Nov 5, 2010
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Hey guys,
I am planning to do my externship next month at New York Hospital of Queens, anyone been there, I heared they do lots of ex-fix, charcot reconstruction etc...any feedback will be appreciated.
thx.
 

BuckeyeDoctor

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It is a really good program. You will probably hear a lot of negatives on here because people don't truly know anything about the training in NY. There are a ton of programs in NY and most are pretty bad but there are a couple good programs and Queens is one of them.

It is a busy, busy, busy program. There are not enough residents to handle the load so the residents are worked very hard. They do it all. The surgical diversity is amazing. You need to know your medicine.

A lot of students who visit get scared by the amount of work that this program requires. These are the type of students who have always done the minimal amount to get by and they get exposed when coming here. You will work long hours, do a ton of surgery and a lot is expected.

Enjoy your month, you will learn a ton
 
Aug 26, 2010
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Is Dr. Charles Lombardi associated with this program?
Interesting story I had with him. As a student, I got a call from him personally encouraging me to apply to his program at the time. I remember this because the fee was one of the highest at the time simply to put in an app. I was very excited as a residency director calls me PERSONALLY to apply to his program. I send in the fee and the app. Didn't get an interview. Non-refundable application fee. Imagine my surprise.
 

Skippygonenuts

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Interesting story I had with him. As a student, I got a call from him personally encouraging me to apply to his program at the time. I remember this because the fee was one of the highest at the time simply to put in an app. I was very excited as a residency director calls me PERSONALLY to apply to his program. I send in the fee and the app. Didn't get an interview. Non-refundable application fee. Imagine my surprise.
ouch
 
Aug 26, 2010
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One of the things with a small profession like ours is that you have to be extremely careful who you step on. I'm no famous who knows who by any stretch, and have a small practice in a small community, but I've met and interacted with many a director and "high power big name" in my travels who stepped on me while I was coming up, simply because they felt they could at the time.

You just never now who you're going to meet or what can happen.
 

PADPM

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I'll be as diplomatic as possible and simply say that your story doesn't surprise me.
 

BuckeyeDoctor

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Interesting story I had with him. As a student, I got a call from him personally encouraging me to apply to his program at the time. I remember this because the fee was one of the highest at the time simply to put in an app. I was very excited as a residency director calls me PERSONALLY to apply to his program. I send in the fee and the app. Didn't get an interview. Non-refundable application fee. Imagine my surprise.
That's not unique to him. Nowadays the directors come to the school and do a little presentation and tell everyone that they should apply to their program because it is the best.
 
Aug 26, 2010
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That's not unique to him. Nowadays the directors come to the school and do a little presentation and tell everyone that they should apply to their program because it is the best.
Sorry, but that is NOTHING like having a residency director take the time to track me down, get my phone number, call me, take time out of his personal day to encourage me to apply, then take my application fee and effectively saying "eff you very much for the cash". If this is the state of affairs for some program directors, shame on them.

Doing what you mentioned is good PR. Messing with a young, hopeful, impressionable mind like that is just plain disgusting imho.
 

BuckeyeDoctor

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I doubt he took the time to track down 1 person, call them to only screw them over. More likely, he got the contact information for a lot of students from various schools and made phone calls telling them they should apply.

Are you suggesting he randomly selected a couple people to call and get application money knowing he would never accept them? I highly doubt the couple extra application fees he collected amounted to much.


Just commenting on the subject of it all, because I don't know what he apparently said in the phone call. Obviously if he was making all sorts of empty promises, that is different. But generally, these stories are often misreported because the student in question misread the conversation and read more into it than there was.
 
Nov 7, 2010
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That's not unique to him. Nowadays the directors come to the school and do a little presentation and tell everyone that they should apply to their program because it is the best.
interesting since New york Hospital Queens has never had nor does it intend to require an application fee.....something is fishy
 
Aug 26, 2010
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I doubt he took the time to track down 1 person, call them to only screw them over. More likely, he got the contact information for a lot of students from various schools and made phone calls telling them they should apply.

Are you suggesting he randomly selected a couple people to call and get application money knowing he would never accept them? I highly doubt the couple extra application fees he collected amounted to much.


Just commenting on the subject of it all, because I don't know what he apparently said in the phone call. Obviously if he was making all sorts of empty promises, that is different. But generally, these stories are often misreported because the student in question misread the conversation and read more into it than there was.
"I've heard good things about you and would like you to consider applying to my program." It went something like that. Why would a director take that kind of time to call all these students? THAT doesn't sound right to me at all. Remember, I've been through this as a student, resident and am still involved in a residency, so I've been around. Frankly, this is unheard of in the circles I talk to. Good residencies have to fight AWAY the good applicants, not call them on the phone encouraging them to apply. If you're suggesting that I wasn't the only one he called, but he called 50 students, that can amount to a significant sum.

I was the student in question and remember the situation VERY clearly. I'm not misreporting, and have nothing to gain or lose by disclosing this other than to warn prospective applicants of an unpleasant situation I was faced with. I can tell you other similar experiences with other residency directors that myself and some of my classmates had, but his name came up and obviously, there have been issues.

This was also over ten years ago. No application fee ever? Is this the only residency Dr. Lombardi has ever been associated with? Is he still the director or an attending?
 
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Aug 26, 2010
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interesting since New york Hospital Queens has never had nor does it intend to require an application fee.....something is fishy
Took about 2 minutes of searching to find that Dr. Lombardi was indeed the Residency Director of the Wycoff program until 2008. I'm certain that if you do a little more looking you'll see that in fact they did have an application fee for potential consideration as a residents about 10 years ago.

Interesting that you have one post and came to the immediate defense of a seemingly good program. You don't have all the facts though. Feel free to do your own research on the matter and let me know what you find.
 

sanggydaddy81

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I did my externship @ NYHQ August 2010.
I truly enjoyed this program. Here's my feedback about this program. And as far as I know program fee is free for this cycle.

How much driving: All sites are within 5 – 10 minutes of the hospital.
Housing for students: FREE Housing available.
Pro's:
- FREE Housing available. ( Including FREE meal, internet, Cable TV) I think I saved $1500.
- The residents were extremely confident with general medicine. As far as I know they do 6 months of internal medicine during 1st year rotation. They learn how to medically manage the patient first and learn surgery during 2nd year.
- manageable load of in-patients,
- hospital library with internet access
- the surgical load was steady – with a variety of cases and procedures daily.
- ample hands-on for the student (not just retracting, but suturing, drilling, etc.)
- there was a 50/50 clinic and surgery load for students
- the residents really worked like a team and were welcoming, friendly and encouraging
-great attendings and residents; this is a great program, with variety of pathology all over the world and an amazing exposure to surgery on daily basis
- weekly Tuesday Night didactic session would include resident led discussions, presentations, journal club articles and guest speakers.
- very enjoyable environment, with kind OR staff, floor nurses and medical education staff.
- 15 minutes away from New York City
- The residents get lots of chances to learn by doing it which means long hours. You will hate this program if you are looking for a chill program.


Con's:
- schedule was sometimes found out that morning so it was difficult to prepare for cases
- Parking.

Advice:
- Read up on the surgeries the night before, and be prepared.
- Take advantage of seeing the community… NYC, Amazing Chinese and Korean Food.
- Be 15 minutes early for in-patient rounding. It starts 7 am everyday including weekends. Get all the supplies ready and have your coat pocket full of bandage supplies.
- be EARLY to surgery and offer to help prepare the OR.
- help the OR staff prepare the room and clean the room after cases…they will love you and will help you out during the case.
- Take A GPS
- have a good attitude!

Good luck!!!
 
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FALL06

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Hate to tell you this kidsfeet, but chazdpm doesn't need to do the research...you're speaking to the man himself.

I've rotated through his program, was amazing. Dr. Lombardi would even show up to show support and not even scrub into the case...just sit back and watch his residents do a good job.




Took about 2 minutes of searching to find that Dr. Lombardi was indeed the Residency Director of the Wycoff program until 2008. I'm certain that if you do a little more looking you'll see that in fact they did have an application fee for potential consideration as a residents about 10 years ago.

Interesting that you have one post and came to the immediate defense of a seemingly good program. You don't have all the facts though. Feel free to do your own research on the matter and let me know what you find.
 
Aug 26, 2010
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Hate to tell you this kidsfeet, but chazdpm doesn't need to do the research...you're speaking to the man himself.

I've rotated through his program, was amazing. Dr. Lombardi would even show up to show support and not even scrub into the case...just sit back and watch his residents do a good job.
Chazdpm is Dr. Lombardi?

So are you suggesting that the attending in the case wouldn't even scrub to supervise his residents working on his private patients? Show support? I'm confused. Residents don't need "support" in surgery. They need guidance and a more experienced hand in case something should go wrong. I'm an attending and would never dream of not scrubbing cases that residents are involved in. Particularly if the patient on the table is trusting ME with the wellfare of their feet. Interesting.

You are still not addressing, and neither is Chazdpm, why a director would call students personally and invite them to apply to a program and than accept a fee, but not offer an interview. Please explain this as I'm still baffled.
 

Podfather

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Chazdpm is Dr. Lombardi?

So are you suggesting that the attending in the case wouldn't even scrub to supervise his residents working on his private patients? Show support? I'm confused. Residents don't need "support" in surgery. They need guidance and a more experienced hand in case something should go wrong. I'm an attending and would never dream of not scrubbing cases that residents are involved in. Particularly if the patient on the table is trusting ME with the wellfare of their feet. Interesting.

You are still not addressing, and neither is Chazdpm, why a director would call students personally and invite them to apply to a program and than accept a fee, but not offer an interview. Please explain this as I'm still baffled.
It could be that when he received your application something excluded you. If I remember correctly you required a Visa. Some programs do not accept non US citizens???? Just a thought and possible explanation.
 
Aug 26, 2010
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It could be that when he received your application something excluded you. If I remember correctly you required a Visa. Some programs do not accept non US citizens???? Just a thought and possible explanation.
At the time the only programs not accepting non-US Residents were the VA programs. I was to need a working VISA (H1-B1) as a resident, and since that particular hospital system didn't just have podiatry residents, but all sorts of medical interns/residents it seems unlikely that this was the case. If it was, it would have also been mentioned in the CASPR profile of the program. I was VERY careful about this and would not have sent in a fee if this was the case as this could have jeopardized my immigration status.

That being said I would have expected one of two scenarios if that was in fact the case. Check into that BEFORE making a call to an impressionable and tight budgetted student, or returning the fee due to a clerical error on their part. "So sorry, didn't realize you weren't a US resident yet, here's your money back and sorry for the misunderstanding". I would be telling a much different story if that had been the case. Interestingly, as I mentioned in another thread, I applied to only a small number of programs for residency interviews and some of the programs that didn't select me as an interviewee, sent me my checks back. Honorable way to do things to say the least.
 

Foot Doc

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Chazdpm is Dr. Lombardi?

So are you suggesting that the attending in the case wouldn't even scrub to supervise his residents working on his private patients? Show support? I'm confused. Residents don't need "support" in surgery. They need guidance and a more experienced hand in case something should go wrong. I'm an attending and would never dream of not scrubbing cases that residents are involved in. Particularly if the patient on the table is trusting ME with the wellfare of their feet. Interesting.
Depending on the case as well as the resident that is covering me, I will sometimes not scrub in, but I am ALWAYS in the room until the dressing goes on.
 
Aug 26, 2010
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Depending on the case as well as the resident that is covering me, I will sometimes not scrub in, but I am ALWAYS in the room until the dressing goes on.
The only person I trust without reservation in the OR with my private patients is me.
 

krabmas

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The only person I trust without reservation in the OR with my private patients is me.
this is the attitude that prohibits learning by doing on the part of the resident. At some point the leash must be let go and it is not fair to the next generation of podiatrists being trained to not have the experience of "running" an OR and making the decisions. If you have taught them well, thus far, and trust in your abilities to teach, you should trust them to make a decision or two on your patient. this is the learning process in residency.

This is the HUGE difference between MD surgical training and DPM surgical training.

I'm not sure how others feel about their residency training, but I felt like the MD's that we worked with at my residency program trusted us with their patients far more than the DPM's did.

If you question this concept of trusting the resident I suggest reading "Genius on the edge : the bizarre double life of Dr. William Stewart Halsted" / Gerald Imber.

not only is it a very interesting read about Halsted's life, but it also describes the founding and beginnings of The Johns Hopkins Hospital and Medical School. In short, Hopkins was the first hospital in the country to have true medical residents that resided in the hospital and learned their craft by seeing, doing and teaching. Every program in the country at that point changed how they taught residents based on the hopkins system.

If you never completely trust your resident, how will they have the confidence upon graduating to treat their own patient. They also probably never completely trusted the 2nd year resident either even with year appropriate tasks. Giving someone your trust is a way of telling them "good job", "you know what you are doing" "you can do this". Not every decision is appropriate for the resident to make, that is where your expertice as a teacher comes into play, know what, when and who to trust.
 

PADPM

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In MY opinion, this has absolutely nothing to do with "trusting" your resident, though that's a great way to spin the conversation. This is ALL about the "trust" my patient has placed in ME.

My patient didn't make an appointment with the resident at his/her office. The primary care physician didn't refer the patient to the resident. The patient's friend or family member didn't refer the patient to the resident. During the initial visit or subsequent follow up visits for the initial complaint, the patient probably never met the resident. When we finally decided upon surgical intervention, MY patient never met the resident. When I reviewed (yes me, not my staff) the consent form and went over the benefits, risks and complications, the patient never met the resident.

Yes, the consent form says that the procedure will be performed by me or who ever I may "designate", etc., etc. However, I see no reason why any attending, no matter how much he/she trusts his/her residents would not at least scrub into the case. I was a residency director and have been involved with training residents for a very long time, and have allowed residents to perform a lot of intricate surgical procedures while I was inches away, not while I stood or sat "unscrubbed".

I'm not an attorney, but I'm not even sure if that's legal.

Obviously when the op report is dictated, if a doctor is NOT scrubbed, his/her name can not appear on the operative report (THAT would be illegal) as the surgeon or the assistant. And if for some reason the case went bad and ended up in a courtroom, I can assure you that the attorney would have a field day with this scenario.

Trust or confidence has absolutely nothing to do with this situation. It's simply a responsibility to your patient as the attending. I can think of no rational reason for an attending NOT to scrub in on a case, even if he/she wants to let the resident perform the case skin to skin. The attending stll must be the "captain of the ship", and you can not have that title if you're not scrubbed.

I've been an expert witness on cases like these, and my advice, no matter how much you allow the resident to perform on the case......SCRUB IN, even if you do nothing.
 
Aug 26, 2010
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In MY opinion, this has absolutely nothing to do with "trusting" your resident, though that's a great way to spin the conversation. This is ALL about the "trust" my patient has placed in ME.

My patient didn't make an appointment with the resident at his/her office. The primary care physician didn't refer the patient to the resident. The patient's friend or family member didn't refer the patient to the resident. During the initial visit or subsequent follow up visits for the initial complaint, the patient probably never met the resident. When we finally decided upon surgical intervention, MY patient never met the resident. When I reviewed (yes me, not my staff) the consent form and went over the benefits, risks and complications, the patient never met the resident.

Yes, the consent form says that the procedure will be performed by me or who ever I may "designate", etc., etc. However, I see no reason why any attending, no matter how much he/she trusts his/her residents would not at least scrub into the case. I was a residency director and have been involved with training residents for a very long time, and have allowed residents to perform a lot of intricate surgical procedures while I was inches away, not while I stood or sat "unscrubbed".

I'm not an attorney, but I'm not even sure if that's legal.

Obviously when the op report is dictated, if a doctor is NOT scrubbed, his/her name can not appear on the operative report (THAT would be illegal) as the surgeon or the assistant. And if for some reason the case went bad and ended up in a courtroom, I can assure you that the attorney would have a field day with this scenario.

Trust or confidence has absolutely nothing to do with this situation. It's simply a responsibility to your patient as the attending. I can think of no rational reason for an attending NOT to scrub in on a case, even if he/she wants to let the resident perform the case skin to skin. The attending stll must be the "captain of the ship", and you can not have that title if you're not scrubbed.

I've been an expert witness on cases like these, and my advice, no matter how much you allow the resident to perform on the case......SCRUB IN, even if you do nothing.
Thank you PADPM. As usual, we are on the same wavelength. I could not have said it better myself.

Krabmas, since you brought up trust, trust is EARNED. Most residents feel that it is a right rather than a privilege to do surgery on their attendings' patients. We've already EARNED our patient's trust. How have you earned the trust of your attendings? Residents think they show up and the work is handed to them. This is not what my residency was like. I had to take it in stages and start by knowing how to retract well. It was honor for us in our residency when our attendings gave us the knife. When I hear residents complain "He doesn't let me do ANYTHING in there!!", I am at a loss at how to address this. You got to retract, suture, learn how I would prefer the case to go, put on the post op dressing (which is in essence very important, since this is what the patients SEES), put on a splint (which is also very important as a poorly placed splint can cause all kinds of problems), but sure, you didn't DO ANYTHING.

I would NEVER not scrub a case. Its more tiring to watch a resident do a case than for me to actually do it since my spider sense is up 100% of the time. Don't forget that now I am the one retracting for YOU. Many of my cases are automatic to me already, but when a resident is cutting, I have to be 110% aware and make sure I watch every slice. Its taxing and not everyone is willing, so be thankful there are docs out there who put their patients on the table for you to learn on.
 

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Even when a resident HAS earned his/her way to the top of the food chain and more importantly has earned my trust and confidence, that does not negate the fact that it is still my patient on the table, and I will absolutely be scrubbed in and standing beside the resident even if I decide to let the resident perform the entire case. I know my hands are ready, willing and able and inches away at any time I believe necessary.

Egos are checked at the door.
 

dtrack22

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Kidsfeet said:
Krabmas, since you brought up trust, trust is EARNED. Most residents feel that it is a right rather than a privilege to do surgery on their attendings' patients. We've already EARNED our patient's trust. How have you earned the trust of your attendings? Residents think they show up and the work is handed to them. This is not what my residency was like. I had to take it in stages and start by knowing how to retract well. It was honor for us in our residency when our attendings gave us the knife.
Speaking of spinning the conversation. Nobody said that a PGY-1 should walk in and be handed the keys to the car. I would hope 3 years of work with a particular attending would be enough to earn his/her trust. Is it reasonable to expect this day 1, or even year 1? No, but then again nobody said it was.

I would hope that by the time you've logged 100 Digital procedures you and your attending would have the confidence to let you run the show. I don't really care wether they scrub in or not, just make it feel like "my OR" once before I complete my training...well, hopefully more than once.
 
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Speaking of spinning the conversation. Nobody said that a PGY-1 should walk in and be handed the keys to the car. I would hope 3 years of work with a particular attending would be enough to earn his/her trust. Is it reasonable to expect this day 1, or even year 1? No, but then again nobody said it was.

I would hope that by the time you've logged 100 Digital procedures you and your attending would have the confidence to let you run the show. I don't really care wether they scrub in or not, just make it feel like "my OR" once before I complete my training...well, hopefully more than once.
How many residents have you trained? You would be AMAZED at how many expect this from day one and are VERY vocal about it too. Some residents after logging 100 toe procedure still may not know how to do a hammertoe WELL.

You should care whether I scrub in or not, and no matter how much I make you feel like its "YOUR" OR, I am your strongest ally and supporter in the OR when you are training. Also, until you're in there on your own, as the captain of the ship, you won't know what its like. I can simulate private practice all I want for you, but until its yours, the experience isn't even close. ESPECIALLY for your first case in private practice.
 

dtrack22

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Kidsfeet said:
How many residents have you trained? You would be AMAZED at how many expect this from day one and are VERY vocal about it too.
Regardless of your experience, it doesn't change the fact that your post was specifically responding to/addressing krabmas, who never once said she expected to be GIVEN anything without earning it.

Kidsfeet said:
Also, until you're in there on your own, as the captain of the ship, you won't know what its like. I can simulate private practice all I want for you, but until its yours, the experience isn't even close. ESPECIALLY for your first case in private practice.
Is this your excuse for not letting students perform cases on their own? Because it doesn't really matter since it's nothing like out in preactice? Why practice anything? Suturing a skin pad is nothing like the real thing. Injections on a cadaver are nothing like the real thing. Casting a classmate's foot/ankle is nothing like the real thing...

It might not be exactly the same...but it sure as heck couldn't hurt to simulate "the real thing".

PADPM said:
...I will absolutely be scrubbed in and standing beside the resident even if I decide to let the resident perform the entire case. I know my hands are ready, willing and able and inches away at any time I believe necessary.
I personally wouldn't care if the attending wanted to scrub every case. Like I said, as long as I get to run the show a few times before I complete my training, I'm ok. Although it would be nice to know there is no security blanket standing there who will undoubtedly jump in as soon as you do something they don't like...
 
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Regardless of your experience, it doesn't change the fact that your post was specifically responding to/addressing krabmas, who never once said she expected to be GIVEN anything without earning it.

I was responding to the general notion MANY residents have that as soon as they enter into residency, they EXPECT to be handed the knife immediately. As I pointed out, neither you nor Krabmas has had the pleasure of helping to train resident yet by allowing them access to YOUR private patients.


Is this your excuse for not letting students perform cases on their own? Because it doesn't really matter since it's nothing like out in preactice? Why practice anything? Suturing a skin pad is nothing like the real thing. Injections on a cadaver are nothing like the real thing. Casting a classmate's foot/ankle is nothing like the real thing...

It might not be exactly the same...but it sure as heck couldn't hurt to simulate "the real thing".

I certainly don't let students do anything in my OR. Once they become residents, they have the privilege of learning on my private patients and if they earn it, they get to do skin to skin procedures with me in the room, retracting for THEM, making sure they cut true and sure on MY private patients. This isn't the school clinic anymore my man. These are MY patients trusting ME on the table because of MY reputation.


I personally wouldn't care if the attending wanted to scrub every case. Like I said, as long as I get to run the show a few times before I complete my training, I'm ok. Although it would be nice to know there is no security blanket standing there who will undoubtedly jump in as soon as you do something they don't like...
You should care if an attending is around at all times. You NEVER know when something can go wrong and you should WANT them around to help in immediately in case something should happen that you didn't anticipate and they might have.

What do mean by "run the show"? Any responsible attending will always be there and nod to the nurses to allow you to seemingly "run the show". Where is your security blanket in practice? Your resident?? No one is there to bail you out in practice if something goes wrong. What are you going to do then?
 

dtrack22

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Kidsfeet said:
I was responding to the general notion MANY residents have that as soon as they enter into residency, they EXPECT to be handed the knife immediately.
Next time don't put someone's s/n in the sentence right before you start making a point. Believe it or not, it makes it look like "the point" is directed at them...

Kidsfeet said:
What do mean by "run the show"? Any responsible attending will always be there and nod to the nurses to allow you to seemingly "run the show".
I mean, the attending sits back and doesn't say a word. The attending can assist, but the resident is doing the procedure, skin to skin, without interruption.

Kidsfeet said:
Where is your security blanket in practice? Your resident?? No one is there to bail you out in practice if something goes wrong. What are you going to do then?
Ding, Ding, Ding! That's the point! I don't want the security blanket there at some point near the end of my training. If you are always there to take over when you see me doing something you don't like, when do I learn how to get myself out of a jam? Your residents most likely couldn't answer that last, bolded question other than what they've read out of a textbook. You don't give them the opportunity to learn what to do if something goes wrong.

It's like learning to ride a bike. The training wheels eventually come off and you start doing more and more of the work yourself. But even after you gain that additional responsibility, your dad will still hold onto your seat and run with you a ways. He is your "strongest ally and supporter". That's great since you need the help as soon as the wheels come off. But at some point, dad has to let you get on the bike, stand on the pedals, and ride all by yourself, without any help. Personally, I want someone to let go while I'm riding around the driveway (ie PGY-3)...I don't want the first time to be on a busy 4 lane road (ie my own practice).
 
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It's like learning to ride a bike. The training wheels eventually come off and you start doing more and more of the work yourself. But even after you gain that additional responsibility, your dad will still hold onto your seat and run with you a ways. He is your "strongest ally and supporter". That's great since you need the help as soon as the wheels come off. But at some point, dad has to let you get on the bike, stand on the pedals, and ride all by yourself, without any help. Personally, I want someone to let go while I'm riding around the driveway (ie PGY-3)...I don't want the first time to be on a busy 4 lane road (ie my own practice).
Interesting analogy. Let me take it apart a bit.

When you're learning to ride a bike, how many cuts and scrapes and dings on your bike did you get? Sorry, but I bet your parents had you learn and ding up YOUR bike, not their $1300 racing bike that Dad uses to train for his Ironman Triathlon.

That patient on that table is MY $1300 racing bike. So I'll run beside you the whole time whether you like it or not. Ding up your own patients on your own if you like, OR when you start teaching residents let them ding up your patients.

You mention that my residents probably don't learn very much about how to get out a jam. That really depends on their attitude. When they get into a jam and I take the knife and salvage their error, if they pout in the corner, you're darn right they don't learn a thing. If they stick around and let me explain to them the mistake they made and how I'm going to avert a disaster they caused, they learn A LOT.

This is not a duel of egos here. I'm trying to teach whether they like my methods or not. You only learn as much as you let yourself learn.
 

dtrack22

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But you signed up to let residents ding up your patients. You can't tell me that you don't have residents break pins, strip screws, make the wrong cut etc. None of which may be serious complications but they are "dings" none the less. Every time you bring in a patient, you run the risk of a resident screwing things up. That's where the whole trust/quality of training thing comes in.

Sure you can explain to the resident how they screwed up and what you're doing to fix it, just like my anatomy instructor can explain how to disect out the internal thoracic artery. At some point though you have to stop, think about what you are trying to accomplish, and come up with a solution on your own BEFORE your attending jumps in to save the day. By reading your posts you don't strike me as the person who is going to let the resident explain what they would do to fix the problem. Heaven forbid they have a chance to fix it themselves before you jump in.
 

krabmas

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well stated many times over dtrack22.

you my friend understand the plight of the resident which is easy to understand when you are the student or resident.


PADPM and Kidsfeet: It is very nice of you to volunteer your time and patients to residency training, however it is really a farce if you never at any point take the training wheels off and let the resident go. If you have worked with a resident for 3 years and have done even close to 100 of any type of procedure with them and do not have confidence in them even if they are all thumbs maybe there IS something wrong with your teaching style that they still cannot perform said procedure.

FYI, I do currently have my own patients that I see initially, decide they need surgery, explain the procedure, risks, benefits and alternatives. Have them sign informed consent - me, not my staff - wow just like you 2.

I do not currently have residents so I do not have to share my patients with them. I do think about this often, how I will teach residents, how I will make sure they feel prepared to run their own OR, how will I do this and make sure the patient is not harmed. Oh, wait... that's right... we all took an oath as students to "do no harm" do you think the residents you are working with did not take that seriously? If that is the case, maybe there is a bigger problem that needs to be addressed. What is to say that you would not accidently harm the patient either? Are you not human like your resident?

Luckily part of my residency program has us rotate in a location where we get to experience running the OR. The attending understands the need to train residents and balances this with protecting the patient. We are 3rd year residents during this rotation and said attending trusts the training process. The knife and patient in not handed day one, it is a process and handled differently for each resident, this is called tailoring your teaching to match the resident. It is a sign of a good educator.

Teaching residents is not just about showing up with patients and surgical cases and watching you "perform".

In the words of one of my favorite attendings in residency and not a podiatrist... "Surgery is not a spectator sport". He did not hand me the knife day 1 that I worked with him, it was certainly earned by retracting, anticipating his next step while assisting, writing orders, taking call for his in-house patients. But by my 3rd year when we rotated in his office he would ask what our treatment plan was after evaluating the patient and would often trust our decision on how to treat the patient. Most of these patients had elective procedures and had many years left to enact a lawsuit if desired.

Many times an attending asks how you want to do something, a surgical procedure, your treatment plan... and you come up with a reasonable plan, but it is not the exact way the attending would do it, so the resident becomes wrong. If there is no discussion explaining that the resident's way may have been OK, just not how the attending likes it, the next time that attending asks the same of the resident, the resident does not think for themself how they would do it, they try to guess how that attending would do it. I hardly see this as an ideal way to learn to be a thinking doctor or surgeon. If you want to make a good technician this works great.

Just because you have been a residency director and actively train residents does not mean that you do it right or are the authority on how to do it. You can do something for 50 years the sameway, but if it was wrong the 1st year it will still be wrong in year 50. If you are complacent in your teaching process then you are not improving or advancing, how can you expect the resident to advance when his teacher will not?
 

PADPM

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Krabmas,

Maybe you should take the time to actually read what I wrote, and not lump what I wrote together with Kidsfeet's post.

Yes, go back and actually read what I wrote prior to criticizing my ways. I know that you vast experience over these past few months overshadows everything I've done, but please actually read what I've written and dissect my words away from Kidsfeet's words.

When you do, you will read that I stated that I simply stated that an attending should always scrub on a case. I'm not arguing the point regarding competence, confidence, letting a resident "fly" on his/her own, etc. I even made it a point to state that even WHEN I let a resident go skin to skin, I'm still scrubbed.

So this has nothing to do with my ego, teaching skills, old school attitude, etc. It is simply the fact that I don't believe ANY attending should sit in an OR and not scrub when his/her patient is on the table. That is independent of how much the resident is involved with the case.

So, for the last time. Even when I let the resident perform EVERYTHING, yes EVERYTHING, I'm still scrubbed in on the case. And that is/was my entire point.

I'm alot more valuable teaching my residents even when they are performing skin to skin when I'm scrubbed and standing next to them, then when I'm standing in a corner somewhere.

Now Kidsfeet can speak for himself.
 
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But you signed up to let residents ding up your patients. You can't tell me that you don't have residents break pins, strip screws, make the wrong cut etc. None of which may be serious complications but they are "dings" none the less. Every time you bring in a patient, you run the risk of a resident screwing things up. That's where the whole trust/quality of training thing comes in.

Sure you can explain to the resident how they screwed up and what you're doing to fix it, just like my anatomy instructor can explain how to disect out the internal thoracic artery. At some point though you have to stop, think about what you are trying to accomplish, and come up with a solution on your own BEFORE your attending jumps in to save the day. By reading your posts you don't strike me as the person who is going to let the resident explain what they would do to fix the problem. Heaven forbid they have a chance to fix it themselves before you jump in.
You assume I'm the only one teaching the residents where I am. In my residency, they never took the training wheels off and I did just fine thank you very much.

Perhaps you should live the experience first, before criticizing the the ones that take their time to try to teach you. Talk to me after you've been doing this ten years and perhaps your tune will change.
 
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well stated many times over dtrack22.

you my friend understand the plight of the resident which is easy to understand when you are the student or resident.


PADPM and Kidsfeet: It is very nice of you to volunteer your time and patients to residency training, however it is really a farce if you never at any point take the training wheels off and let the resident go. If you have worked with a resident for 3 years and have done even close to 100 of any type of procedure with them and do not have confidence in them even if they are all thumbs maybe there IS something wrong with your teaching style that they still cannot perform said procedure.

FYI, I do currently have my own patients that I see initially, decide they need surgery, explain the procedure, risks, benefits and alternatives. Have them sign informed consent - me, not my staff - wow just like you 2.

I do not currently have residents so I do not have to share my patients with them. I do think about this often, how I will teach residents, how I will make sure they feel prepared to run their own OR, how will I do this and make sure the patient is not harmed. Oh, wait... that's right... we all took an oath as students to "do no harm" do you think the residents you are working with did not take that seriously? If that is the case, maybe there is a bigger problem that needs to be addressed. What is to say that you would not accidently harm the patient either? Are you not human like your resident?

Luckily part of my residency program has us rotate in a location where we get to experience running the OR. The attending understands the need to train residents and balances this with protecting the patient. We are 3rd year residents during this rotation and said attending trusts the training process. The knife and patient in not handed day one, it is a process and handled differently for each resident, this is called tailoring your teaching to match the resident. It is a sign of a good educator.

Teaching residents is not just about showing up with patients and surgical cases and watching you "perform".

In the words of one of my favorite attendings in residency and not a podiatrist... "Surgery is not a spectator sport". He did not hand me the knife day 1 that I worked with him, it was certainly earned by retracting, anticipating his next step while assisting, writing orders, taking call for his in-house patients. But by my 3rd year when we rotated in his office he would ask what our treatment plan was after evaluating the patient and would often trust our decision on how to treat the patient. Most of these patients had elective procedures and had many years left to enact a lawsuit if desired.

Many times an attending asks how you want to do something, a surgical procedure, your treatment plan... and you come up with a reasonable plan, but it is not the exact way the attending would do it, so the resident becomes wrong. If there is no discussion explaining that the resident's way may have been OK, just not how the attending likes it, the next time that attending asks the same of the resident, the resident does not think for themself how they would do it, they try to guess how that attending would do it. I hardly see this as an ideal way to learn to be a thinking doctor or surgeon. If you want to make a good technician this works great.

Just because you have been a residency director and actively train residents does not mean that you do it right or are the authority on how to do it. You can do something for 50 years the sameway, but if it was wrong the 1st year it will still be wrong in year 50. If you are complacent in your teaching process then you are not improving or advancing, how can you expect the resident to advance when his teacher will not?
Once again, MANY residents enter the fray expecting EVERYTHING day one. Its amazing that no one seems to understand this. And once again, this is the attendings' private patients. You don't like that they think you are "wrong" and you want to do it your way. No problem! When are you going into private practice?

I'm not a residency director, just a lowly attending. You're right maybe I do need to change my ways since residents don't like to work with me as I actually try to TEACH them something, and they seem to prefer those attendings that just hand them the knife and go sit and chat with the nursing staff while these residents butcher the attendings' private patients. Interesting how everyone talks about LEARNING, but don't seem to want to go through the motions.

And I'll tell you what I told dtrack. When you've been doing it ten years and have the experiences I've had, then we'll talk again.

Our students keeps worrying about the shortage of residencies not realizing what a thankless job running a residency really is. Many just plain burn out. Have you ever asked yourself why that is?
 
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But you signed up to let residents ding up your patients. You can't tell me that you don't have residents break pins, strip screws, make the wrong cut etc. None of which may be serious complications but they are "dings" none the less. Every time you bring in a patient, you run the risk of a resident screwing things up. That's where the whole trust/quality of training thing comes in.

Sure you can explain to the resident how they screwed up and what you're doing to fix it, just like my anatomy instructor can explain how to disect out the internal thoracic artery. At some point though you have to stop, think about what you are trying to accomplish, and come up with a solution on your own BEFORE your attending jumps in to save the day. By reading your posts you don't strike me as the person who is going to let the resident explain what they would do to fix the problem. Heaven forbid they have a chance to fix it themselves before you jump in.
Its been my experience that VERY few can fix their own errors as once they get into a mess they get so flustered THEY hand ME back the knife. For the ones with skill, I hand the knife back. All of you assume that we all start with a same blank page with surgical training. That is far from the truth. You forget about something called TALENT, and we can spot that a mile away. Someone with ALL THUMBS may NEVER be able to do good surgery, regardless of their training.

Honestly, you need to be an attending for a few years and actually see what goes on from a private practitioners viewpoint.

I do it because I love to teach, and the residents that have spent time (by choice) with me tell me they appreciate how I do things. They don't have to tell me anything, but make it a point to tell me before they leave the program. The ones that don't want to LEARN complain about every one, so I don't worry about it.
 

Podfather

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My two cents is as follows: Yes I believe it is important for residents to be allowed to slowly progress to a confident, independent practitioner. However, the patients have rights too. If a private patient goes to see a doctor they are expecting them to render any care they receive. My private patients know that I supervise (key word) my residents and they help me within the OR. My "turning over the knife" is dependent on the complexity of the surgery, the skill of the resident, and how well they are prepared. I scrub all cases for a number reasons: Patient safety, education (it would be hard to teach if I was not close enough or able to demonstrate something), liability issues, and hospital requirements/rules. Yes, even when scrubbed in and with close attention I have had numerous resident errors made that I had to personally or through channeling correct. However some mistakes are difficult to fix or perhaps the outcome is suboptimal. Do attendings have complications? Yes, but I can say with certainity less often than a novice surgeon. MDCO made through the STJ, a lacerated PT artery, numerous poor osteotomies/fixation, skin, tendon lacerations, fracturing of a bone, even a bovie burn, and self-inflicted injury to the resident or worse to me! When the end result is suboptimal the PR for the attending can be horrible and in one case killed a long term referral source. Residents sometimes forget this. Let's not forget the increased tourniquet time and attending time away from patients when a novice is at the helm (and yes even on the last day of 3 years you are still a novice). Look up the 10,000 hour rule.

Now having said that, if you are teaching you have a passion. You understand the risk and must teach. Teaching is not always turning over the knife but showing how and why you do something and questioning the resident on their thought process. I let residents treat within the ED and on the floors without me there BUT after they call me and tell what and why they want to do something. County clinics or indigent clinics where the patient is assessed,treated, and often followed by a resident is another situation where supervision is looser. When you compare other specialties to us remember many cases done in a teaching hospital are clinic not private practice patients. Not that these patients are less valuable but often resident care is the only thing out there.
 

PADPM

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Podfather,

Perfectly stated. I believe that the two of us are certainly in agreement that no matter how much confidence we have in a resident or how much we decide to let a resident perform on a particular patient, we will still be "scrubbed" on that case.

And once again, that was really my entire point. It had little to do with any doctor or residency director's personal teaching methods or relationship with his/her residents. That will always differ from doctor to doctor. I was simply commenting on the fact that I believe an attending should ALWAYS scrub on every case despite the competency of the resident or the involvement of the resident.
 
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I think I'm going to let PADPM and Podfather speak for me from now on as they are much more eloquent than I am. They seem to incite less student/resident fury than I do too.

I should really just learn and keep my mouth shut lol.
 

Foot Doc

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The only person I trust without reservation in the OR with my private patients is me.
well that's a problem with your program/role in teaching. The residency I work with is the one I graduated from in July and the residents are MORE than competent to do anything in the foot and ankle by the end of their training.

As I said, depending on the case and the resident, I may not scrub.

Last week one of my cases was a toe amp...I did not even scrub because I had a good 3rd year resident covering me.

Today one of my cases was an open Achilles repair....I scrubbed it but let the resident do the entire case while myself and the student assisted.

I do not mind letting them do the entire case if they are competent and well versed in the operative plan.
 

Foot Doc

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Interesting analogy. Let me take it apart a bit.

When you're learning to ride a bike, how many cuts and scrapes and dings on your bike did you get? Sorry, but I bet your parents had you learn and ding up YOUR bike, not their $1300 racing bike that Dad uses to train for his Ironman Triathlon.

That patient on that table is MY $1300 racing bike. So I'll run beside you the whole time whether you like it or not. Ding up your own patients on your own if you like, OR when you start teaching residents let them ding up your patients.

You mention that my residents probably don't learn very much about how to get out a jam. That really depends on their attitude. When they get into a jam and I take the knife and salvage their error, if they pout in the corner, you're darn right they don't learn a thing. If they stick around and let me explain to them the mistake they made and how I'm going to avert a disaster they caused, they learn A LOT.

This is not a duel of egos here. I'm trying to teach whether they like my methods or not. You only learn as much as you let yourself learn.
but after you have shown him that you can ride a bike dad should let you take out his $1300 bike
 

PADPM

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well that's a problem with your program/role in teaching. The residency I work with is the one I graduated from in July and the residents are MORE than competent to do anything in the foot and ankle by the end of their training.

As I said, depending on the case and the resident, I may not scrub.

Last week one of my cases was a toe amp...I did not even scrub because I had a good 3rd year resident covering me.

Today one of my cases was an open Achilles repair....I scrubbed it but let the resident do the entire case while myself and the student assisted.

I do not mind letting them do the entire case if they are competent and well versed in the operative plan.

As I have already stated (too many times!), I also often let a resident go skin to skin, but always scrub in on the case.

My question to you is that on the cases where you decide NOT to scrub and let your resident perform the case, how is the operative report dictated?

You certainly can't be listed as the surgeon of record if you weren't scrubbed, nor can you be listed as an assistant. Both of those scenarios would be fraudulent. So for your own sake, I would check with the hospital by-laws (yes, even if it's a teaching hospital and other doctors are doing the same thing, doesn't mean it's following the by-laws), and I would check with an attorney. You can possibly be setting yourself up for a future disaster.

I don't know if the rules/laws differ if your hospital has a "clinic" and patients know the resident is in charge, etc., but when performing cases on your "private" patients I would urge you to look into the matter as I've outlined.
 

Podfather

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well that's a problem with your program/role in teaching. The residency I work with is the one I graduated from in July and the residents are MORE than competent to do anything in the foot and ankle by the end of their training.

I would hope so or the program is not doing their job. Competence and confidence are important. And I agree once you graduate your training should dictate your privileges. Scrubbing or not scrubbing is a moot point in regards to trusting your resident and has more to do with patient's rights and safety IMO. If you have trained the resident, their skills are where they should be, they have prepared for the case then yes you let them fly. I often say (while scrubbed in) it's six months from now and I am not here what do you do next? and it's your case doctor.

As I said, depending on the case and the resident, I may not scrub.

If these are private patients and they have not been informed that you are not scrubbing in good luck in court. The op record will show just that. I have been an expert for the defense for many years and the ghost surgeon/uninformed patient (as to who was doing the case) has cost a few a settlement or two. Be careful! My hospital forbids this so I do not even have to make the decision. I am permitted to leave while they close and dress the foot and sometimes will.

Last week one of my cases was a toe amp...I did not even scrub because I had a good 3rd year resident covering me.\

Good or bad has nothing to do with it.

Today one of my cases was an open Achilles repair....I scrubbed it but let the resident do the entire case while myself and the student assisted.

Anyone who teaches residents does this on a regular basis.

I do not mind letting them do the entire case if they are competent and well versed in the operative plan.
Of course. BTW when you get your 10,000 hours in I'll bet you will be awesome!
 

Podfather

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well that's a problem with your program/role in teaching. The residency I work with is the one I graduated from in July and the residents are MORE than competent to do anything in the foot and ankle by the end of their training.

As I said, depending on the case and the resident, I may not scrub.

Last week one of my cases was a toe amp...I did not even scrub because I had a good 3rd year resident covering me.

Today one of my cases was an open Achilles repair....I scrubbed it but let the resident do the entire case while myself and the student assisted.

I do not mind letting them do the entire case if they are competent and well versed in the operative plan.

Also another warning is the billing of those procedures. Some insurers will have issues if you billed a procedure and were not scrubbed and others will re-imburse less if a resident performs the service and you are not scrubbed in. My advice is at least scrub in and if your hospital permits it break scrub whenever you want to.
 

MarquetteGuy

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Also another warning is the billing of those procedures. Some insurers will have issues if you billed a procedure and were not scrubbed and others will re-imburse less if a resident performs the service and you are not scrubbed in. My advice is at least scrub in and if your hospital permits it break scrub whenever you want to.
Just my two cents, and not that I'm agreeing one way or the other, but this is not uncommon practice within the orthopedic residency arena. Most ortho residencies will have an attending running multiple ORs at the same time. Their residents are performing the cases and the attending circulates around through all of their ORs and will quick scrub in to a case, if needed, for a few minutes, and will then break scrub and continue to circulate through the rest of his/her cases that are simultaneously going on. I have seen this numerous times. As for billing/liability in this situation, I have not a clue how that works. I'm just sharing what I've witnessed firsthand. As a side note, the podiatry residents would also function under this same teaching style while they were either on the ortho service, or if they simply would routinely cover all of the foot/ankle ortho cases. Again, just my two cents from an impartial observer.
 
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Also another warning is the billing of those procedures. Some insurers will have issues if you billed a procedure and were not scrubbed and others will re-imburse less if a resident performs the service and you are not scrubbed in. My advice is at least scrub in and if your hospital permits it break scrub whenever you want to.
Billing wise, if you are not scrubbed in, you can't be listed as the surgeon on record for the case. If you're not the surgeon on record, you can not bill for the procedure and have just done a free case.

If this case should ever go to court, not only will you lose on the basis of you not being "there" for the case, but rest assured that the insurance company will get involved and could ding you for fraudulent billing, which will spark an audit. If you fail the audit for ANY reason, this can become public record and other insurance carriers may find out. What do you think will happen next?
 
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Just my two cents, and not that I'm agreeing one way or the other, but this is not uncommon practice within the orthopedic residency arena. Most ortho residencies will have an attending running multiple ORs at the same time. Their residents are performing the cases and the attending circulates around through all of their ORs and will quick scrub in to a case, if needed, for a few minutes, and will then break scrub and continue to circulate through the rest of his/her cases that are simultaneously going on. I have seen this numerous times. As for billing/liability in this situation, I have not a clue how that works. I'm just sharing what I've witnessed firsthand. As a side note, the podiatry residents would also function under this same teaching style while they were either on the ortho service, or if they simply would routinely cover all of the foot/ankle ortho cases. Again, just my two cents from an impartial observer.
You are correct that this is how its done for other surgical residencies. What you are not seeing is where those cases come from and who the patients are.

I am in a BIG teaching institution connected to a medical school and I PROMISE, when a Vascular, General or Ortho Surgeon is taking care of their private patients, they don't let residents OR fellows anywhere near these people. I was a resident at this institution, so I have first hand experience with this. Clinic and indigent patients are a whole different story.