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Residency Rap
Fellowships: To Do ‘Em Or Not

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

I just received the ACFAS Update newsletter in the mail and noticed on the front page the article Kurgan Ilizarov Mini-Fellowship: The Experience of a Lifetime. First, I want to offer my congratulations to those physicians who did the fellowship. Reading the article got me thinking about fellowships. If you’ve read the prior Residency Rap editorials, you know I’m a senior resident and like many residents in my position, the decision regarding exactly what to do next is constantly on my mind.

As we all know, our colleagues in the MD and DO world perform fellowships of varying lengths in order to specialize or sub-specialize within a particular field. If you want to be a cardiologist, then you have to do an internal medicine residency (3 years after internship) and a cardiology fellowship (another 3 years). Want to specialize in spine or hand surgery? Let’s do 5 years of orthopedics residency after internship, then another year of a spine or hand fellowship. (Don’t even get me started on orthopedic foot and ankle fellowships!). I’ve spoken to many MD and DO residents over the last several years of my training, and none of them seem troubled by the extra time they have to spend with their training.

Podiatry over the last several years seems to be following the natural progression of medicine and is now offering fellowships of its own. Currently, fellowships include trauma, sports medicine, surgery, wound care, reconstruction, and research (I may have missed a few – sorry!). The only one that I haven’t heard of yet is a pediatric fellowship. If anyone knows of one let me know.

Personally, I’m in favor of fellowships for extra training. In my opinion, no residency program sees every type of surgery or medical issue, so a year spent specializing in, say, diabetic limb salvage, utilizing lots of external frames or foot and ankle trauma makes sense. Do I think it’s absolutely necessary? No. If you do a legitimate 3-year surgery and medicine residency, you should see the vast majority of what you’ll come across in practice. In addition, your program should have enough didactics to be teaching you a reasonable thought process in attacking foot and ankle pathology, so you can reason through those problems you don’t see often (or know when to refer).

Where I think fellowships are useful (besides those sub-specialties like sports medicine) are for those folks in 2 year programs who don’t feel they received enough training and want to supplement their education with an extra year. One caveat to that statement: those programs that are shortchanging their residents really should get their acts together and provide a comprehensive education. They’re doing a disservice to their residents and the profession.

Additionally, I’m of the opinion that all fellowships should be reviewed, accredited, and standardized (with respect to their educational requirements) in the same manner as residencies are. Fellows should not be taken advantage of; they’re not high paid scut monkies!!

That’s one resident’s opinion. What’s yours? How do you feel about the mini-fellowships like the Ilizarov and AO? Should we have more? Less? Write in and post your response.

What do you think? Let the residency community hear your opinion…

SEND YOUR COMMENTS TO ME BY CLICKING ON THIS LINK
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

From:       Kristi Kelly Nemes, DPM
Subject: PDAs

I have to say I fall into the Frazier Crane level of organization. One issue that I had at the beginning of residency was dictations. How would I remember what to dictate? It seemed hard enough back then to remember what screws were put in and what direction they were inserted, nevermind every other step of the case! I also could never think of a good way to end a dictation or where to fit sentences about vessels being isolated and cauterized. So, the night before each surgery I would sit down with Gerbert's bunion book/McGlamry/etc. and type into the "Notes" of my PDA how that surgery should go start to finish... what I would dictate if the surgery went exactly by the book. They would be titled: Lapidus dictation or Austin dictation or Weil dictation, you name it. Then when I went into the OR I had fully reviewed every step of the case (great for beginners). After the case I would take a patient sticker and on the back write the cuff time, cc's of local used and screw sizes. I would then use my dictation template from the night before to dictate what was done, obviously amending it where needed. I felt it was a great way to prepare for a case and to dictate quickly so I could get back to clinic. It also stopped dictating from being a major cause of anxiety for me. The major lesson here is if there is no program, make up notes or documents that you'll find useful for yourself!

I have an iPAQ that I love and would feel lost without. Another thing I do with my PDA is transfer all Window's based documents to it that my residency director sends to us. That way I never forget my journal club topic, lecture dinner topic or even when the month officially ends. Being organized is such an integral part of residency, particularly when you are on non-podiatry rotations. I often wondered how I would compete with the knowledge of surgical residents on trauma. Looking back I realize my organization got me through. They may have known more, but I got my tasks done efficiently which often gets recognized more than what questions you can answer correctly.

Kristi Kelly Nemes, DPM
St. Mary's Medical Center R3
hokiekk@yahoo.com

Editor's Response
I couldn’t agree more with your assertion on the importance of being organized. Time management is the key to a successful residency experience. I use a similar method with my surgical dictations and notes. Palm software uses a program called DataVis which converts Word documents to a Palm format. I’ve converted most of my notes to this format. Without the calendar function I’d be lost!
- Jarrod

From:       Kevin Lam, DPM
Subject:   PDAs

I am have recently graduated from my residency in Mount Sinai Medical Center in Miami, FL, and applaud the residency information part of PRESENT. PDA's are great, I started with the Palm Vx, now I'm up to the Treo600, of course 650 is better with more toys and memory. JOHN HOPKINS put out a PDA version of their antimicrobial guide for FREE. Just go to their website and sign up http://hopkins-abxguide.org

Kevin Lam, DPM
klamdpm@hotmail.com

Editor's Response
I hadn’t used this program before. After downloading it and looking though it, I can see how useful it could be. Write in your submissions for other PDA programs that come in handy. They don’t have to be medically oriented, just useful.
Here’s another medical program for the PDA. It’s called mobileMICROMEDEX http://www.micromedex.com/products/mobilemicromedex/
This one’s only free if your hospital subscribes to the service.
- Jarrod

This is a question regarding Resident logs for PM&S-36 programs (first year residents).

I am curious how residents in other programs are logging f/u outpatient office clinic visits on Podiatry RR.

The two options are "other clinical" or "focused history and physical."

If you look up the definition focused history and physical and billing requirements for 99212: a podiatry f/u established patient visit meets criteria of focused history and physical as long as the components are met
- a problem focused history
- a problem focused exam
- a straightforward medical decision-making

I was wondering what others were doing? I did call CPME and Podiatry RR regarding this question and am awaiting the answer.

Christine Gosch, DPM
Attending Physician
DVA - Palo Alto Healthcare System
cgosch@everdream.com

Editor's Response
I’m not sure exactly how the PM&S programs would work since I’m in a PSR. However, In my follow up office visits I do not re-question my patients on their medical history, allergies, surgical history, family history, medications, etc which would cover a focused history and physical for a new patient. When I log my follow up patients I usually do the “other clinical” option. I’d like to hear what the PM&S 24 and 36 residents are doing?
- Jarrod