Scut work

[DPMer]

Is a podiatry resident expected to interpret ECG strips, read radiology films (i.e. MRIs, CT scans, ultrasounds, and X-rays other than foot/ankle/leg), perform auscultations with a stethoscope, perform arterial blood gases (ABGs), IVs, catheters, arthrocenteses, and central lines independently at the same level as the allopathic residents when they are in allopathic medicine rotations? Especially in PGY-1, which to allopathic physicians is called THE SCUT YEAR? Thanks.

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[Traum]

Same exact responsibilities as any other "allopathic" intern, PGYI. You are a physician in training. You will do everything but the ankle/foot as a PGYI. As a sub-I, your podiatric schooling/rotations/core clerks have hopefully trained you for this intense year of 12h on/12 off, even though that "80h" week max. rule is in effect, many work well above this time restriction.

Then PGY II and III, ankle/foot immersion similar to optho, uro, or hand services.

As a physician, podiatric specialists must learn everything and do everything. "scut" work is highly important to manage patients in the in-house setting. Long gone are the days of "I am a foot doctor", I do not need to know this.

Podiatry has evolved and podiatric surgical interns act no different that any other surgical resident.

Best of luck.

 

[densmore22]

Is a podiatry resident expected to interpret ECG strips, read radiology films (i.e. MRIs, CT scans, ultrasounds, and X-rays other than foot/ankle/leg), perform auscultations with a stethoscope, perform arterial blood gases (ABGs), IVs, catheters, arthrocenteses, and central lines independently at the same level as the allopathic residents when they are in allopathic medicine rotations? Especially in PGY-1, which to allopathic physicians is called THE SCUT YEAR? Thanks.

Yes, but with a lot of gray. You've always got someone above you or co-interns/residents to run stuff by when you're doing things so while most services expect you to function at the same level as their interns/residents on whatever service you're on, in general, you always have someone to bounce stuff off of. The only people I've seen do central lines solo is either a chief/senior surgical resident or an attending. Interns are rarely allowed to do significant procedures by themselves (at least at the Hospital(s) I'm rotating at).

My take on scut work has changed significantly after having gone through and currently going through it. There's simply no better way to learn what to do unless you do it. Unfortunately, that involves scut work. You just have to do it, get what you can out of it and move on. On my gen surg month, I was essentially floor b**ch, but walked away comfortable and capable of handling essentially anything that came up (including running/participating in codes). Yes, I will NEVER do that on my day to day work when I'm done (at least I hope I don't), but it certainly doesn't hurt my training or my ability of being a Podiatrist by being able to discuss stuff and recognize when someone's got something significant and urgent/emergent going on. It's all part of the training. I say do what you can, put yourself in a situation where you're out of your comfort level, it's simply the best way to learn, bar none.

 

[PADPM]

Yes, but with a lot of gray. You've always got someone above you or co-interns/residents to run stuff by when you're doing things so while most services expect you to function at the same level as their interns/residents on whatever service you're on, in general, you always have someone to bounce stuff off of. The only people I've seen do central lines solo is either a chief/senior surgical resident or an attending. Interns are rarely allowed to do significant procedures by themselves (at least at the Hospital(s) I'm rotating at).

My take on scut work has changed significantly after having gone through and currently going through it. There's simply no better way to learn what to do unless you do it. Unfortunately, that involves scut work. You just have to do it, get what you can out of it and move on. On my gen surg month, I was essentially floor b**ch, but walked away comfortable and capable of handling essentially anything that came up (including running/participating in codes). Yes, I will NEVER do that on my day to day work when I'm done (at least I hope I don't), but it certainly doesn't hurt my training or my ability of being a Podiatrist by being able to discuss stuff and recognize when someone's got something significant and urgent/emergent going on. It's all part of the training. I say do what you can, put yourself in a situation where you're out of your comfort level, it's simply the best way to learn, bar none.

Very well stated. There are simply some tasks that do require senior residents to perform and/or supervise, and other tasks that form an excellent foundation of knowledge, though in reality you won't be performing these tasks when you enter private practice.

Similarly, a dermatologist won't be performing these tasks, but it's nice to be on an equal playing field and understand everything to allow you to speak intelligently with other medial professionals regarding the total care of a patient.

 

[347932]

In my first year I WAS the intern on the service.On some of my rotations, I had no one but the attendings to bounce ideas off of. It was scary, but I learned A TON.

 

[DPMer]

in my first year i was the intern on the service.on some of my rotations, i had no one but the attendings to bounce ideas off of. It was scary, but i learned a ton.

cool!

 

[PADPM]

In my first year I WAS the intern on the service.On some of my rotations, I had no one but the attendings to bounce ideas off of. It was scary, but I learned A TON.

I was in a similar situation, and if you are ever in that situation please remember to put your ego on the back burner and make the patient's safety your priority.

Although the training now in many aspects is superior to when I was a resident, we also had some significant responsibilities off the podiatry service without some of the technology available today (cell phones, internet, etc.). Therefore, it wasn't as easy to access information or people in times of need and often decisions had to be made quickly.

However, even in those situations, there were many decisions that were simply out of my league and please know when you are in one of those situations for your benefit and ultimately the benefit of the patient.

 

[347932]

I was in a similar situation, and if you are ever in that situation please remember to put your ego on the back burner and make the patient's safety your priority.

Although the training now in many aspects is superior to when I was a resident, we also had some significant responsibilities off the podiatry service without some of the technology available today (cell phones, internet, etc.). Therefore, it wasn't as easy to access information or people in times of need and often decisions had to be made quickly.

However, even in those situations, there were many decisions that were simply out of my league and please know when you are in one of those situations for your benefit and ultimately the benefit of the patient.

Absolutely agree 100%. I was very lucky that my attendings were awesome and they realized that I was ALONE on their service. It didn't have anything to do with my subspecialty, but when there were 10-15 patients on a service and I was the only taking care of them (I also sometimes had med students to teach), they were great with lending an ear and a hand when they circumstances warranted.

 

[DPMer]

Has any podiatry attending or podiatry resident been ever involved in a sudden surprising unexpected emergency "code" in the wards (i.e. med/surg floor) in the middle of your podiatry work (i.e. rounds on floors/writing charts in nursing station)? Did you use your ACLS/BCLS training to good use? Thanks a bunch.

 

[347932]

Has any podiatry attending or podiatry resident been ever involved in a sudden surprising unexpected emergency "code" in the wards (i.e. med/surg floor) in the middle of your podiatry work (i.e. rounds on floors/writing charts in nursing station)? Did you use your ACLS/BCLS training to good use? Thanks a bunch.

Yes. I had that happen a couple of times. ACLS did come in handy until the "code" team showed up. One died, the other, I never found out.

 

[PADPM]

Yes. I had that happen a couple of times. ACLS did come in handy until the "code" team showed up. One died, the other, I never found out.

I heard this actually happened quite often early in Kidsfeet's career, until he figured out the touniquet was supposed to be placed on the ankle, NOT the neck.

 

[Ferocity]

I heard this actually happened quite often early in Kidsfeet's career, until he figured out the touniquet was supposed to be placed on the ankle, NOT the neck.

 

[streetsweeper]

Being an intern myself, I want to chime in on "scut work" .. it really isn't all that hard to be an intern on medicine once u figure out how the system works. B/c u have people to report to and all of the daily chores (orders, chasing lab results, consults,communicating with PCP or other providers, patient family, etc) is decided during rounds with upper residents & attendings. The rest of your day is just all about completing the chores. This can take a significant amount of time and when you're following 6+ patients (each with 5+ co-morbidities), it can take all day before "sign out" to the evening team. And then in between all this, you have to do new admission H&P/paperwork/dictations as well as discharge paperwork/dictations for those going home...So time management is essential.

As for ACLS/BCLS, we have algorithms that we follow and it's nicely packaged into a neat little card that u carry in your pocket...yes even allopathic residents pull these out in a code situation.


The real thing that separates us from the allopath interns is the knowledge base. Podiatry schools do a poor job in
teaching us medicine and when we're thrown in a medicine rotation with allopaths, we are basically medical students with the ability to sign documents and write orders. Sure, you're learning a ton with each patient you're following especially the ones with complex medical co-morbidities but the other interns are way ahead of you and you're just playing catch up.. it's not fun to look like an idiot every day during rounds.
All in all, I gained a ton out of that medicine rotation and I'm glad I'm done with it. Movin on.

 

[DPMer]

Being an intern myself, I want to chime in on "scut work" .. it really isn't all that hard to be an intern on medicine once u figure out how the system works. B/c u have people to report to and all of the daily chores (orders, chasing lab results, consults,communicating with PCP or other providers, patient family, etc) is decided during rounds with upper residents & attendings. The rest of your day is just all about completing the chores. This can take a significant amount of time and when you're following 6+ patients (each with 5+ co-morbidities), it can take all day before "sign out" to the evening team. And then in between all this, you have to do new admission H&P/paperwork/dictations as well as discharge paperwork/dictations for those going home...So time management is essential.

As for ACLS/BCLS, we have algorithms that we follow and it's nicely packaged into a neat little card that u carry in your pocket...yes even allopathic residents pull these out in a code situation.


The real thing that separates us from the allopath interns is the knowledge base. Podiatry schools do a poor job in
teaching us medicine and when we're thrown in a medicine rotation with allopaths, we are basically medical students with the ability to sign documents and write orders. Sure, you're learning a ton with each patient you're following especially the ones with complex medical co-morbidities but the other interns are way ahead of you and you're just playing catch up.. it's not fun to look like an idiot every day during rounds.
All in all, I gained a ton out of that medicine rotation and I'm glad I'm done with it. Movin on.

I agree with you Streetsweeper about the knowledge base. It is my concern that Podiatry PGY-1s are not as knowledgeable in Internal Medicine as the Allopath and Osteopath PGY-1s and can easily look like idiots. I met a podiatry PGY-2 who felt that way on her Internal Medicine rotation as well when she was a PGY-1. Man, I wonder if this is a general feeling among Podiatry residents when they rotate on Internal Medicine during PGY-1?

 

[densmore22]

I agree with you Streetsweeper about the knowledge base. It is my concern that Podiatry PGY-1s are not as knowledgeable in Internal Medicine as the Allopath and Osteopath PGY-1s and can easily look like idiots. I met a podiatry PGY-2 who felt that way on her Internal Medicine rotation as well when she was a PGY-1. Man, I wonder if this is a general feeling among Podiatry residents when they rotate on Internal Medicine during PGY-1?

YES. Agree with the prior post as well. As long as you have co-interns that are cool and understand, then life is good. My goal is not to create more work for them, but if I can take some of the work load and make their life easier, then they are usually pretty happy with us (podiatry residents). I think Pod schools do a piss poor job of preparing the students to function as residents in a medicine setting. I don't care if we're never going to manage that stuff when we're done. You're going to manage it when you're on those rotations. It does make us look like idiots. Fortunately, for myself, I've rotated with some pretty awesome people from other specialties and I take the opportunity to educate them on my education and training because NONE of them knows, including Ortho residents.

 

[Feli]

YES. Agree with the prior post as well. As long as you have co-interns that are cool and understand, then life is good. My goal is not to create more work for them, but if I can take some of the work load and make their life easier, then they are usually pretty happy with us (podiatry residents). I think Pod schools do a piss poor job of preparing the students to function as residents in a medicine setting. I don't care if we're never going to manage that stuff when we're done. You're going to manage it when you're on those rotations. It does make us look like idiots. Fortunately, for myself, I've rotated with some pretty awesome people from other specialties and I take the opportunity to educate them on my education and training because NONE of them knows, including Ortho residents.

Well, that's basically the dilemma in our training model: to get to the level of MD grads, then we have to lose what makes us unique and different.

Personally, I wouldn't change a thing. I love that we have a very solid foundation in lower extremity anat, pod med/path, and pod surg right out of school. I think MDs waste a lot of time personally. In practice, it's basically "use it or lose it." You are beginning to see more and more MD residencies beginning to focus on their specialty earlier with direct match situations (neuro, uro, plastics, ortho, plastics, ER, etc). Years ago, they did int med or gen surg residencies and then fellowship. Now, the knowledge base is increasing to the point where more and more are need to start specializing earlier (and maybe even add a sub-specialty fellowship at the end).

...While we're doing pod office and pod surg rotations 3rd and 4th year, they're doing medicine and more medicine. I know my school had me rotate int med, anesth, ER, path, gen surg, etc, and I felt fairly prepared for my medicine and surg rotations in residency. I think that the main goal of rotations outside your specialty is essentially just to get a basic knowledge of what those specialists treat and what you can refer to them.

In the end, if you can take a good H&P and want to learn, the rotation resident and attendings generally will want to teach you. If you have a good history and a couple diff dx, they will make the treatment plan. They know it's not your specialty and it's just a month rotation, but if you show interest and positive attitude, that goes a long way.

 

[amaprez]

Well, that's basically the dilemma in our training model: to get to the level of MD grads, then we have to lose what makes us unique and different.

Personally, I wouldn't change a thing. I love that we have a very solid foundation in lower extremity anat, pod med/path, and pod surg right out of school. I think MDs waste a lot of time personally. In practice, it's basically "use it or lose it." You are beginning to see more and more MD residencies beginning to focus on their specialty earlier with direct match situations (neuro, uro, plastics, ortho, plastics, ER, etc). Years ago, they did int med or gen surg residencies and then fellowship. Now, the knowledge base is increasing to the point where more and more are need to start specializing earlier (and maybe even add a sub-specialty fellowship at the end).

...While we're doing pod office and pod surg rotations 3rd and 4th year, they're doing medicine and more medicine. I know my school had me rotate int med, anesth, ER, path, gen surg, etc, and I felt fairly prepared for my medicine and surg rotations in residency. I think that the main goal of rotations outside your specialty is essentially just to get a basic knowledge of what those specialists treat and what you can refer to them.

In the end, if you can take a good H&P and want to learn, the rotation resident and attendings generally will want to teach you. If you have a good history and a couple diff dx, they will make the treatment plan. They know it's not your specialty and it's just a month rotation, but if you show interest and positive attitude, that goes a long way.

This is a very realistic and comforting post to read. I have met allopathic medicine PGY-1's with fabulous funds of knowledge and who are rockstars. I have seen other PGY-1's on the same rotation who struggle far more. Never have I seen an attending or senior resident jump on a PGY-1 for not knowing the answer to a pimp question. On the other hand, laziness, pride, a negative attitude: those things WILL get you yelled at by your superiors. The same principles should apply whether you're a podiatric or allopathic/osteopathic resident.

Thanks Feli!

 

[zane870]

I heard this actually happened quite often early in Kidsfeet's career, until he figured out the touniquet was supposed to be placed on the ankle, NOT the neck.

The things they don't teach you in pod school!

 

[densmore22]

Well, that's basically the dilemma in our training model: to get to the level of MD grads, then we have to lose what makes us unique and different.

Personally, I wouldn't change a thing. I love that we have a very solid foundation in lower extremity anat, pod med/path, and pod surg right out of school. I think MDs waste a lot of time personally. In practice, it's basically "use it or lose it." You are beginning to see more and more MD residencies beginning to focus on their specialty earlier with direct match situations (neuro, uro, plastics, ortho, plastics, ER, etc). Years ago, they did int med or gen surg residencies and then fellowship. Now, the knowledge base is increasing to the point where more and more are need to start specializing earlier (and maybe even add a sub-specialty fellowship at the end).

...While we're doing pod office and pod surg rotations 3rd and 4th year, they're doing medicine and more medicine. I know my school had me rotate int med, anesth, ER, path, gen surg, etc, and I felt fairly prepared for my medicine and surg rotations in residency. I think that the main goal of rotations outside your specialty is essentially just to get a basic knowledge of what those specialists treat and what you can refer to them.

In the end, if you can take a good H&P and want to learn, the rotation resident and attendings generally will want to teach you. If you have a good history and a couple diff dx, they will make the treatment plan. They know it's not your specialty and it's just a month rotation, but if you show interest and positive attitude, that goes a long way.

I agree with you, but learning medicine from what's required in Pod school is insufficient. We can still learn all we do plus the medicine/surg component to function better in residency without sacrificing what makes Podiatry, Podiatry. The allopathic 4th year of medical school is pretty lax. They have something like 4-5 months FREE (with variability, naturally). We spend far too much time doing routine nail care that can and should be mastered in a month on a rotation while the other rotations could potentially be filled with medicine/surgical rotations that would provide the Pod student a good basis and foundation to expand upon in residency. That's great the Barry alloted those rotations for you and your fellow classmates, but that's the exception, not the norm for Podiatry students. I'm all for focused and specialized Podiatric rotations, but 1 required month of Medicine in 4 years of schooling...come on! We're missing the boat here. There's plenty of time to pick up those basic pod skills without sacrificing our uniqueness (if that's even a word) and providing the medicine and surgical skills needed to function on a multispecialty medical/surgical rotation in residency.

 

[streetsweeper]

I agree with you, but learning medicine from what's required in Pod school is insufficient. We can still learn all we do plus the medicine/surg component to function better in residency without sacrificing what makes Podiatry, Podiatry. The allopathic 4th year of medical school is pretty lax. They have something like 4-5 months FREE (with variability, naturally). We spend far too much time doing routine nail care that can and should be mastered in a month on a rotation while the other rotations could potentially be filled with medicine/surgical rotations that would provide the Pod student a good basis and foundation to expand upon in residency. That's great the Barry alloted those rotations for you and your fellow classmates, but that's the exception, not the norm for Podiatry students. I'm all for focused and specialized Podiatric rotations, but 1 required month of Medicine in 4 years of schooling...come on! We're missing the boat here. There's plenty of time to pick up those basic pod skills without sacrificing our uniqueness (if that's even a word) and providing the medicine and surgical skills needed to function on a multispecialty medical/surgical rotation in residency.

Thank you! I was going to comment on how we can drop a lot of B.S. rotations in pod school and put in place some more int medicine without sacrificing our unique core rotations. A regular MS-3 will get at least 3 months of int med, have to follow ICU patients for some time, and then finish that block with outpatient medicine. When they come out, they come out very strong and capable of handling almost any rotation b/c it's the foundation. I've rotated with med students who have already completed medicine and those who have not (when I was on trauma)..the difference was night and day.

Internal med is the common denominator that connects all the different specialties together. Whether you're an intern for ortho, ent, neuro, etc. I'm not sayin we should revamp the whole podiatry curriculum..but one month of internal med out of 4 years? we can do better.

I've always had to educate people about podiatry in every off service rotation I've been to..even as a pod student. I don't mind that. But many times, I am the only podiatry person they will ever encounter and when they see that I am not as knowledgeable in internal med as them, how should they think about podiatry? If I am just one person, imagine the hundreds of podiatry residents nationwide feeling the same way?

 

[densmore22]

This is a really interesting thread. This topic is something I've suspected but have not been able to gain accurate information on (from speaking 3rd and 4th years). I personally feel this is something that is downplayed by older students because no one wants to admit to not being as competent to their MD/DO peers. As a P2 student I know deep down I am NOT getting the same general medical education that my fellow allopathic classmates are getting in their basic biomedical science courses. It seems like they have a ton of more clinical information built into their classes while the Pods get a more basic overview of the same biological science topics. If we get clinical information a lot of it is geared towards pathology we will see as future podiatrists. The only class we deal with general medicine topics are our essentials of clinical reasoning course and our pathology course (both courses taken with the allopaths). I understand every school's curriculum is different though. I personally believe that students at DMU, AZPOD and Western get a better education in general medicine (since they take a lot more classes with DO students). I'd love to read comments from students who graduated from those schools (not western since they haven't had their first graduating class yet) and see if they had the same issues that we are reading here.

You are.

 

[NatCh]

Back when I did residency in the mid-1800s I was expected to perform ALL of the same functions on the different rotations as my M.D./D.O. counterparts. There were a lot of areas where I did not have the same base knowledge as they did, but most of the teams were hospitable as I got myself caught up.

I know we try to measure up to M.D./D.O. standards in medicine and surgery, but have you ever wondered how an M.D./D.O. student or resident would measure up against a podiatry student or resident during a podiatry rotation?

 

[DPMer]

Back when I did residency in the mid-1800s I was expected to perform ALL of the same functions on the different rotations as my M.D./D.O. counterparts. There were a lot of areas where I did not have the same base knowledge as they did, but most of the teams were hospitable as I got myself caught up.

I know we try to measure up to M.D./D.O. standards in medicine and surgery, but have you ever wondered how an M.D./D.O. student or resident would measure up against a podiatry student or resident during a podiatry rotation?

Mid 1800s????

 

[densmore22]

Back when I did residency in the mid-1800s I was expected to perform ALL of the same functions on the different rotations as my M.D./D.O. counterparts. There were a lot of areas where I did not have the same base knowledge as they did, but most of the teams were hospitable as I got myself caught up.

I know we try to measure up to M.D./D.O. standards in medicine and surgery, but have you ever wondered how an M.D./D.O. student or resident would measure up against a podiatry student or resident during a podiatry rotation?

I pose that analogy to most of them and then they realize the situation I (we) are in on that rotation. I've yet to come across any MD/DO resident that has been anything but understanding and helpful towards myself as a podiatry resident. I mentioned to this Neurosurgery intern and a 4th year Sub-I about the various forms of bunion correction. I figuratively blew their minds when I said fusing a joint is an option. They both seriously thought you just shaved the bump down. So yeah, they know they would do poorly on our rotations, but I, personally, and I hope all on here and at residency programs, would give them the same slack that they give us.

 

[Ferocity]

Mid 1800s????

Seems legit to me.

 

[NatCh]

Mid 1800s????

Okay, so it was the early-1800s but you're only as old as you feel, right?

 

[NatCh]

I pose that analogy to most of them and then they realize the situation I (we) are in on that rotation. I've yet to come across any MD/DO resident that has been anything but understanding and helpful towards myself as a podiatry resident. I mentioned to this Neurosurgery intern and a 4th year Sub-I about the various forms of bunion correction. I figuratively blew their minds when I said fusing a joint is an option. They both seriously thought you just shaved the bump down. So yeah, they know they would do poorly on our rotations, but I, personally, and I hope all on here and at residency programs, would give them the same slack that they give us.

For the most part the other residents on my various rotations were understanding and helpful, however I do remember being on an internal medicine floor rotation for a month and the residents were really high strung and generally heinous. I was pretty happy when that rotation ended. It did reinforce that I made the right choice not pursuing a career in internal medicine.

 

[NatCh]

Internal med is the common denominator that connects all the different specialties together. Whether you're an intern for ortho, ent, neuro, etc. I'm not sayin we should revamp the whole podiatry curriculum..but one month of internal med out of 4 years? we can do better.

Do you think more internal medicine would be pretty helpful in your future practice? When I did it I managed a lot of CHF and COPD, so about one month of that seemed like enough. Not sure how much of that carried over into my practice. Maybe I got more out of it than I realize, but I don't know. Perhaps the most beneficial thing I took away from it was doing H&P's a thousand times over. Nowadays if my patient has an internal medicine problem I send him to his PCP.

 

[streetsweeper]

Do you think more internal medicine would be pretty helpful in your future practice? When I did it I managed a lot of CHF and COPD, so about one month of that seemed like enough. Not sure how much of that carried over into my practice. Maybe I got more out of it than I realize, but I don't know. Perhaps the most beneficial thing I took away from it was doing H&P's a thousand times over. Nowadays if my patient has an internal medicine problem I send him to his PCP.

Oh, most definitely. I was managing everything that came overnight..no discrimination in the type of cases I get...CHF...COPD exacerbation to a young man with metastatic lung cancer and complications with his chemo, necrotizing pancreatitis, uti with bacteremia, PE's, etc. There are podiatrists out there who admit and medically manage their own patients (still shocked about that). A lot are doing Pre-Op H&P's... my thing is..what if the patient walks into your clinic lookin normal but had an irregularly irregular heart rhythm and was noncompliant with medication and he thinks he's suppose to take coumadin..what do we do in that situation? What if we have forgotten what that rhythm sounds like? How often do we catch an S3 gallop sound? I know we have other channels like anesthesia doing their own pre-op clearance but I've seen cases where the anesthesiologist just look at our H&P's and go from there (when I was a student).

I don't know, maybe I'm freaking out over nothing. I too would send patients to their PCP to get pre-op clearance once I'm out in practice.

 

[NatCh]

what if the patient walks into your clinic lookin normal but had an irregularly irregular heart rhythm and was noncompliant with medication and he thinks he's suppose to take coumadin..what do we do in that situation?

Realistically what I think would happen in this case is I'd address his foot problem and tell him to contact his PCP regarding his medication instructions. I don't see where I'd want to do an EKG in my office on a normal looking patient. I don't even have an EKG machine in my office.