do a closing wedge ostomy through the entire tarsal bones and beam everything as well as fuse the hind foot. Now at our actual hospital, the Charcot recons are a little bit more common where it would be probably two - three every few months vs in private practice where the doc told me he probably does that once a year to two years and sometimes longer.

So overall, from a surgical standpoint, in my opinion, in private practice we can range from overtrained (since the majority of the time we're not gonna be doing anything more invasive than a flat foot recon or an ankle fusion) to undertrained if you had subpar training where even 4 foot stuff is questionable for you.

If I were a hospital employed podiatrist that's not associated with a residency program, I would probably feel over trained since it seems like most of them only get consults for infections and wounds, which we should all be pretty darn good at at this point. I know there are some hospital employ docs that get the ankle fracture and Achilles rupture consults, which I also feel comfortable with, but it seems in the real world that that stuff usually doesn't get consulted to us so in that regard, we would be over trained.

 

[Weirdy]

Skill atrophy very, very real without proper reps after residency.

 

[Adam Smasher]

3 years ago, I wrote:

the path to licensure is needlessly long for what I am doing right now. I think the UK/Canada/Australia do it right, podiatrists have bachelor’s degrees and basically do chiropody procedures only. Instead of a doctorate + 3 year residency, we could have a “Master’s of Chiropody” or something, so you can learn pharmacology and prescribe Lamisil/antibiotics and not cut deeper than the subcutaneous tissue and still do 90% of everything I’m already doing.

4th year of podiatry school is pointless, clerkships are basically job interviews for residency. After interviews in January of 4th year, everyone mentally checks out and isn’t really learning anything anyway. Residency training was a speed bump for me on the way to licensure. If we MUST be surgeons, 2 years is enough to figure out hallux valgus and diabetic foot infections. My director did it in 1.

As it stands, 100% of podiatrists undertake a course of training that is for the benefit of 10-20% who will actually use it.

For perspective, I met a nurse practitioner recently who was certified in wound care as well as foot care. She started her private practice focused on wound care and visits nursing homes to trim toenails on the side. Not bad for a zero-year residency.

 

[MicroPod]

To be fair, I think doctors who spend most of their time in clinic probably feel over trained with 90% or more of their patients. Its the 10% of the time where you need that extra training/education to recognize what is going on and provide appropriate treatment. I think the surgery part is different and should be separate part of discussion.

 

[Feli]

...Charcot recons are a little bit more common ....
...So overall, from a surgical standpoint, in my opinion, in private practice we can range from overtrained (since the majority of the time we're not gonna be doing anything more invasive than a flat foot recon or an ankle fusion) to undertrained if you had subpar training where even 4 foot stuff is questionable for you. ...

Yeah, we have a wide variation in training.

You can always go from calc fractures and flat foot to just bunions and Haglunds... but you can't do the reverse.

Charcot [major recon types, not just planing or TAL/tendonot]... don't even get me started on that.
Charcot is the epitome of podiatry not having enough surgery and work to do. You can talk patients into anything.
There are the very rare centers that do it well and often (usually teaching), but it's still mostly a fool's errand that ends BKA.
I've done maybe two or three actual RRA type Charcot recon since residency... and not because I don't know how. They are just so futile. The patients are so unhealthy. Just CROW/cast until they can get into DM custom insole shoes... or until they get their amp. You have to move on the the patients who can actually be fixed. It's great to understand Charcot dx and educate patients, but I always find the Charcot recon lectures a very good stretch and phone call break at any CME meeting. It cracks me up when the limb salvage guys drone on "surgery #5 was a nail at the start of this year, then 6th was a tendonotomy for forefoot re-ulcer, 7th surgery was I&D VAC for heel ulcer, and 8th for skin graft last month... they're doing well." 🙂

 

[msion]

For pure musculoskeletal stuff no, I don't feel we are overtrained and definitely have a place in the healthcare system. I enjoy treating these pathologies. It's all about biomechanics and respect the science of tissue healing. Can make a big difference in their lives.

But... at least for me private practice has somewhat turned into a chronic pain management clinic. Heel pain, sure can treat that. But wait, they got lower back pain, fibromyalgia and throw some connective tissue disorders on top of it then this becomes a nightmare. They never get better. They should really see pain management. But pain management doesn't want to see them.
My worst fear is walking into the room and they start telling me that intense burning radiating pain on their legs.

 

[air bud]

For pure musculoskeletal stuff no, I don't feel we are overtrained and definitely have a place in the healthcare system. I enjoy treating these pathologies. It's all about biomechanics and respect the science of tissue healing. Can make a big difference in their lives.

But... at least for me private practice has somewhat turned into a chronic pain management clinic. Heel pain, sure can treat that. But wait, they got lower back pain, fibromyalgia and throw some connective tissue disorders on top of it then this becomes a nightmare. They never get better. They should really see pain management. But pain management doesn't want to see them.
My worst fear is walking into the room and they start telling me that intense burning radiating pain on their legs.

ALL biomechanics. When you figure out how to explain this to patients in layman's terms your practice explodes. And not Dennis Shavelson biomechanics