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Residency Rap
Our Mentors

by Jarrod Shapiro, DPM
PRESENT Resident Editor
Botsford General Hospital
Farmington
Hills, MI
Good day, colleagues.
We’re getting ever closer to graduation this year. For us third years, we’re all
looking forward to our next step into practice with mixed emotions. We’re joyful
to finally be on our own, with no one standing behind us, telling us what to do.
But we’re also nervous to finally be on our own, with no one standing behind us
as a safety net. Personally, I can’t wait to have my own patients and be
completely responsible for all of my own medical decisions. Some people might be
worried about this new autonomy, but I’m not, and I attribute this to excellent
training, specifically from two of my attending mentors during residency.
Both physicians, though different in style and approach to
podiatry, are similar in many ways. First, they have an unerring dedication to
resident training. Working with residents is one of their passions. They are
truly excited and interested by the interactions they have with their residents,
and it’s this interaction that makes them stay current and motivated. They also
treat their residents with respect, rather than belittling and degrading them.
We’ve all dealt with these types of people; they’re all too common in surgery
and are usually ineffective teachers.
Second, and most importantly, these physicians have
required me to make my own decisions. I’m expected to be ready for the cases I
scrub and the patients I see in clinic. If a problem occurs during a case, I
have to be able to get myself out of it. For those of you who have attendings
that take the knife away at the first sign of trouble, you know this doesn’t
teach you anything. These attendings let me go during a case (as long as what
I’m doing has a reasonable thought process behind it). This is the reason I can
look forward to practicing without any trepidation.
These two attendings have not only provided me with the
didactic and clinical education to make my own decisions, they have acted as the
example of what a podiatric physician should be. I have attempted to emulate
this example with my coresidents and the students who rotate through our service
and plan to take these lessons into practice. Physicians like these, who
dedicate their experience, time, and caring, provide a long lasting service to
our community, making it better one new physician at a time.
Do you have a mentor at your program, an attending who has
taught you how to be an excellent podiatrist? Perhaps it’s another resident
who’s a mentor. Write in and recognize that person or persons. Have a great week
and good luck to those of you taking the ABPS qualification exams this week.
Speaking of mentors. Here’s a public service announcement
and a chance for you to mentor July’s incoming residents:
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Residency Insight (John Steinberg's
column on making the most of residency education) and
Residency Rap.
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Subject: Logging System is Simple
and Logical
The logging system is quite simple and
logical. Lets take the bimalleolar fracture-- this is what is: a fracture of the
ankle that is complex and requires knowledge on mechanism of injury etc. and is
treated as one injury not broken down into the component parts. One must know
restoration of fibular length, reduction of medial clear space, and
determination of a syndesmotic tear. This must be treated and evaluated as a
whole, not just the repair of the fracture.
Let’s take another example-- triple arthrodesis--anyone that
is performing these procedures understands that this is one procedure that
involves three joints. It is difficult to get these pieces to fit back together
and make a functional foot. On the other hand a TN fusion and Evans calcaneal
osteotomy are two separate procedures that do not rely on each other.
Another example is a pan metatarsal head resection- when you
perform this procedure you must evaluate the parabola and determine the
appropriate length. Think of these as procedures that treat a condition or rely
on each other and cannot be separated into its parts
Charles M Lombardi, DPM
Director, Podiatric Medical Education
Wyckoff Heights Medical Center
Brooklyn, NY
chazdpm@aol.com
Editor's Response
I don’t
disagree that each of these examples represents one reconstruction which would
be significant, for billing purposes. However, as I’m sure you’re aware,
resident education is not the same as billing in the real world. I’ll refer you
back to my prior editorials where I assert that the logging should be based on
the educational content of the procedure. Would you let one of your
residents who’s trained to do a triple perform an isolated subtalar fusion?
Sure you would. That’s because the complexity of a triple and its educational
content (including the thought processes) are sufficient to allow that resident
to perform a less complex procedure. Hence, my argument that the triple should
count for 3 experiences (or 3 procedures). Of course, I’ll log however I’m
supposed to, as soon as I have a clearly written document that tells me what to
do.
- Jarrod
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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/
Talk to me,

Jarrod Shapiro, DPM
PRESENT Resident Editor
jarrod@podiatry.com
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This program is supported by an educational grant from
Ameripath/Dermpath Diagnostics

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