Residency Training

[johnmuggs0011]

So I am currently at a 1st year at a program that I scrambled into without knowing knowing too much about it. I thought it would be a program that would provide me adequate training although I'm not sure that is the case. I am a hard working individual and willing to learn every day but this program has limited surgical cases per week to learn from and we are mainly at the clinic almost every day. Even with the cases we have per week, majority of them are the same bread and butter electives. The clinic does not really offer too much new pathology to learn from. I was wondering how this type of training would impact my future job prospects and how I will be as a podiatric physician/surgeon. Also, have you seen successful attendings that have came out from poorly trained residencies?

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[wakaflocka88]

Sorry to hear about the situation but from what you’re describing in terms of the volume and work it will be difficult to get well versed in the full scope if you’re not actively doing it. This doesn’t mean you can’t have a career doing what you feel comfortable with. In terms of success only you can determine that path. I’ve seen new grads try to do fractures and advanced recon when they had little exposure in training which to me is not a good idea.

 

[johnmuggs0011]

That makes sense. Have you heard/know of any attendings from poorly trained residencies that are great physicians/surgeons and are successful?

 

[air bud]

That makes sense. Have you heard/know of any attendings from poorly trained residencies that are great physicians/surgeons and are successful?

I have a hard time seeing how that can happen. There's plenty of great surgeons out there who trained at lesser known programs that still had good training there. Transferring maybe an option to look into

 

[Feli]

Repetition is the mother of skill.

You can only get so far from watching videos or reading articles. You still need a decent number of reps with various dissections, suture, fixation, etc. If you are only seeing basic cases or are not getting enough cases/reps, that is a problem. Like some guys from GTEF programs, I do a lot of stuff I never did in residency and do it well, but I have done/scrubbed ridiculous numbers of similar cases, similar hardware, etc where I feel good with it (I just plan a bit more if it's something I haven't done or haven't done in awhile). The anatomy and the instruments don't change, and fixation changes very minimally but you have to get very, very highly skilled with them during training.

Good advice above. I would look into transfer if you don't think you are in a situation to get enough to do the cases you want to after residency. You can make a fine living doing bread and butter and sending the rest out, but you can't learn it later (and most metro places wouldn't give RRA privileges if your logs don't support it and/or you aren't board qual for it).

But it's a moot point. Always remember, residency doesn't matter... fellowship is where it's at now

 

[johnmuggs0011]

Repetition is the mother of skill.

You can only get so far from watching videos or reading articles. You still need a decent number of reps with various dissections, suture, fixation, etc. If you are only seeing basic cases or are not getting enough cases/reps, that is a problem. Like some guys from GTEF programs, I do a lot of stuff I never did in residency and do it well, but I have done/scrubbed ridiculous numbers of similar cases, similar hardware, etc where I feel good with it (I just plan a bit more if it's something I haven't done or haven't done in awhile). The anatomy and the instruments don't change, and fixation changes very minimally but you have to get very, very highly skilled with them during training.

Good advice above. I would look into transfer if you don't think you are in a situation to get enough to do the cases you want to after residency. You can make a fine living doing bread and butter and sending the rest out, but you can't learn it later (and most metro places wouldn't give RRA privileges if your logs don't support it and/or you aren't board qual for it).

But it's a moot point. Always remember, residency doesn't matter... fellowship is where it's at now

I completely understand. I mainly chose this residency program based off of location because all my family/friends etc are here. So if I don’t get the training I want in residency, would fellowship help me achieve that? Or is fellowship more of just the same as residency?

 

[Feli]

I completely understand. I mainly chose this residency program based off of location because all my family/friends etc are here. So if I don’t get the training I want in residency, would fellowship help me achieve that? Or is fellowship more of just the same as residency?

Yeah, you can go that route. Fellowship is just more of residency (in podiatry), but that can sometimes be a good thing for the trainee (and almost always is for the training docs).

I would see how you feel after 2yrs. You might feel ok and be able to get more RRA than you think. If you don't, just be honest with the fellowship interviews and say you chose unwisely based on residency location instead of volume/quality, but you want to work hard now and get more reps at their program. You obviously have to try to pick a higher volume no-bull surgical fellowship like Hallowell or Klutts or Hofbauer and not some crap derm or practice mgmt one. Those type probably don't have the glitter and glam of some others since they don't have as much research or name value, but you will still get a lot of good RRA if you didn't get that in residency.

Either way, you are ahead of most if you have realized your training is limited where you are at. That is much better than being ok with limited scope/offerings to patients... or much worse, "faking" the RRA afterwards.

Back before there was a fellowship on every corner, people who did mediocre/low level residency (when all residency hospitals went to 3yr surgical PM&S model but some had nowhere near enough cases) would sometimes realize they needed more cases to do the stuff they wanted to know. They would sometimes look for open 3rd year spots at good programs or create a "fellowship" at one of those places to do after graduation, and I'm sure it improved their development. It is obviously not the ideal path for efficiency when you can just try to get over to a decent 3yr program instead (exactly what one of my co-residents did: transferred in after 1st year, worked hard for 2nd and 3rd year, now RRA cert and more proficient that he ever would have been at his original program + fellowship).

 

[Boba Foot]

I completely understand. I mainly chose this residency program based off of location because all my family/friends etc are here. So if I don’t get the training I want in residency, would fellowship help me achieve that? Or is fellowship more of just the same as residency?

Most fellowships are just PGY-4, if even that. I guess you could ask yourself if you’d rather transfer or if you’d like to do a fourth year of residency.

 

[shadesofgrey]

I graduated from school at the height of the residency shortage. I had decent but not spectacular grades. Ended up matched at a safety net program that I didn't know that much about. Within the 1st week I knew the training was subpar. I probably should have transferred out, but didn't as it was in the geographic area that I liked and the lifestyle was unbeatable (literally the most enjoyable years of my life). I studied very hard on my own and ended up board qualified in both foot and RRA.

However, it is very hard to translate that book knowledge into the OR, additionally I am someone that needs a lot of repetition to feel comfortable with procedures. As a result surgery is challenging for me and that is not the way you want to go into the OR. I've tried to make up for the gaps in training by taking a lot of surgical courses, which is costly and not a true replacement. When I first got out in practice I found myself taking on cases I shouldn't have because I was embarrassed that my colleagues would think less of me. Well it didn't take long to get a bad result, and that was honestly the worst feeling I have ever experienced. Everyone from the scrub tech to the rep knew it was a disaster. I went home from the OR and was actually sick that night, almost vomited. I now refer out to my partners or ask for help on cases that are over my head, and they have been very gracious about it. My skills are getting better, but with any less than perfect result I am left wondering if a better surgeon would have gotten a better outcome.

I would suggest you think long and hard about a transfer if your training isn't up to par and you want to do surgery. I loved, loved, loved the people I worked with and my time in that residency, even now, I'm not sure I would change anything if I could go back in time. However, my friends are gone now; it's just me in the OR, and more importantly for the rest of my career it's just me walking in to see the postops. This is the time to train and hone your skills, and if you are going to sacrifice this, make sure the return is worth it.