Residency Rap
 

Variety vs Numbers

by Jarrod Shapiro, DPM
PRESENT Resident Editor
Botsford General Hospital
Farmington Hills, MI

Good autumn everyone. Here in Michigan the leaves are falling and the temperature is dropping slowly but surely. Soon we’ll be bundled up like little podosnowmen and women!

Recently I was reviewing the CPME 320 document and comparing the requirements to my surgical numbers. This exercise had me thinking back to when I a student searching for a residency program. Before I became more educated about the process, I believed residency was all about the surgical numbers. Then I did some externships, talked to folks, and visited programs. I modified my thinking to the belief that surgical numbers were important, but so were strong clinical and academic experiences. Hence, I chose Botsford.

Then, CPME changed the programs from the prior models to the current PM&S models. Along with the change to competency-based education and some of the categorization came a greater emphasis on variety in our training. According to the CPME, it is no longer so important that we do 1,000 bunionectomies, but that we perform a large variety of these procedures.

I can agree with this to a large extent. For example, if you do 1,000 Austin bunionectomies during your residency without learning any other first ray procedures, you’ll have plenty of numbers, but heaven forbid you have a patient with first ray hypermobility, and they would have benefited from the Lapidus you never learned to do. Does every hammertoe need an arthroplasty? What if you never learned to perform a digital arthrodesis? I’d bet your clinical outcomes wouldn’t look so good!

On the other hand, I want to tell my patients that I’ve performed a ton of the procedure I’m telling them they’ll need. If you’ve only done one Austin, how likely is it you’ve dealt with all the potential intraoperative complications? Additionally, there are many variations to the Austin bunionectomy (or any procedure for that matter): dissection, bone cuts, fixation, etc.

In this resident’s opinion, it’s probably a 60-40 balance between variety and numbers. I’d rather have a large number of surgical options in my armamentarium for my patients’ needs (variety) while having performed enough of those procedures to be comfortable on my own. What’s your opinion? Was the CPME correct in changing its emphasis? Is variety more important or should numbers be our emphasis? Take a few minutes to complete the survey and participate in your resident community.