Residency Rap

The other day I was talking with my director, who’s involved with the residency accreditation process and national resident education. We were discussing the PM&S model, with its new emphasis on competency as the acquisition of knowledge, skills, and attitudes in performing podiatric medicine and surgery. We were observing, however, that confidence doesn’t seem to play a role in this process at all. In fact, I don’t think confidence was a goal in any of the prior models of residency training, whether allopathic, osteopathic, or podiatric.

In this resident’s opinion, confidence is an extremely important end-goal in residency training. But how many physicians truly feel confident in their clinical or surgical skills when they graduate from residency? This is a pretty esoteric and ephemeral quality to measure in a person. It’s easy to see whether or not a resident can successfully perform a bunionectomy or history and physical exam and say that resident is competent. It’s simple to test a person and determine if they understand the Lauge Hansen classification. But how do you determine if a resident is actually confident in their decision-making or surgical skills? A physician who can confidently make decisions and advocate for his or her patients is a quality physician.

I think we’ve all met people who appear confident on the surface but later realize their confidence is a façade. Sometimes, though, this façade works to our advantage. I’ve often given a piece of advice to first year residents just before they walk into their first “C” case: walk into the OR with confidence; be verbal and in control of what’s happening.

Honestly, this boils down to a little bluff and bluster. How confident can you really be if you’ve NEVER done a surgical case before? If you appear confident, and you have a generous attending, you’ll perform your first case skin to skin, and it’ll go reasonably well. In contrast, if you appear unconfident, how long do you think your attending will let you hang on to that blade? Over a short period of time, and with hard work, this will translate into true competence. I’m not advocating cockiness or dishonesty. Of course, there’s a balance. There’s nothing worse than someone who’s cocky and also has no skill.

Perhaps confidence is an innate characteristic in each person that has nothing to do with training or practice. In comparison to the above, we’ve all known people who seem to have an innate confidence, and everything just seems to go their way no matter what happens. Maybe confidence is a trait we pick up after years of practice, making mistakes and having successes. Does a long career build confidence? Is it a combination of all these influences?

So, what is it? Bluff and bluster? An innate quality? Experience? Should confidence be part of our evaluation along with knowledge, skills, and attitudes? What do you think? Write in and participate in your resident community.

As with all PRESENT publications, all issues of Residency Rap will be stored on the PRESENT  website, so if you miss an issue or you want to refer back to a prior issue, it'll be at:

http://www.podiatricresidency.com/residencyrap/