The panelists discuss how they use information provided by both internal and external evaluations of their residency programs, and how they integrate attending and residents into the process.

Q:

As the year is quickly approaching, have you had your annual program review? Who attends this meeting? What changes has your Podiatry Residency Committee decided on to improve the education of your residents?

A: 

David Bernstein, DPM, FACFAS relates his program’s evaluation occurred in May. It is attended by the 10 members of the Podiatry Curriculum Committee, the Program Coordinator, the Radiology Program Director and the three senior residents. 

Sabrina Minhas, DPM, DABPM, states that all residents attend along with the Residency Director and Assistant Residency Director. She says the teaching staff is invited to this meeting as well but their attendance varies from year to year. At his program, Lawrence Fallat, DPM, FACFAS says that faculty and members of the residency selection committee attend, but the meeting is open to any interested individuals on the medical or podiatry staffs.

Caitlin Zarick, DPM notes that her program’s residency committee, comprised of the Director, Assistant Director and core faculty, meets quarterly on their own to review the program and resident progress. 

Lawrence Fallat, DPM goes on to say that this year, his program is supplementing faculty lectures with short presentations to be made by residents. 

“We find that if residents do the research and give a presentation, they retain much more of the information,” states Dr. Fallat. 

He also adds that several years ago, his program began a policy of the residents presenting a surgical case the night before the procedure, in which they would be the first assistant. They then are responsible for key elements offollow-up care of the patient, including checking culture reports, pathology reports and ordering postoperative imaging. 

Dr. Zarick relates that her program holds an annual retreat, with both attendings and residents, which informs changes for the following year. This year resulted in changes in length of certain rotations, and in the amount of call each resident class will take. 

Dr. Bernstein relates the main changes planned for next year’s schedule are an increase of two weeks for the private office rotation and a resultant reduction in the podiatric medicine and surgery rotation. Lastly, Dr. Minhas shares that after taking into consideration feedback from her program’s review, there are plans for more surgical rotations and increased resident salaries in the upcoming year. 

Q:

Also at this time of year, we receive our residents’ confidential evaluations of individual attendings and what they feel would improve the program. Some answers are comments like “needs to explain about procedure choices and billing in much more detail.” Do you sit down with your teaching faculty to review these comments? Are the faculty receptive to such feedback? Can you recall examples where this exchange had an impact?

A: 

If comments are made about a specific attending, Dr. Minhas says the residency directors meet with the attending and discuss what was said. She maintains that faculty have always been receptive and amenable to change, and that there have been no major concerns about core faculty reported by the residents. 

Dr. Fallat shares that reviewing resident evaluations with faculty can be challenging at times. However, he will approach the attending, provide suggestions and reassure the attending as to the value of his or her teaching, if necessary. 

“The residents feel that the faculty has so much to offer them and would like to draw on their knowledge,” adds Dr. Fallat. 

Dr. Zarick agrees that approaching individual faculty is difficult, in her program’s case, with over 50 podiatric surgical faculty and attendings from other specialties. Instead, her program opts to address specific faculty as needed, and plans to modify resident evaluations this upcoming year to enhance the insight they provide.

Dr. Bernstein shares a structured approach to handling resident evaluations. He speaks to all members of his program’s Curriculum Committee, who he states provide the majority of daily education to the residents. Individual resident comments are kept strictly confidential, he explains, but are shared in aggregate. A careful file is kept each year of these conversations. 

“As a result, several attendings now understand the need to spend more time with teaching preoperative planning, postoperative care and billing of procedures,” notes Dr. Bernstein. 

Q:

What kind of changes have you enacted in your residency program in recent years based on resident evaluations and feedback? Can you recall a specific example or two?

A: 

Dr. Fallat relates, in addition to resident presentations, his program has instituted an attending review of surgical cases after the resident has served as first assistant. Discussion may include particular successes within the case, challenges faced and what could be done in the future to improve. 

Dr. Bernstein adds that several attendings now participate in events like Morbidity Conference, Radiology Conference and Journal Review. Also, he shares that his residency program is starting a mentoring program on July 1, which will enable each resident to choose an attending to speak with every week.

Dr. Zarick explains that entire rotations have been removed in the past based off of resident feedback. One example is the addition of a SICU rotation in place of internal medicine. She also cites an instance of a rotation at an outside facility being so successful that they will be sending additional residents to cover cases in the upcoming year. “Our program is truly different every year because of resident feedback and our actions to change,” says Dr. Zarick. 

Dr. Minhas states that after residents asked for more experience with billing and coding a few years ago, her program enacted several changes. First, they added more clinical time with a variety of attendings so learning could come from expanded sources. Next, the program encouraged residents to continue to spend time with attendings after their rotations are complete in order to get more one-on-one experience. Lastly, several mandatory lectures on billing and coding are scheduled throughout the year on this topic. 

“Some of the more motivated residents have taken advantage of these resources,” she states, “and subsequently have learned a lot.” 

Dr. Bernstein is the Director of the Podiatric Residency Program at Bryn Mawr Hospital in Wayne, Pa. He is a Fellow of the American College of Foot and Ankle Surgeons.

Dr. Fallat is the Director of the Podiatric Surgical Residency at Beaumont Hospital-Wayne in Wayne, Mich. He is a Fellow of the American College of Foot and Ankle Surgeons.

Dr. Minhas is the Assistant Residency Director for Podiatry at Roxborough Memorial Hospital in Philadelphia. She is board-certified by the American Board of Podiatric Medicine and is President-Elect of the Pennsylvania Podiatric Medical Association.

Dr. Zarick is the Assistant Residency Director at MedStar Washington Hospital Center’s Podiatric Surgical Residency Program in Washington, DC. She is an associate professor in the Department of Plastic Surgery at Georgetown University.