Why Residents Should Get OR Experience As Early As They Can

The first year of residency is so important. It defines the training for the next two years. The Council on Podiatric Medical Education (CPME) has mandated that each resident complete certain non-podiatric rotations. The CPME also mandates that no more than 20 percent of the total training can be in the private practice setting. I am going to explain my first-year experience and how I feel I benefited most from it.

I will start out by saying that podiatrists, along with pharmacists, are the only residents at our hospital. We are not a teaching institution and our non-podiatry attendings make much appreciated accommodations to assist us in our training.

The typical first-year resident spends almost an entire year away from podiatric medicine and surgery while working through the required rotations. Most rotations are a month long. First-year residents take calls including emergency room consults, inpatient rounding and add-on surgeries. These surgeries may be the majority of that first-year resident’s surgical numbers for the first year.

I chose my residency program, among many other reasons, due to the fact that as a first year, I was only off service for about six months, giving me six months of podiatric surgery and medicine. The rest of our required rotations are spaced out through the next two years. This was critical to my education.

As fourth-year students, we spend our time on externships scrubbing cases and learning all about the surgeries we will perform. By the time our fourth year ends, we are well read, motivated and in most cases, experienced in the basics of surgery. Then we get a break, anywhere from four to six months from when our rotations end to when residency begins. So at the peak of our preparation we are no longer involved in surgery for quite some time.

Adding another year of hiatus from consistent podiatric surgery does us a disservice. Sure, we may become very good at internal medicine, emergency medicine and the other rotations we are involved in, but in the end, I am a podiatrist. I will be performing foot and ankle surgery. That is where my main focus should be. So in total it can be up to a year and a half before some residents really get immersed back into podiatric surgery. The American Board of Foot and Ankle Surgery (ABFAS) boards are in March in the third year of residency. So that gives some residents only a year and a half or less to learn everything needed to pass boards qualifications. That’s a tough task.

I was fortunate enough to be immersed early and often into podiatric surgery as a first-year resident. I feel this has been critical to my training. Now as a second-year resident, I am comfortable with the basics of surgery, the standard approaches, indications and complications. Now I am able to further my studies into being able to better recognize procedure selection criteria, fixation options and long-term expectations of these procedures.

I have always said the surgery part is easy; it’s the fine print that makes podiatry difficult. Knowing how to perform an Evans osteotomy is important. But knowing why we are doing this procedure versus another, knowing the overall effects on the foot, and knowing the most effective postoperative course are the difficult aspects of surgery. I truly believe this level of understanding cannot happen until you are no longer actively learning the basics.

The earlier we can expose ourselves, the better prepared we will be for that day we are the only one in the OR.