New York Hospital of Queens - Podiatry

[347932]

but after you have shown him that you can ride a bike dad should let you take out his $1300 bike

I see. Let me put a different spin on it.

You have a fancy Porsche in your garage that you've spent years dreaming about and working hard to be able to afford.

Sure your sixteen year old can drive well, and even though they have a POS Honda in the garage waiting for them to get their license, the day they get their license, they couldn't care less about the Honda. They want to get a crack at the Porsche!!! What now?

I'm sorry, but the day my kid learns to ride their bike without training wheels, they should be very happy to tool around the neighborhood with their little bike. Simply for the excitement of not needed training wheels anymore. If they are not, that is indicative of a whole different set of issues.

As I've said, in my residency they never gave me that freedom of no training wheels because all of the cases were their private patients. I understood this and really respected the fact that they let me do anything on these people that were in the OR trusting THEM.

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[MarquetteGuy]

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.

I agree to a point. I am also in a large teaching institution, and rotated through many others. Again, from firsthand experience, I know some of these attendings were bringing their own patients for residents to work on. I saw some of these patients in the attending's own private clinic and then saw them on the OR table. Obviously, this will differ from institution to institution. Also, when a particular attending is doing 5+ cases per day, they are not all going to be for free. The hospital cannot afford it, and the ortho companies cannot afford to give away free hardware/implants all day, every day. Understandably, the hospital is making money off the residency program, but still. The other problem with this argument is that it doesn't matter if you're working on the CEO of the hospital or the homeless person down the street, you are still liable nonetheless. Just because it might be an indigent patient, that doesn't make you any less liable. You still take on the same risk, for most likely, little or no pay.

 

[347932]

I agree to a point. I am also in a large teaching institution, and rotated through many others. Again, from firsthand experience, I know some of these attendings were bringing their own patients for residents to work on. I saw some of these patients in the attending's own private clinic and then saw them on the OR table. Obviously, this will differ from institution to institution. Also, when a particular attending is doing 5+ cases per day, they are not all going to be for free. The hospital cannot afford it, and the ortho companies cannot afford to give away free hardware/implants all day, every day. Understandably, the hospital is making money off the residency program, but still. The other problem with this argument is that it doesn't matter if you're working on the CEO of the hospital or the homeless person down the street, you are still liable nonetheless. Just because it might be an indigent patient, that doesn't make you any less liable. You still take on the same risk, for most likely, little or no pay.

Yes, these docs do bring their private patients, BUT they do indeed scrub these cases and at least where I am, the directors of their respective programs do the actual surgery on these patients themselves.

Your liability is actually NOT the same when doing surgery on a CEO of company with insurance vs the homeless patient from the indigent clinic. If you are not getting paid for doing the surgery as the patient has no inurance and can't afford to pay you, you actually have ZERO liablility (assuming you are practicing within your scope of practice). This is of huge concern where I am since a few of us volunteer our time at the indigent resident clinic and end up doing some free emergency cases with high risk patients. All of our attorneys have assured us that these patients can't end up trying to litigate for the sole reason that we are doing this as volunteers and are not compensated for our time.

Of course, the hope is that you treat ALL patients equally, regardless of their ability to pay, but liability wise, you are protected when treating patients with no insurance, who don't pay. This even extends to private practice, if you do the odd pro bono case here and there. At least around here you are.

 

[Podfather]

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.

Yes but your key words were they scrubbed in quick or otherwise. Also trauma admitted through the ER or a clinic where the resident started and continued care is perceived (by patients anyway) differently than say a private patient worked up by a doc, consulted by the same doc, and then they find out the doc who they thought was doing the procedure never even scrubbed. Lets say you are the patient and you want to see a neurosurgeon for a spinal fusion who has an excellent reputation. You see him/her, they consult with you, and in fact you even ask how many of these they have done. Now postop you have a complication or intraoperatively there is a mishap. You then find out a senior resident did the case and the attending didn't even scrub in. How would you feel?

 

[347932]

Yes but your key words were they scrubbed in quick or otherwise. Also trauma admitted through the ER or a clinic where the resident started and continued care is perceived (by patients anyway) differently than say a private patient worked up by a doc, consulted by the same doc, and then they find out the doc who they thought was doing the procedure never even scrubbed. Lets say you are the patient and you want to see a neurosurgeon for a spinal fusion who has an excellent reputation. You see him/her, they consult with you, and in fact you even ask how many of these they have done. Now postop you have a complication or intraoperatively there is a mishap. You then find out a senior resident did the case and the attending didn't even scrub in. How would you feel?

I would feel like suing for malpractice. And guess what? I would win hands down, because there would be a quick, big settlement to avoid the matter going public in front of a jury and the community I live in.

 

[dtrack22]

Sure your sixteen year old can drive well, and even though they have a POS Honda in the garage waiting for them to get their license, the day they get their license, they couldn't care less about the Honda. They want to get a crack at the Porsche!!! What now?

No, it would be like your 18/19 year old kid who has been driving for 3 years wanting to take out the Porsche for prom or a nice date. You are a d*** if you don't let your kid drive your car for one night, given that you trust and have confidence in him to take care of your car. If you don't want to let your kid drive the car at any point in his/her life, don't have kids, or don't buy the car.

Regarding this thread in general, from a student's perspective I don't think the decision of the attending to scrub or not to scrub is an issue. It's more about the attending getting to a point where he/she will let you (the resident) do the procedure without interrupting. From reading these posts I get the feeling that PAPDM, Podfather, and Foot Doc have the ability to scrub, assist, and make it feel like they aren't even there. I feel like the resident would have the opportunity to work through the case as if it was their own and if something did go wrong, the resident would at least have the opportunity to tell the attending what he/she would do to fix it and possibly be given the opportunity to fix the problem assuming they have a good "gameplan".

I don't get this feeling at all from Kidsfeet's posts. Reading those posts makes me think of a hovering attending who is quick to point out everything that you are doing right or wrong. That's great for 1st and 2nd year residents and probably many 3rd years, but this discussion STARTED regarding competent and 3rd year residents nearing the end of their training. That sentiment may not be accurate (regarding Kidsfeet) but that's the way those posts come off. And I'm sure I'm not the only one who would read through this thread and feel that way.

 

[347932]

No, it would be like your 18/19 year old kid who has been driving for 3 years wanting to take out the Porsche for prom or a nice date. You are a d*** if you don't let your kid drive your car for one night, given that you trust and have confidence in him to take care of your car. If you don't want to let your kid drive the car at any point in his/her life, don't have kids, or don't buy the car.

Regarding this thread in general, from a student's perspective I don't think the decision of the attending to scrub or not to scrub is an issue. It's more about the attending getting to a point where he/she will let you (the resident) do the procedure without interrupting. From reading these posts I get the feeling that PAPDM, Podfather, and Foot Doc have the ability to scrub, assist, and make it feel like they aren't even there. I feel like the resident would have the opportunity to work through the case as if it was their own and if something did go wrong, the resident would at least have the opportunity to tell the attending what he/she would do to fix it and possibly be given the opportunity to fix the problem assuming they have a good "gameplan".

I don't get this feeling at all from Kidsfeet's posts. Reading those posts makes me think of a hovering attending who is quick to point out everything that you are doing right or wrong. That's great for 1st and 2nd year residents and probably many 3rd years, but this discussion STARTED regarding competent and 3rd year residents nearing the end of their training. That sentiment may not be accurate (regarding Kidsfeet) but that's the way those posts come off. And I'm sure I'm not the only one who would read through this thread and feel that way.

Hmmm well, if you look at the statistics, most teens who are killed in car wrecks are 18-19. So, hell no, they're not driving the Porsche. Call me whatever you want brother. When you're a parent and have that Porsche we'll talk.

As far as how I come off. This is in writing and a very poor way to get the feel for how someone is in person. I'm generally very calm, keep to myself, and even though in the OR I tend to be quite quiet, there tends to be a lot going on in my head during my cases and in my office when I'm seeing my patients. My staff will tell you how quiet I am in general and how I don't raise my voice to anyone, except my business partner lol. Whether others feel as you do about the way I "come off" doesn't really mean a thing, as I can only say what I feel and have little control over how you or anyone reading this perceives it. As I've said, I find Podfather and PADPM much more eloquently spoken than I am on these forums. Does that mean what I say doesn't have merit, or simply that they have a better way of expressing themselves here on these forums?

I'm interested at your perception of how I deal with residents, as I would never "hover" over them and quickly point out their errors in a way that would compromise their authority in the OR. Resident or not, they are still surgeons and the balance of power in an OR can be quite delicate. I am acutely aware of this and my residents can vouch for that. Not only do I not "hover", but I'm concentrated not only on what they are doing on my patient, but also on how to to best assist them by getting them the instrumentation they need before they even realize they need it and make sure I am retracting effectively, so they can work more smoothly. This is what a useful surgical assistant does.

What I think you and many residents and students don't realize is that once you do that case, you're gone. Once you finish your residency, you're gone. The attendings are the ones who have to deal with the patients you've worked on long term. As has been pointed out, sometimes YOUR mistakes cost US patients and referral sources. Don't worry (as I don't), one day you will be in our shoes and be faced with these situations. Maybe then you'll have your "A-HA" moment and maybe realize that what we're saying collectively has merit. Maybe not, and I'm just a tool, spouting irrelevant rhetoric. Only time will tell.

 

[Podmeister]

From what I've read...Kidsfeet definitely deserve a refund.

 

[347932]

From what I've read...Kidsfeet definitely deserve a refund.

LOL, I think I love you in a platonic, bromance kind of way (unless of course you're female LOL).

 

[dtrack22]

Hmmm well, if you look at the statistics, most teens who are killed in car wrecks are 18-19. So, hell no, they're not driving the Porsche.

Really? The highest percentage of motor accidents and fatalities is in the 45-54 year old age group. I know you aren't very "eloquent", but by your own reasoning in 10 years or so you shouldn't be allowed to drive your own Porsche. Although I'm sure your next post will have some new spin on the point being made.

 

[347932]

Really? The highest percentage of motor accidents and fatalities is in the 45-54 year old age group. I know you aren't very "eloquent", but by your own reasoning in 10 years or so you shouldn't be allowed to drive your own Porsche. Although I'm sure your next post will have some new spin on the point being made.

LOL Dang it!! I better cash in my kids' college funds and get me my Porsche!!! Although, if I'm shooting for that, I may as well get something a little more exotic. Like a Nissan Leaf!!!

My whole post and all you have is to argue about traffic fatalities!! Jeez, have some imagination!! PLEASE! And still...NO you can't drive the darn Leaf!! You just can't!!

Let's stop beating a dead horse. I said what I have to say on the matter. No more trolling (for this topic at least) for me. Oh and just FYI, please learn to read. I said most TEENS who are killed in these accidents. C'mon man, stop giving me all this material to use against you. Cheers =)!

 

[dtrack22]

No more trolling (for this topic at least) for me

Finally. you dragged this on like every one of your posts about how terrible ALL associate positions are and how everyone should be in private practice because being your own boss is blah, blah, blah. You should go defend yourself on the Budget thread, you are getting hammered.

Oh and just FYI, please learn to read. I said most TEENS who are killed in these accidents. C'mon man, stop giving me all this material to use against you.

More spin. And you still don't know what you are talking about. Of course more 18-19 year olds are killed, more of them drive than 16 year olds. When you actually look at the percentages of accidents and fatalities to drivers, the numbers are pretty much identical. Which is why I brought up adults. Since the only accurate way to measure the nonsense in your post is fatalities as a percentage of total drivers, I simply brought up that middle aged individuals are even more likely to die than teens, you changed your original argument, I figured I could change mine. Of course you never actually looked for any statistics. You just made a claim without any evidence, much like most of your posts on these threads.

Your original analogy of the 16 year old made zero sense, and then you changed your argument (more 18 year olds die) to defend yourself, and now you twist words/statistics to attack me? I thought you were supposed to be an educator...

 

[PADPM]

I think some of this thread has gone way off topic, and some of the analogies have been taken a little too literally. So I'm simply going to hopefully provide a little "advice" based on my years of experience.

FootDoc,

Podfather and I have been around for quite a while and have both been intimately involved with the training of residents and have been very actively politically within the various organizations in our profession such as the ABPS, ACFAS, etc. As a result, we've "been there, done that" and although I can't completely speak for Podfather, I've made more than my share of mistakes along the way, and attempt to pass those along to the residents I encounter to hopefully assure they won't repeat my errors.

I've also witnessed just about every type of personality imaginable in residents, students and attendings.

Please take what I say as simple advice and not as criticism. Read what I write and then simply decide whether you believe my comments or valid, and you can choose to utilize or discard my "advice".

I am more than confident that you are very bright and very well trained. Now you are extremely proud to be an "attending" and even prouder to have the ability and prestige to be an "attending" at the same facility where you trained.

During your training you may have witnessed attendings book cases and not scrub in, since the resident was more than competent enough to perform the case(s). And now that you are an attending, it's definitely an ego boost to be in that same situation.

PLEASE, PLEASE re-think that entire concept. Have all the confidence in any resident you want, and use your own judgement on how much or little you will allow a resident to perform in a given surgical case. But do NOT make the mistake of "watching from the sidelines" and not scrubbing in on the case. There is no right time, but especially this early in your career.

As a new attending, you should want to have your hands in every case. You can give me every excuse or reason in the world, but there is absolutely NO rational reason why you can justify not scrubbing in on a case. NONE And if this case ever lands in a courtroom, you might as well just hand over a check.

I stated it in my prior post and Podfather stated it in his post. I've been an expert witness more than once in this type of case, and it gets UGLY. The doctor does not come off looking very good when he/she is on the stand and the attorney is quizzing you why you didn't scrub. The jury will be wondering why this young, "rich" (they always think you're rich) doctor was too "lazy" to scrub on the case. No matter WHAT you say, the attorney will tear you apart and the jury will just keep thinking that the "poor" patient trusted YOU and you didn't even have the decency to put on a pair of gloves, etc.,etc.

So please don't worry about what the other doctors did, or what other departments do, worry about yourself and start setting new standards for future residents. Allow your residents to go skin to skin if that's what you desire, but be there all scrubbed in next to them, even if it's just for the show. And in the remote chance a resident may actually need your expertise, it's nice to know you're ready and able.

Just a little "fatherly" advice.

 

[347932]

dtrack,

That whole post was a tongue in cheek attempt to lighten the whole dispute.

Yes, I'm an a-hole. There was no malicious intent at all.

Please lighten up a tad. You have been openly criticizing me this whole thread.

I am an educator. I've been training residents for years and they all appreciated the efforts I make to educate them. I am a nationally recognized lecturer who gets invited back to lecture at conference, not because I'm a tool, but because the organizers feel I have something positive to contribute. I work with the APMA and other affiliate organizations to help with advancing our profession. I also participate on thesd forums to try and pass on some of my experiences and knowledge.

I have no issues dealing with your criticisms at all. It does seem that you have a lot to say, which is a good thing, even if I disagree with it. That's what open, honest dialogue is about. We are all equal on these forums save for one instance. And that is experience. I have some, but still have a lot to learn. You have less, but also have a lot to learn.

 

[krabmas]

dtrack,

That whole post was a tongue in cheek attempt to lighten the whole dispute.

Yes, I'm an a-hole. There was no malicious intent at all.

Please lighten up a tad. You have been openly criticizing me this whole thread.

I am an educator. I've been training residents for years and they all appreciated the efforts I make to educate them. I am a nationally recognized lecturer who gets invited back to lecture at conference, not because I'm a tool, but because the organizers feel I have something positive to contribute. I work with the APMA and other affiliate organizations to help with advancing our profession. I also participate on thesd forums to try and pass on some of my experiences and knowledge.

I have no issues dealing with your criticisms at all. It does seem that you have a lot to say, which is a good thing, even if I disagree with it. That's what open, honest dialogue is about. We are all equal on these forums save for one instance. And that is experience. I have some, but still have a lot to learn. You have less, but also have a lot to learn.

telling us how important you are and listing all your leadership roles and telling us how other people appreciate you does not get you real far on these forums.

Look back at podfather and PADPM's posts. they did this very often. No one cares.

You could be the president of ACFAS and APMA at the same time and the director of the #1 residency program in the country... if you give advice that the readers of this forum don't like and sound like a tool it doesn't matter what your credentials are.

 

[PADPM]

Look back at podfather and PADPM's posts. they did this very often. No one cares.

I'm not going to comment on Kidsfeet's posts, that's up to him.

However, I will comment on your quote above. First of all, it's nice to know that you speak for all members of this forum when you state "NO ONE cares".

I'm confident that it's true that many don't care, but I often receive a significant amount of PM's that will prove you wrong that "NO ONE cares".

But I'm afraid that you and others may simply miss the point. Podfather and I don't come on here to toot our own horn, though unfortunately on the surface that's the way it appears.

If you simply sit back and look a little deeper, you'll understand that we have nothing to gain. You don't know who we are, so tooting our own horn does not feed our egos. However, the reason we (I apologize for speaking for Podfather) discuss our past or present leadership roles is simply to speak of our experience(s).

This is a forum where I believe my past experience(s) can benefit those who have not "been there, done that" yet. By listing my past or present affiliations, it simply lets others know that I'm not speaking hypothethicaly, but speaking from real experience. I believe that adds credibility.

But the beauty of this forum is you can simply read those comments and decide to ignore the advice/comments or incorporate those ideas into your future. No harm done.

Or you can criticize and tell us that "no one cares". Well, I would respectfully disagree that "no one cares". Because some believe that experience counts.

I understand that you've just finished an excellent training program at Innova and that you're fortunate enough to be involved with an excellent fellowship training program at the present time, but you're still a little too early in your career to have formed STRONG opinions. I'd recommend that you maintain an open mind and let experience dictate your path and realize that experience may end up being your most valuable teacher.

 

[347932]

telling us how important you are and listing all your leadership roles and telling us how other people appreciate you does not get you real far on these forums.

Look back at podfather and PADPM's posts. they did this very often. No one cares.

You could be the president of ACFAS and APMA at the same time and the director of the #1 residency program in the country... if you give advice that the readers of this forum don't like and sound like a tool it doesn't matter what your credentials are.

Firstly, I was responding to dtrack's making a comment directed to my role as an educator.

LOL trust me, I don't need to toot anything to anyone. I'm comfortable with who I am and what I do for the people I work with. What those of you that don't care need to realize is that some of us do work within our profession that directly impacts YOU.

There is a huge difference between not liking what someone has to say and not realize that even if you don't like it, it may just be the reality that YOU will face very soon. Sometimes its intriguing that intelligent people have reality explained to them multiple times, refuse to believe it and then wonder what goes wrong for them when it slaps them in the face or burns them really hard. Meh, whatever, I guess I'm just one of the older guys now with tons more expereince but very little to offer.

I'll be very interested to see how your, Krabmas, perception will be in five years. Same with dtrack. Once dtrack gets out of school and residency and starts in practice, I wonder how likely he/she will be to look back and realize that MAYBE what I and other docs in practice have to say may just be the case. Maybe you all will realize that that "No one cares" attitude won't get you very far once you are a working colleagues, because really, in a profession as small as ours, you SHOULD care and not blast the people who try to help you.

 

[Foot Doc]

I think some of this thread has gone way off topic, and some of the analogies have been taken a little too literally. So I'm simply going to hopefully provide a little "advice" based on my years of experience.

FootDoc,

Podfather and I have been around for quite a while and have both been intimately involved with the training of residents and have been very actively politically within the various organizations in our profession such as the ABPS, ACFAS, etc. As a result, we've "been there, done that" and although I can't completely speak for Podfather, I've made more than my share of mistakes along the way, and attempt to pass those along to the residents I encounter to hopefully assure they won't repeat my errors.

I've also witnessed just about every type of personality imaginable in residents, students and attendings.

Please take what I say as simple advice and not as criticism. Read what I write and then simply decide whether you believe my comments or valid, and you can choose to utilize or discard my "advice".

I am more than confident that you are very bright and very well trained. Now you are extremely proud to be an "attending" and even prouder to have the ability and prestige to be an "attending" at the same facility where you trained.

During your training you may have witnessed attendings book cases and not scrub in, since the resident was more than competent enough to perform the case(s). And now that you are an attending, it's definitely an ego boost to be in that same situation.

PLEASE, PLEASE re-think that entire concept. Have all the confidence in any resident you want, and use your own judgement on how much or little you will allow a resident to perform in a given surgical case. But do NOT make the mistake of "watching from the sidelines" and not scrubbing in on the case. There is no right time, but especially this early in your career.

As a new attending, you should want to have your hands in every case. You can give me every excuse or reason in the world, but there is absolutely NO rational reason why you can justify not scrubbing in on a case. NONE And if this case ever lands in a courtroom, you might as well just hand over a check.

I stated it in my prior post and Podfather stated it in his post. I've been an expert witness more than once in this type of case, and it gets UGLY. The doctor does not come off looking very good when he/she is on the stand and the attorney is quizzing you why you didn't scrub. The jury will be wondering why this young, "rich" (they always think you're rich) doctor was too "lazy" to scrub on the case. No matter WHAT you say, the attorney will tear you apart and the jury will just keep thinking that the "poor" patient trusted YOU and you didn't even have the decency to put on a pair of gloves, etc.,etc.

So please don't worry about what the other doctors did, or what other departments do, worry about yourself and start setting new standards for future residents. Allow your residents to go skin to skin if that's what you desire, but be there all scrubbed in next to them, even if it's just for the show. And in the remote chance a resident may actually need your expertise, it's nice to know you're ready and able.

Just a little "fatherly" advice.

Thanks for the advice...I'll make sure I scrub every case from here on out.

I let my residents do A LOT in my cases because I trust them A LOT. If I was not sure the resident could handle the job then I would do it myself.

I didn't have a problem letting a 3rd year resident who has done 1200 + cases amputate a toe on her own, but I can see where it could become "sticky" medicolegally.

 

[PADPM]

Foot Doc

You've just proven me correct, that you're a bright young doc. I believe that your decision to follow my advice in this matter regarding scrubbing on all your cases will prove to be a wise decision now and in the future.

While scrubbed, it's always up to you how much to let a resident perform, but at least you're there and ready at all times.

Hopefully, you can now set a new standard at your hospital and the residents you train will consider this the "norm".

 

[347932]

As a new practitioner I would suggest actually DOING all your cases. Let residents do a bit, but you really need to get your hands in there and even though training wise you might be at the top of your game, its a whole different scenario when its your patient on the table.

The whole "Captain of the Ship" thing does take some getting used to, and also for your Boards, you really want to put your best foot forward for your cases and want to be sure you are submitting the best you've got. If you're relying on your residents for that, its just one more variable to contend with. Its not bad or wrong by any means, but as I said, just one more variable.

Medico legally I've seen young docs get burned with this as well. "So Doctor, do you have so little confidence in your skills that you let a resident work on all your patients for you?". Believe it or not, after you're Boarded, this has very little merit legally, but it can bite you beforehand.

This is NOT a criticism about residents or students doing cases. I know someone will try to spin it that way. This is also NOT a criticism on an attending's decision to let resident participate in their cases or an attending's skill level.

This is about protecting yourself as a new practitioner and helping you get to the next level.

 

[Foot Doc]

As a new practitioner I would suggest actually DOING all your cases. Let residents do a bit, but you really need to get your hands in there and even though training wise you might be at the top of your game, its a whole different scenario when its your patient on the table.

The whole "Captain of the Ship" thing does take some getting used to, and also for your Boards, you really want to put your best foot forward for your cases and want to be sure you are submitting the best you've got. If you're relying on your residents for that, its just one more variable to contend with. Its not bad or wrong by any means, but as I said, just one more variable.

Medico legally I've seen young docs get burned with this as well. "So Doctor, do you have so little confidence in your skills that you let a resident work on all your patients for you?". Believe it or not, after you're Boarded, this has very little merit legally, but it can bite you beforehand.

This is NOT a criticism about residents or students doing cases. I know someone will try to spin it that way. This is also NOT a criticism on an attending's decision to let resident participate in their cases or an attending's skill level.

This is about protecting yourself as a new practitioner and helping you get to the next level.

I am in the OR walking my residents through every step of the surgery. The only case I did not scrub out of the 55 or so I've done since July was the 1 toe amp I have had.

If the screw placement/osteotomy/fracture reduction is not up to my standards, I will do it myself.

The only residents I have let have near absolute freedom in the OR are the PGY-3's I have worked with and known for 3+ years since they were students.

 

[347932]

I am in the OR walking my residents through every step of the surgery. The only case I did not scrub out of the 55 or so I've done since July was the 1 toe amp I have had.

If the screw placement/osteotomy/fracture reduction is not up to my standards, I will do it myself.

The only residents I have let have near absolute freedom in the OR are the PGY-3's I have worked with and known for 3+ years since they were students.

Awesome. I think your residents should count themselves lucky to have a level headed, highly trained new attending around.

 

[PADPM]

As a new practitioner I would suggest actually DOING all your cases. Let residents do a bit, but you really need to get your hands in there and even though training wise you might be at the top of your game, its a whole different scenario when its your patient on the table.

The whole "Captain of the Ship" thing does take some getting used to, and also for your Boards, you really want to put your best foot forward for your cases and want to be sure you are submitting the best you've got. If you're relying on your residents for that, its just one more variable to contend with. Its not bad or wrong by any means, but as I said, just one more variable.

Medico legally I've seen young docs get burned with this as well. "So Doctor, do you have so little confidence in your skills that you let a resident work on all your patients for you?". Believe it or not, after you're Boarded, this has very little merit legally, but it can bite you beforehand.

This is NOT a criticism about residents or students doing cases. I know someone will try to spin it that way. This is also NOT a criticism on an attending's decision to let resident participate in their cases or an attending's skill level.

This is about protecting yourself as a new practitioner and helping you get to the next level.

Sorry Kidsfeet, I'm not sure I'm going to agree with you on this one and I think you're starting to beat a dead horse. My entire point and major concern was simply that an attending should ALWAYS scrub on a case. Period.

I'm confident that FootDoc is smart enough to use his own judgement and know when to hold and when to fold, and intervene, etc. We all have our own teaching styles, and if he feels comfortable letting residents perform a lot of the surgery, it's not our place to dictate what's right or wrong. If and when he sees the results are suboptimal, and not worthy of submitting for the boards, he will make his own decision.

Similarly, I'm not sold on the argument that medical-legally he will be hung out to dry if he ends up in court, when asked why he lets a resident perform X amount of the surgery. No where is it "recorded" how much time the knife is in the residents hand, and with the amount of surgery most of us do, it is reasonable to say "I don't recall exactly how much the resident performed, though I do let residents participate in the surgery, since it is a teaching hospital". So the jury is never goig to be faced with the situation where the doctor is looked upon as the guy who let the resident "do everything".

So, the bottom line is that FootDoc has his own preferences for teaching, and now understands the importance of scrubbing on all cases. How much he decides to actually perform HIMSELF during a case is simply a personal decision based on his philosophy, his goals and his confidence in the residents. That's something that is an individual choice, no different from me telling you to perform your blunt dissection with a finger and wet gauze vs. a Metzenbaum. That's your choice.

 

[347932]

Hi PADPM,

Thanks for the input.

I've had experiences that lead me to some of my conclusions. This is NOT a reflection of Foot Doc AT ALL, since I don't know him.

Let me give you an example. I've known new attendings to make mistakes that you would think they should have known better because they were confused about their new role. They let residents get ahead of themselves because of lack of confidence in themselves as a new attending. Not a lack of confidence in the OR, but they wanted to not only fit in with the residents, as their "friends" but also as the "nice guy" attending rather than focus on what they should have been. These people were very intelligent but just didn't know how to handle this new situation. It had nothing to do with their abilities or intelligence, but just a lack of experience in this situation. That's what makes me nervous when I hear that a new doc in practice lets residents do much of their cases. AGAIN, I don't know Foot Doc and this is not a reflection of his capacity in his new position.

Some of my classmates were in a situation with litigation and being questioned about their role as an attending and how much their residents are involved with their cases.

 

[Foot Doc]

Hi PADPM,

Thanks for the input.

I've had experiences that lead me to some of my conclusions. This is NOT a reflection of Foot Doc AT ALL, since I don't know him.

Let me give you an example. I've known new attendings to make mistakes that you would think they should have known better because they were confused about their new role. They let residents get ahead of themselves because of lack of confidence in themselves as a new attending. Not a lack of confidence in the OR, but they wanted to not only fit in with the residents, as their "friends" but also as the "nice guy" attending rather than focus on what they should have been. These people were very intelligent but just didn't know how to handle this new situation. It had nothing to do with their abilities or intelligence, but just a lack of experience in this situation. That's what makes me nervous when I hear that a new doc in practice lets residents do much of their cases. AGAIN, I don't know Foot Doc and this is not a reflection of his capacity in his new position.

Some of my classmates were in a situation with litigation and being questioned about their role as an attending and how much their residents are involved with their cases.

luckily I don't care about being the "nice guy"....I can be quite an *******...lol

 

[347932]

luckily I don't care about being the "nice guy"....I can be quite an *******...lol

LOL nice...