Is burnout real during residency? (not trolling)

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blessed.pod

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Is burnout a problem for those people that worked laborious jobs (blue collar/construction/military) before medical school?

For sure residency will be mentally and physically exhausting but I feel like there are certain people that are built different and actually can handle these stressors.

From what I seen from people that complained the most about long hours and being on-call where most often the lazy students. I mean theses students would complain that leaving at 3pm from a clinical rotation was "late" for them. I feel like these are the type that will burnout often and fast...

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You will see for yourself out on clerkships. There are the whole spectrum.

Some pod programs are long hours and pretty hard since they legitimately have much work, surgery, inpatients, academics, etc... this is maybe 25% of DPM residencies (usually the best training programs we have, provided they have reasonable variety of cases + attendings).

Some pod programs are long hours and fairly hard just for the sake of being hard (they don't have a ton of surgery but find ways to triple scrub it, take in-house call for nonsense like minimally infected wounds or stable fractures, see consults for dumb derm/nail stuff, etc). This is maybe another 15% of residencies.

Half of podiatry residencies are inadequate and essentially fudge logs, few academics or very low quality ones (yet some of them will find ways to work long hours anyways).

Overall, the majority of our podiatry residencies are a cakewalk compared to nearly any MD residency. That's largely because nearly all of theirs are at teaching centers and univ hospitals with high overall standards and good resources while many of ours for podiatry are at little community centers or VA hospitals with little oversight/accountability. You will see this if you do residency or rotate at major teaching hospital(s). Most MD programs are up early for inpatient rounds (juniors earlier than seniors, but all fairly early), then grand rounds or M&M or board prep or etc... then to legit busy surgery or clinic all day, prepping for boards more or doing research in some afternoons, occasional evening academics also, some residents on call overnight. Call is typically inpatient for at least one resident - esp for surgical specialties. Those type of average MD resident hours and academics and exp would only be seen at our best DPM programs, which are a small minority.

...the best thing to do if you want a country club program is to clerk and see for yourself. The senior/chief residents decide the program culture a bit too, so those might be the pgy1s or the pgy2s depending what time of year you clerk there. If you want a good program, pick accordingly. If you want easy hours, pick a lax place with a largely absent director and senior residents who don't run academics and usually leave early themselves - so they won't even notice if their juniors do. You can plan to be home by 4pm or earlier most days and not have to read much... and also plan to fail ABFAS qual and have limited job options after residency. :)

In all seriousness, I look at it this way: do the best residency you can get, work pretty hard (but avoid programs that are hard just for the sake of being hard). Later on, it's all downhill afterwards. For me, as an attending...
Going in occasionally for gas gangrene amp or the odd irreducible ankle fx is not bad... I did that 2-5x or more maaany nights as a resident.
Hard cases are not hard. I saw many that were much worse on residency pod or trauma, ortho, etc rotations.
Surgical planning is not bad... I've seen basically any and every type of fixation and implant in residency because I had so many attendings.
Tests are not tough... I simply have to review a bit to get back to a fraction of what I knew in residency when I read almost daily.
Getting up early for surgery a few days per month now is what I used to do almost every single day in residency.
I can do occasional clinic days on a half night's sleep since I did it hundreds of times in residency.
^If I would've chosen a low quality residency, that stuff would seem much harder... or impossible (assuming I could even get privileges).

...and, sadly enough, the real "burnout" comes probably about one year after residency graduation. That is when you face the rough realities of the podiatry job market, financials, and that being an associate is depressing. Don't say SDN doesn't warn you. Out in the real world of podiatry, you are forced to come to terms with the fact that you 95% won't have the opulent "doctor lifestyle" and ~50% might struggle to even have an upper middle class lifestyle. In residency, you can gleefully ignore those things, enjoy good health insurance, pretend you will be different and find a good job, and you don't have much time to spend $ you make anyways. For the first year out, you might not be happy with your job, but you don't realize right away how little ~$100k or $150k is after taxes and student loans. The way to weather that is to have a financially competent partner and/or frugal and realistic expectations. It will hit you hard, though. There is no getting around that for 90% or more of young DPMs. :(
 
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Is burnout a problem for those people that worked laborious jobs (blue collar/construction/military) before medical school?

For sure residency will be mentally and physically exhausting but I feel like there are certain people that are built different and actually can handle these stressors.

From what I seen from people that complained the most about long hours and being on-call where most often the lazy students. I mean theses students would complain that leaving at 3pm from a clinical rotation was "late" for them. I feel like these are the type that will burnout often and fast...
Thats the beauty of podiatry! The lack of uniform training allows you to pick country club residencies if you are worried about this. Hint- there is no such thing as home by 3pm every day in general surgery. But there is in podiatry! It was impossible for me to burn out when I could choose to be back in bed by 9am most days my 3rd year. I got called in 1 time in my 3 months of inpatient podiatry call. Now here I am 7 years out, board certified in foot and RRA with a hospital employed job. Failing upward!
 
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It’s definitely real. I remember some times waiting to do a two amp at 2 AM, just to get up two hours later to get to the hospital in time at 5:30 for academics.
Saving lives!
 
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70-80 hrs per week gets old no matter who you are. There are going to be people who complain and some who complain less. You only have so many hours to learn during residency, make the most of all of them.
 
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I find that you have to do little tricks to keep your sanity. For example I always like to vary the RPM of my dremel and then hum the harmonic frequency as close as possible.
 
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I think the big difference is call. You could’ve worked tough jobs in the past but there were always set hours and when you were home your day was done. There’s a light at the end of the tunnel knowing that no matter how hard your day was, or how tired you are physically, once you punch that clock you can go home sit down and pound a beer.

Residency is not like that. At my program if you were on call you were expected to go in to the hospital every time the ED put a consult in. 24 hours sometimes for a month in a row or longer. That is very exhausting mentally because you can never fully feel at peace. You can have a crap day and got no sleep, and it’ll just all start over again. There were times I went up to 72 hours without laying down in a bed and getting more than an hour of real sleep.

Even if you weren’t on call, there were still times where the resident on call would have a last minute emergency (car won’t start, they didn’t answer a phone so the attending called you, etc) and all of a sudden you’re expected to go in.

Now, MD and DO residencies are harder sure, but from my experience on off rotations I’ve found that time off and call rules for MDs and DOs were more set in stone (as in, if I’m not on call, nobody can call me and it’s purely the attending doing the work) whereas with podiatry it was much more wishy washy.

That stuff was not healthy for me to always feel on edge like that. It’s why now as an attending I refuse to take proper call (other than office call/patients known to me) no matter how much I would get paid to do it.

I got good at doing toe amps and limb salvage, but honestly didn’t retain or learn much in the way of elective and reconstructive cases because I spent more time either half asleep or just zoning out wishing the case would end because I was tired, or thinking about the 5 consults I have to see after this triple rather than actually reading up and paying attention to what was going on.
 
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I didn’t like call during residency but I did it. When I wasn’t on call we did photography around the city, watched movies, etc.

I’m sure it was more stress for other people but I picked a less stressful residency because that was more important to me. I was not a surgical fanatic. I needed a residency for a license so I did the residency. Look at what you want.
 
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...Even if you weren’t on call, there were still times where the resident on call would have a last minute emergency (car won’t start, they didn’t answer a phone so the attending called you, etc) and all of a sudden you’re expected to go in.

Now, MD and DO residencies are harder sure, but from my experience on off rotations I’ve found that time off and call rules for MDs and DOs were more set in stone (as in, if I’m not on call, nobody can call me and it’s purely the attending doing the work) whereas with podiatry it was much more wishy washy...
Exactly, podiatry has a looong way to go.

Besides the obvious reasons of inadequate cases and diversity and academics, this is another reason why the standalone podiatry programs, programs sponsored at VAs, programs sponsored at little community hospitals, etc (which together make up the majority of our types of residencies) are largely inadequate. There not enough oversight or accountability. Without other MD/DO residencies at the hospital for comparison, they can hide out and play by their own rules for the most part; they are not held accountable to ACGME rules, they usually don't have research support, they don't have very good GME office support, they don't have necessity for academics, off service rotations may be missing or a joke, and many more potential deficiencies...

ACGME rules for post-call, duty hours, etc (also adopted by AOA residencies for awhile... until they ceded to ACGME) will generally be mandated and closely followed by podiatry resident program in any bona fide teaching hospital or univ hospital (99% of MD programs, vast majority of DO programs... but only a small % of DPM residencies).

We need to get DPM programs into real hospitals... real rotations, real academics. It's not to our benefit to be hiding in VAs and small hospitals where we're the only program, it's only us and FP, we're the only surgical program, etc. A lot of the podiatry joke programs will get washed out if we had real standards, but the training, the board pass, the competence, the respect from MDs would rise if we came closer to their standards and rotated side by side with them. I was lucky to have that training in a major teaching hospital with dozens of MD residency and fellowship programs, but that is rare right now among current DPM residency training.
 
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70-80 hrs per week gets old no matter who you are. There are going to be people who complain and some who complain less. You only have so many hours to learn during residency, make the most of all of them.
counterpoint....learn just enough to be successful as a podiatrist. That does NOT take 70 to 80 hours of work per week. Hint you won't ever be expected to save a life or even manage someone's BP or glucose meds. Punt everything! Sorry Mrs Jones, I think that is better managed by your PCP who knows you overall medical condition better. There is plenty of time during residency to learn how to do a good bunion, understand a bird's eye view of biomechanics, and still have a social life. And if you feel like you need more training....there is always fellowships!! Jk that's a waste of time you are still a podiatrist.
 
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Now, MD and DO residencies are harder sure, but from my experience on off rotations I’ve found that time off and call rules for MDs and DOs were more set in stone (as in, if I’m not on call, nobody can call me and it’s purely the attending doing the work) whereas with podiatry it was much more wishy washy.
It's almost like most podiatry attendings are in it for the free labor and not to be a teacher....
 
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It's almost like most podiatry attendings are in it for the free labor and not to be a teacher....
Literally the only reason 95% of attendings work with residency programs is because you get to have someone else to walk into the ED to see your calls rather than yourself, or to have a retractor in the OR so you don’t need to have a first assist.

There’s a few (usually one at most programs) who is actually there for the teaching aspect. But that’s about it.

Granted, a majority of my attendings were eager to hand the blade to residents. But whenever I read the residency reviews of high power programs here who have residents just retracting…we know what’s up.

I’m a VERY firm believer in that you don’t learn from watching. I only ever learned from doing. Any case where I had to retract I just zoned out and nothing ever stuck. The only cases im comfortable doing as an attending were the ones I was allowed to go skin to skin in during residency.
 
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need to get DPM programs into real hospitals... real rotations, real academics. It's not to our benefit to be hiding in VAs and small hospitals where we're the only program, it's only us and FP, we're the only surgical program, etc. A lot of the podiatry joke programs will get washed out if we had real standards, but the training, the board pass, the competence, the respect from MDs would rise if we came closer to their standards and rotated side by side with them. I was lucky to have that training in a major teaching hospital with dozens of MD residency and fellowship programs, but that is rare right now among current DPM residency training.
In one of the 5 largest cities in America, with the largest medical center in the world there are 5 podiatry residencies(I think don't pay attention anymore) and there is not 1. NOT 1 legit off service rotation. Because...... podiatry
 
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Is burnout a problem for those people that worked laborious jobs (blue collar/construction/military) before medical school?

For sure residency will be mentally and physically exhausting but I feel like there are certain people that are built different and actually can handle these stressors.

From what I seen from people that complained the most about long hours and being on-call where most often the lazy students. I mean theses students would complain that leaving at 3pm from a clinical rotation was "late" for them. I feel like these are the type that will burnout often and fast...
Residency doesnt care what job you've worked previously or if you came from a privileged background.

Most jobs, no matter how taxing, when you go home you are done. Take care of your family, crack open a cold one, have some dinner, wash up, go to bed so you can wake up the next day and be functional.

Imagine getting up at 4-5am to round on patients, full day of clinic seeing 30+ patients. Finish charting, tie up loose ends.
You get home 5-6pm. Manage to microwave your food. Pager goes off. You are now back in the ED at 7pm.
You finish seeing the patient/charting. It is now 8pm. Go home shower. Settle into bed.
Get paged again- 11pm. Reduce an ankle, get them in a splint, finish charting. It is now 1230am.
You have 4.5hrs before you need to be at the hospital to round, rinse, repeat.
A patient pages you at 2am. They are a post op from day prior and are wondering why their leg hurts. They have not taken their pain medications or elevated or loosened outer bandage. They are crying and blame you for their symptoms entirely.

it is 230am. You've got 2hours before you need to get up, brush, get to hospital to round.

Repeat above schedule for 3-4 days straight. Add in getting reamed by attendings in clinic/surgery, putting up with non compliant patients, whatever other administrative BS, maybe even toxic coresidents.

God forbid you throw a kid in the mix or are a volunteer SDN mod. Then you go home and get pummeled even more while scrolling through podiatry memes.
 
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And I know I've been joking, but the reality is 99% of podiatrist will not have a schedule like that in real life. Residency is great for finding busy work. There's no reason for you to be in the ER reducing an ankle fracture. That is the EDs job. If a Podiatry resident is doing that, it's just because they are lazy and taking advantage of a resident....or maybe trying to provide a learning experience at best. And if you decide you don't want a lifestyle that may have you doing that due to infection, then you don't have to choose it and just deal with for few years.
 
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And I know I've been joking, but the reality is 99% of podiatrist will not have a schedule like that in real life. Residency is great for finding busy work. There's no reason for you to be in the ER reducing an ankle fracture. That is the EDs job. If a Podiatry resident is doing that, it's just because they are lazy and taking advantage of a resident....or maybe trying to provide a learning experience at best. And if you decide you don't want a lifestyle that may have you doing that due to infection, then you don't have to choose it and just deal with for few years.
Learning experience strictly. Am fortunate to be in a good and supportive residency.
 
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And I know I've been joking, but the reality is 99% of podiatrist will not have a schedule like that in real life. Residency is great for finding busy work. There's no reason for you to be in the ER reducing an ankle fracture. That is the EDs job. If a Podiatry resident is doing that, it's just because they are lazy and taking advantage of a resident....or maybe trying to provide a learning experience at best. And if you decide you don't want a lifestyle that may have you doing that due to infection, then you don't have to choose it and just deal with for few years.

ED docs get paid big money. They can reduce an ankle. They can drain a pus blister. They can repair a lac.

The problem is when EDs switch 80% of their providers to NPs or PAs for overnights who have never seen an ulcer in their life, look at a stable DM ulcer, and throw in a STAT consult for nec fasc
 
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Residency doesnt care what job you've worked previously or if you came from a privileged background.

Most jobs, no matter how taxing, when you go home you are done. Take care of your family, crack open a cold one, have some dinner, wash up, go to bed so you can wake up the next day and be functional.

Imagine getting up at 4-5am to round on patients, full day of clinic seeing 30+ patients. Finish charting, tie up loose ends.
You get home 5-6pm. Manage to microwave your food. Pager goes off. You are now back in the ED at 7pm.
You finish seeing the patient/charting. It is now 8pm. Go home shower. Settle into bed.
Get paged again- 11pm. Reduce an ankle, get them in a splint, finish charting. It is now 1230am.
You have 4.5hrs before you need to be at the hospital to round, rinse, repeat.
A patient pages you at 2am. They are a post op from day prior and are wondering why their leg hurts. They have not taken their pain medications or elevated or loosened outer bandage. They are crying and blame you for their symptoms entirely.

it is 230am. You've got 2hours before you need to get up, brush, get to hospital to round.

Repeat above schedule for 3-4 days straight. Add in getting reamed by attendings in clinic/surgery, putting up with non compliant patients, whatever other administrative BS, maybe even toxic coresidents.

God forbid you throw a kid in the mix or are a volunteer SDN mod. Then you go home and get pummeled even more while scrolling through podiatry memes.

This honestly sounds like a lot of programs. Sucks when you have a big case the next morning and you need to study for it too and you have all this going on. Whats worse is on those drives back and forth from the hospital you have some time to think and realize you're doing all this for a 100k a year job. Really hits hard when you have to fill up on gas on the way to see a consult.
 
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The ED docs can do plenty of things but nothing beats that sweet consult note money
 
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I loved residency. It was a constant major pain in my ass but I loved it.
Never in my life in such a short period of time did I grow like I did in residency.
I took the 3 years I had there and gave it everything I had.
The attendings recognized this and taught me everything they could.
Hard work creates respect. Mutual respect (amongst DPMs but also ER/hospitalist/ortho/vascular/gen surg/Interventionalists/etc) makes residency more tolerable.
I had letters of rec from chief of ortho, chief vascular, general surgeon, and my program director.
Got a good job pretty easy.

I didnt have a kid in residency. That would make the above scenario much harder.
 
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Any case where I had to retract I just zoned out and nothing ever stuck.
Summed up my fourth year student clinical rotations perfectly. I still don't understand how they can actually charge tuition for that year. Biggest scam.
 
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There's no reason for you to be in the ER reducing an ankle fracture. That is the EDs job. If a Podiatry resident is doing that, it's just because they are lazy and taking advantage of a resident....or maybe trying to provide a learning experience at best.

You should have experience close reducing ankle, STJ, Lisfranc dislocations in the OR as a resident. You don’t need to do hundreds or anything, but you will need to be able to do it in practice depending on your job situation. Yes, most ED physicians can close reduce ankle fractures. They are less likely to get an STJ or midfoot dislocation back and you or ortho will get called. Most of the time they’ll do a good job with closed orthopedic injuries, but not always. And someone else is correct that as EDs get more PA and NP coverage, the reductions will get worse and the calls to ortho or an on call podiatrist will become more frequent.
 
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As the on call total toenail replacement surgeon, I find that the ED will have you come in for more complex issues in the middle of the night like a partially avulsed nail from severe trauma such as stubbing the toe. So that’s when I find myself headed to the ER to save lives. The ED staff are always extremely happy when I show up to help, I’m guessing this is because they can’t handle more complex issues like this.
 
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I’m a VERY firm believer in that you don’t learn from watching. I only ever learned from doing. Any case where I had to retract I just zoned out and nothing ever stuck. The only cases im comfortable doing as an attending were the ones I was allowed to go skin to skin in during residency.

Maybe if you paid more attention and was more proactive, you may have been doing more than just retract in those cases. Sounds like the average resident’s behavior, who will get the average teaching from me.
 
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All this work for 3 years. 300k in debt, then you get offered 80-120k as an attending podiatrist…
Residency doesnt care what job you've worked previously or if you came from a privileged background.

Most jobs, no matter how taxing, when you go home you are done. Take care of your family, crack open a cold one, have some dinner, wash up, go to bed so you can wake up the next day and be functional.

Imagine getting up at 4-5am to round on patients, full day of clinic seeing 30+ patients. Finish charting, tie up loose ends.
You get home 5-6pm. Manage to microwave your food. Pager goes off. You are now back in the ED at 7pm.
You finish seeing the patient/charting. It is now 8pm. Go home shower. Settle into bed.
Get paged again- 11pm. Reduce an ankle, get them in a splint, finish charting. It is now 1230am.
You have 4.5hrs before you need to be at the hospital to round, rinse, repeat.
A patient pages you at 2am. They are a post op from day prior and are wondering why their leg hurts. They have not taken their pain medications or elevated or loosened outer bandage. They are crying and blame you for their symptoms entirely.

it is 230am. You've got 2hours before you need to get up, brush, get to hospital to round.

Repeat above schedule for 3-4 days straight. Add in getting reamed by attendings in clinic/surgery, putting up with non compliant patients, whatever other administrative BS, maybe even toxic coresidents.

God forbid you throw a kid in the mix or are a volunteer SDN mod. Then you go home and get pummeled even more while scrolling through podiatry memes.
 
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Maybe if you paid more attention and was more proactive, you may have been doing more than just retract in those cases. Sounds like the average resident’s behavior, who will get the average teaching from me.

How do you like your sutures cut sir?

If average teaching in podiatry means just retracting, that is a problem.
 
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How do you like your sutures cut sir?

If average teaching in podiatry means just retracting, that is a problem.

I like them cut just beneath the knot, thx
 
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Maybe if you paid more attention and was more proactive, you may have been doing more than just retract in those cases. Sounds like the average resident’s behavior, who will get the average teaching from me.
I don't think this is fair though. So many programs are just looked as free labor and a free 1st assist to retract for cases without and real attempt from the attendings to teach. Sure residents should be prepared but there were attendings I knew would never let us touch the blade and going into those cases, there would be very little effort on my part as compared to being with attendings who would teach and hand over the blade if we were prepared.
 
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I don't think this is fair though. So many programs are just looked as free labor and a free 1st assist to retract for cases without and real attempt from the attendings to teach. Sure residents should be prepared but there were attendings I knew would never let us touch the blade and going into those cases, there would be very little effort on my part as compared to being with attendings who would teach and hand over the blade if we were prepared.
Well yeah look who they let into podiatry school....never worked with residents. Some people I do know that I saw on rotations I would never hand the blade to so yeah...
 
Well yeah look who they let into podiatry school....never worked with residents. Some people I do know that I saw on rotations I would never hand the blade to so yeah...
Lol to be completely fair I do not hand the blade over at all. I work with them just because they ask nicely but have no actual affiliation with the programs so I get no actual benefit or money from having them in my cases. Unfortunately for the residents the people that are affiliated with the program do a few hammertoes a month and maybe some amps here and there
 
I like them cut just beneath the knot, thx
pro tip for all the fourth years out there, always cut running sutures below the knot. Top residencies and fellowships, and 400k jobs will start appearing out of thin air to recruit you.
 
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Lol to be completely fair I do not hand the blade over at all. I work with them just because they ask nicely but have no actual affiliation with the programs so I get no actual benefit or money from having them in my cases. Unfortunately for the residents the people that are affiliated with the program do a few hammertoes a month and maybe some amps here and there
Yeah, you're under no obligation to let residents do anything.
They will log 'first assist' no matter what they do anyways.

I would always ask them a few questions pertinent to the procedures and let them do basically the whole case. If they seemed timid or were clearly stuck, I'd take over and "watch and learn" them... "Senns, now try malleable, army navy, great job." That is how it worked at my program and most good ones I saw. I had the pleasure of working with a very good program and a very not good one, but there are occasional residents at each that were exception.
 
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Lol to be completely fair I do not hand the blade over at all. I work with them just because they ask nicely but have no actual affiliation with the programs so I get no actual benefit or money from having them in my cases. Unfortunately for the residents the people that are affiliated with the program do a few hammertoes a month and maybe some amps here and there

Congrats on contributing to bogus surgical volume so a poor residency program can show CPME how their residents totally hit their MAVs…
 
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I have no podiatry residents at my hospital but there are gen surg residents who do a "community rotation" or some nonsense. One time a PGY2 just walked in on me doing a TMA and asked to scrub in. So I was like F it and let him do the bone cuts. He didn't like the saw but did ok anyway. We all had a good time.
 
How do you like your sutures cut sir?

If average teaching in podiatry means just retracting, that is a problem.
As you know, many of us are not responsible for teaching residents, it’s the program directors job if they want structure to communicate with the Attendings what their resident needs work on. Otherwise whoever shows up I have no idea what their experience is. It’s up to the resident to be proactive, ask questions, be curious. I got my own stuff to worry about than to figure out what the residents know or don’t know. I’ll still teach stuff I feel is important and will hand over the knife if they scrub a few with me first. But when they’re zoned out it’s obvious. No way I’m handing over the knife to someone whose mind is drifting elsewhere. Residents are adults, can’t act entitled to passively learn stuff
 
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As you know, many of us are not responsible for teaching residents, it’s the program directors job if they want structure to communicate with the Attendings what their resident needs work on. Otherwise whoever shows up I have no idea what their experience is. It’s up to the resident to be proactive, ask questions, be curious. I got my own stuff to worry about than to figure out what the residents know or don’t know. I’ll still teach stuff I feel is important and will hand over the knife if they scrub a few with me first. But when they’re zoned out it’s obvious. No way I’m handing over the knife to someone whose mind is drifting elsewhere. Residents are adults, can’t act entitled to passively learn stuff
Fair enough, I don’t work with residents myself. Nothing against it, just think it’s better for my patients
 
As you know, many of us are not responsible for teaching residents, it’s the program directors job if they want structure to communicate with the Attendings what their resident needs work on. Otherwise whoever shows up I have no idea what their experience is. It’s up to the resident to be proactive, ask questions, be curious. I got my own stuff to worry about than to figure out what the residents know or don’t know. I’ll still teach stuff I feel is important and will hand over the knife if they scrub a few with me first. But when they’re zoned out it’s obvious. No way I’m handing over the knife to someone whose mind is drifting elsewhere. Residents are adults, can’t act entitled to passively learn stuff

This is why residencies should be based primarily out of teaching hospitals. The problem with sending your residents around town to scrub cases with random attendings is exactly what has been highlighted in this thread over the last few posts. Attending doesn’t know or trust residents, residents get devalued experience holding sticks in random ORs, everyone logs the cases to look like they actually performed a majority of the case. Wash, rinse, repeat.
 
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This is why residencies should be based primarily out of teaching hospitals. The problem with sending your residents around town to scrub cases with random attendings is exactly what has been highlighted in this thread over the last few posts. Attending doesn’t know or trust residents, residents get devalued experience holding sticks in random ORs, everyone logs the cases to look like they actually performed a majority of the case. Wash, rinse, repeat.
Residencies should have full time attendings. The medicine residency had employees. Our residency was run by a podiatrist in private practice. The director and his partners actually taught but the other attendings were hit or miss. 🤷🏽‍♂️
 
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This is why residencies should be based primarily out of teaching hospitals. The problem with sending your residents around town to scrub cases with random attendings is exactly what has been highlighted in this thread over the last few posts. Attending doesn’t know or trust residents, residents get devalued experience holding sticks in random ORs, everyone logs the cases to look like they actually performed a majority of the case. Wash, rinse, repeat.
My entire training was at outpatient surgery centers with private practice pods....🤔
 
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My entire training was at outpatient surgery centers with private practice pods....🤔
There are some excellent pod programs that are private practice based (mine was largely like this as well), but for every gem there are 20 awful places with this training model - think NY, etc. I agree with @dtrack22 about teaching hospitals largely eliminating the BS around logging and standardization. Many pros to being a part of a large training organization. Some cons as well. I think we can all name the programs that have a fully functional ortho department have gives pods all foot and ankle trauma, it's a short list.
 
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This is why residencies should be based primarily out of teaching hospitals. The problem with sending your residents around town to scrub cases with random attendings is exactly what has been highlighted in this thread over the last few posts. Attending doesn’t know or trust residents, residents get devalued experience holding sticks in random ORs, everyone logs the cases to look like they actually performed a majority of the case. Wash, rinse, repeat.
Yeah, I don't really get the APMA/CPME agenda of saying let's just create more residency spots when we are still cleaning up the garbage VAs and other nail/wound/forefoot programs from the "everyone gets 3 year training... every DPM will be surgically trained" (with no such infra-structure to actually accomplish such).

It's very likely, with the two new pod schools, that we end up with an even lower % of DPM residencies at major teaching/univ hospitals than we have right now...
or we water down some of those such programs...
or we have a residency shortage by 2030...
or all of the above.


Residencies should have full time attendings. The medicine residency had employees. Our residency was run by a podiatrist in private practice. The director and his partners actually taught but the other attendings were hit or miss. 🤷🏽‍♂️
Yes. If we could get more and more DPM programs into real teaching hospitals and shut down some laggards, that'd be a boon to our overall success. There is a HUGE difference between both pod - and esp non-pod - rotations and their level of academics, involvement in OR, amount of pod academics, quality of attendings, research supports, etc between a teaching service (typically director FTE hospital with much admin time) versus non-teaching. And sure, there are some good DPM programs that don't run out of teaching hospitals yet still do good academics (PI / Emory Decatur probably best example... although they now joined the fringe of a teaching system at least), but for every one of them... there are probably five VA programs that do basic amps and clinic nonsense, sparse low quality academics, and have less than half their chiefs pass ABFAS qual.

The MD programs with many scheduled academics, attendings who teach boards (especially director, almost always hospital FTE with admin time), attendings who are evaluated on teaching minimizes the programs using residents as a paycheck (GME $) or a paycheck enhancer (consults) or a name-enhancer (research monkey). It is just pretty hard to fail boards when you have weekly academics (sometimes daily), required research, pushed to the levels of MDs both on and off service.

At the very minimum, all DPM residency programs should have director as hospital FTE, core faculty board cert (surgery for DPM surgical programs, obviously), 200+ bed hospital minimum, trauma center (level 3 minimum) sponsor hospital or at least rotations at one, in-training exam preps taught and results overseen by hospital GME as well as the residency program admins, nearly all off-service rotations with teaching services, full GME office support, basic research support or better. If that stuff sounds crazy, that's because it is... to most current DPM programs. For MDs, those are bare minimum norms that you hardly find any accredited program not checking all of those boxes (trauma not so essential for non-ER or surgery programs).
 
As they pimp you on topics from their Podiatry Today CME they took over the weekend
 
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Yeah, I don't really get the APMA/CPME agenda of saying let's just create more residency spots when we are still cleaning up the garbage VAs and other nail/wound/forefoot programs from the "everyone gets 3 year training... every DPM will be surgically trained" (with no such infra-structure to actually accomplish such).

It's very likely, with the two new pod schools, that we end up with an even lower % of DPM residencies at major teaching/univ hospitals than we have right now...
or we water down some of those such programs...
or we have a residency shortage by 2030...
or all of the above.



Yes. If we could get more and more DPM programs into real teaching hospitals and shut down some laggards, that'd be a boon to our overall success. There is a HUGE difference between both pod - and esp non-pod - rotations and their level of academics, involvement in OR, amount of pod academics, quality of attendings, research supports, etc between a teaching service (typically director FTE hospital with much admin time) versus non-teaching. And sure, there are some good DPM programs that don't run out of teaching hospitals yet still do good academics (PI / Emory Decatur probably best example... although they now joined the fringe of a teaching system at least), but for every one of them... there are probably five VA programs that do basic amps and clinic nonsense, sparse low quality academics, and have less than half their chiefs pass ABFAS qual.

The MD programs with many scheduled academics, attendings who teach boards (especially director, almost always hospital FTE with admin time), attendings who are evaluated on teaching minimizes the programs using residents as a paycheck (GME $) or a paycheck enhancer (consults) or a name-enhancer (research monkey). It is just pretty hard to fail boards when you have weekly academics (sometimes daily), required research, pushed to the levels of MDs both on and off service.

At the very minimum, all DPM residency programs should have director as hospital FTE, core faculty board cert (surgery for DPM surgical programs, obviously), 200+ bed hospital minimum, trauma center (level 3 minimum) sponsor hospital or at least rotations at one, in-training exam preps taught and results overseen by hospital GME as well as the residency program admins, nearly all off-service rotations with teaching services, full GME office support, basic research support or better. If that stuff sounds crazy, that's because it is... to most current DPM programs. For MDs, those are bare minimum norms that you hardly find any accredited program not checking all of those boxes (trauma not so essential for non-ER or surgery programs).
My residency experience meets all your criteria.

See my previous comments on my off service rotations. Having solid off service rotations is a game changer.
 
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My residency experience meets all your criteria.

See my previous comments on my off service rotations. Having solid off service rotations is a game changer.
Yeah, I still go back and forth on the off-service rotations being what does it. It definitely doesn't hurt.
The results can happen without big hospital (PI, airbud program, mine for decades before big hosp, many others, etc), but the teaching setting just cuts down on the low end podiatry stinker programs by a ton... forces them have some standards and to be at least fair quality.

However it happens, they (teaching hospital setting, GME office accountability, other academic services) absolutely do force the podiatry service/attendings/residents to up their game to reasonable standards (structured academics, eval in-training prep/results, do research, function like a teaching svc, reasonable standards of care, etc). That accountability and structure is what's missing at most DPM programs, and the results are unsurprisingly all over the board.
 
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