PRR

[Shadowfax12]

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Is there any reason to log all patient encounters in PRR? I go to a clinic heavy program and am curious what the benefit is of logging every patient. I have done around 1500 because I was told to log them all. Now it just seems mind numbing

 

[tacoboutit]

My program didn’t ask us to log every clinic patient unless it was for h&p, biomechanics, procedures, peds etc. i stopped logging those once I met my numbers

 

[CutsWithFury]

My program didn’t ask us to log every clinic patient unless it was for h&p, biomechanics, procedures, peds etc. i stopped logging those once I met my numbers

I made up all my biomechanics logs. Complete waste of time.

 

[DYK343]

Oh god I forgot about that.
Once we were at 3x our minimum requirements our director said we didnt have to log anymore clinic encounters.
Its going to be entirely what your director requires you do.

100% log all surgical encounters. That does matter for hospital privileging when you're done.

 

[DYK343]

I had an unexpected month pop up that alloted me an extra month externship. There were limited options. I went to a really horrible VA for that month because they wanted bodies to cut toenails (I didnt know that at the time).

All the residents (and students) did was cut nails all day with some wounds here and there but mostly toenails.

At the end of the day they were forced to sit there and document each and every one of them. They spent 1-2 hours a day logging nail debridements on PRR.

 

[Feli]

Yeah, those PRR categories are just the ABPM reqs for CPME... you can quit once you have 2x or 3x the numbers for biomech, H&P, etc. It needs to be fulfilled, but there's no point to crushing it. Everywhere is going to give you privileges for clinic, wounds, etc.

All I ever logged besides surgery was OR hardware removals as 'other clinical experiences.' The surgery logs from residency are very important for hospitals, privileges, etc (and besides, you'll have to be used to doing it after graduation for ABFAS on PLS).

 

[heybrother]

-Logged a handful of H&Ps on people I admitted from podiatry. Otherwise all H&Ps were logged on IM/ICU/ID. I logged enough that if someone struck down 1/2 I'd still pass. Ended up having to add an ID rotation 3rd year and PD asked me to add enough to "prove" I went. I only logged my first work-up. If was consulted on Monday and rounded daily I only counted the main evaluation.

-Logged more peds than I needed but I pretty rapidly got to the point where I was only logging surgery so it didn't bother me.

-Logged about 50 matrixectomies and stopped. Logged all flexor tenotomies in clinic. Otherwise logged basically nothing from clinic. Never logged ulcers. Never logged nails.

-Logged a little bit over the biomechanical count in case I somehow got audited or rejected. Maybe I hit 2x.

Logged 2nd assist surgery cases 1st year. Only logged 1st assist after. Probably should have just logged everything even if it was 2nd assist.

My program did not allow "split cases". If a case had multiple parts there was no dividing it up. I have spoken to people where 5 people would scrub a 1st MPJ, 4 toes, and a gastrocnemius recession and each of them would claim 1 procedure as 1st assist. We didn't do that. You got all or you got nothing (2nd assist).

The doucheroos at CPME will come out during your re-accredit and make ridiculous claims about how every line of your transcript matters and to put everything down because it will get you a job. That's manure. I occasionally scrub at an orthopedic hospital. Their credentialing I believe required them to go through my surgical logs line by line and count out ankles and calcs and tendon transfers. Nurses who didn't do residency get to debride ulcers at wound healing centers. No one is going to be impressed by this.

 

[dtrack22]

I logged my surgical cases, every H&P on medicine, EM, Gen Surg rotations, and then got to whatever the biomechanics number was and stopped.

Logging in residency doesn’t matter to the resident at all other than surgical logs since those are used for hospital privileges in your first job or two. I guess if your director is a dick they could actually not graduate you because you didn’t log enough, but the requirements are there for CPME to make sure the residency has the cases and clinic encounters to justify the program and number of residents. Meaning, if you were to log 10 biomechanical exams, there is nothing stopping your director from giving you a residency completion certificate, but during the next CPME audit of the program, the program itself could get in trouble for not forcing you to do whatever the minimum is.

Long story short, log the minimum of everything that isn’t a surgical case. Log all of your surgical cases. That’s it. Nothing else matters.

 

[PMG03470]

I made up all my biomechanics logs. Complete waste of time.

glad I'm not the only one!

 

[Shadowfax12]

It amazes me that a deattach reattach of the Achilles’ tendon is not consider a rearfoot number on PRR

 

[Pronation]

It amazes me that a deattach reattach of the Achilles’ tendon is not consider a rearfoot number on PRR

Who cares? The whole thing is a joke... oh, I guess the residents that barely meet rearfoot numbers care.

 

[DYK343]

It amazes me that a deattach reattach of the Achilles’ tendon is not consider a rearfoot number on PRR

Its because its such a common procedure they wanted it included in foot.

People without RRA could be barred from doing it in some systems.

At least thats how I understand it.

 

[podiatryresident]

Hello everyone. I’m PGY-1 in new program without any seniors. Could you please help me to log this case ? Achilles tendon rupture with Haglund’s deformity. procedures : removed the bump, FHL transfer with tenodesis screw. Attached Achilles to FHL. How should I log this appropriately? 2 procedures: tendon transfer and cal osteotomy ? Or tendon transfer , cal osteotomy and Achilles tendon repair?
I read the new guidelines but not sure about this. Thank you so much and happy holidays!

 

[Feli]

Hello everyone. I’m PGY-1 in new program without any seniors. Could you please help me to log this case ? Achilles tendon rupture with Haglund’s deformity. procedures : removed the bump, FHL transfer with tenodesis screw. Attached Achilles to FHL. How should I log this appropriately? 2 procedures: tendon transfer and cal osteotomy ? Or tendon transfer , cal osteotomy and Achilles tendon repair?
I read the new guidelines but not sure about this. Thank you so much and happy holidays!

It is de/reattach 4.19 as procedure 1 and tendon (FHL) transfer/lengthen 5.1.2 is proc 2... exostectomy doesn't count as it's part of de/re for PRR or PLS.

This is your PD's job to tell and teach you these things... they are given lengthy guidelines from ABFAS on how to log PRR properly and common questions/issues and log updates. This issue you ask is clearly addressed. You can also find a lot of this stuff on PRR and ABFAS and CPME websites. I'd read that PPT link in its entirety and learn the common exclusions (unbundling) but I would also start with PD; it is literally what they're paid for. A new program PD should be discussing PRR with you probably weekly and checking your log monthly and prn based on cases and log questions if they intend for it to be a reputable program and keep status.

That is a pretty interesting procedure selection... usually, if the watershed area is diseased, you debride, reinforce, maybe graft or FHL xfer. If it's insertional with Haglund, you remove exostosis and anchor it at insert. Doing both seems a bit suspect to weaken both... it's not that pathology at both watershed and at insertion can't coexist occasionally, but which site was the complaint/issue/partial rupture on MRI and clinically?

Hello everyone. I’m PGY-1 in new program without any seniors..

May the forceps be with you 🙁

Its because [Haglund] is such a common procedure they wanted it included in foot.

People without RRA could be barred from doing it in some systems.

At least thats how I understand it.

Yep... very technically easy procedure, common. You also have to remember some older attendings even do the lateral approach and just retract Achilles to rasp calc (not advised, but not totally uncommon). If de/re was a RRA cat 5, what would be next... plantar calc spur is RRA? That would be crazy for those to not be foot core privi at facilities. Lol.

 

[podiatryresident]

It is de/reattach 4.19 as procedure 1 and tendon (FHL) transfer/lengthen 5.1.2 is proc 2... exostectomy doesn't count as it's part of de/re for PRR or PLS.

This is your PD's job to tell and teach you these things... they are given lengthy guidelines from ABFAS on how to log PRR properly and common questions/issues and log updates. This issue you ask is clearly addressed. You can also find a lot of this stuff on PRR and ABFAS and CPME websites. I'd read that PPT link in its entirety and learn the common exclusions (unbundling) but I would also start with PD; it is literally what they're paid for. A new program PD should be discussing PRR with you probably weekly and checking your log monthly and prn based on cases and log questions if they intend for it to be a reputable program and keep status.

That is a pretty interesting procedure selection... usually, if the watershed area is diseased, you debride, reinforce, maybe graft or FHL xfer. If it's insertional with Haglund, you remove exostosis and anchor it at insert. Doing both seems a bit suspect to weaken both... it's not that pathology at both watershed and at insertion can't coexist occasionally, but which site was the complaint/issue/partial rupture on MRI and clinically?


May the forceps be with you 🙁

Thanks Dr.Feli so much, I should have read entire the ppt carefully before asking the question. My PD is a good podiatrist with very good surgical skills, he is a little bit old school, has advanced ankle privileges in NY but doesn't know the existence of prr @@.
About the case, pt is ~71 y.o with chronic Achilles rupture near insertional, doesn't have much distal portion tendon, big gap. I don't think doing lengthening and speedbridge is a good idea for pt. My PD said he could have done FHL tendon transfer alone is enough for the case. I think because of my present there so he did extra things for teaching purpose @@. I'm a new transfer resident, I like him and the hospital also.
Thanks everyone for my transfer too.

 

[LadyPod]

I had an unexpected month pop up that alloted me an extra month externship. There were limited options. I went to a really horrible VA for that month because they wanted bodies to cut toenails (I didnt know that at the time).

All the residents (and students) did was cut nails all day with some wounds here and there but mostly toenails.

At the end of the day they were forced to sit there and document each and every one of them. They spent 1-2 hours a day logging nail debridements on PRR.

I rotated at a VA during my third year. I cut so many toenails that month I got blisters on my hand !!

 

[diabeticfootdr]

Hello everyone. I’m PGY-1 in new program without any seniors. Could you please help me …

All programs start from somewhere. I’m glad that your faculty is trying to make a difference and dedicating themselves to education.

You’re doing the right thing by asking for help when you need it. No one knows everything and we’re stronger when we help each other.

Happy holidays to you too!

 

[diabeticfootdr]

Yeah, those PRR categories are just the ABPM reqs for CPME... you can quit once you have 2x or 3x the numbers for biomech, H&P, etc. It needs to be fulfilled, but there's no point to crushing it. Everywhere is going to give you privileges for clinic, wounds, etc.

All I ever logged besides surgery was OR hardware removals as 'other clinical experiences.' The surgery logs from residency are very important for hospitals, privileges, etc (and besides, you'll have to be used to doing it after graduation for ABFAS on PLS).

We don’t support MAVs. We’ve advocated for milestones, like ACGME. The CPME did not adopt that change Document 320.

But it MAVs were going to stay, we recommended that biomechanical exams be problem-focused and not comprehensive. That recommendation was adopted for 2023.

 

[AttackNME]

We don’t support MAVs. We’ve advocated for milestones, like ACGME. The CPME did not adopt that change Document 320.

But it MAVs were going to stay, we recommended that biomechanical exams be problem-focused and not comprehensive. That recommendation was adopted for 2023.

Thanks for making it easier. Eventually I hope those biomechanics exams get eradicated entirely.

 

[diabeticfootdr]

I’ve been hearing about many issues with PRR, including its unfriendly user interface, lack of mobile optimization, and non-responsiveness of staff.

ABPM is 50% corporate shareholder. We are preparing to take action.

If you have specific complaints, improvements, optimizations please let me know.

 

[Feli]

Thanks for making it easier. Eventually I hope those biomechanics exams get eradicated entirely.

Yeah, in practicality, nothing truly needs to be logged aside from surgical OR procedures... that and BC/BQ is where the rubber hits the road for any facility privileging. The other stuff is just a formality for residency grad.

The day a hospital Med Staff committee asks for how many office and bedside wound debrides, number of "biologic dressings," how many subtalar ROM exams, how many casts, how many verruca treatments, how many ingrown nails one has done is simply not going to arrive. It is beyond pointless to log such things; it is is easy for CPME to see the residencies have those things on a site visit (and they're also menial things that DPMs without any residency did for many decades and that most current students have already learned at pod student level and only reinforce a bit in residency anyways).

H&Ps could be logged, but those H&Ps and admitting privi are essentially a political facility-by-facility thing for DPMs, regardless of how many one has done or what certs they hold. Just like ankle surgery/call in many places, it'll either be part of privileges... or you have no chance of it regardless of logs due to degree difference. I have lobbied to be able to clear my own ASA 1 and 2 pts, and it's either readily expected and allowed of all on staff... or no-way-no-how (likely based on training and results of past DPMs there?).