Review for Externs

Residents 1st Year – Sandy Khehra (TUSPM), Amy Miceli (KSU),

Sneha Patel (TUSPM), Juliette Smith (NYCPM)

2nd Year – Byron Cook (TUSPM), Randall Eldridge (TUSPM), Wendy Le (Scholl), Emily Rose (TUSPM)

3rd Year – Bijan Andrade (NYCPM), Chris Hood (TUSPM), Simon Tabchi (TUSPM), Luke Vetti (TUSPM)

Attendings Crozer – Samuel; Lehrman

Taylor – Adamo; Massimini

DCMH – Greenfield; Teplica; Cornell; Peacock; Villanueva

Mercy Fitzgerald – Urbas; Ziskowski; Hawley; Oliver

MISC: Romansky; Erfle; Flannery; Jones; Sutera, Rondeau; Denenberg; Conti; Innanuci; Walpole; Schilling; Anghel

Where We Go… Pod 1

Crozer Hospital

Taylor Hospital

Springfield Hospital

Brinton Lake Surgery Center

Pod 2 DCMH (Delaware

County Memorial Hospital)

Mercy Fitzgerald Hospital

Mercy Philadelphia Hospital

Surgery Center of Pennsylvania / Haverford

Rotations 1st Year = Podiatry Surgery (6 months); General Surgery (1

month); Family Practice (1 month); Infectious Disease (1 month); Emergency Department (1 month); Vascular Surgery/Anesthesia (1 month); Pathology/Radiology/Diabetic Wound Care (1 month)

2nd Year = Podiatry Surgery (6 months); Rubin Institute for Advanced Orthopedics (2months); Behavioral Science/Psychology (1 month); Orthopedics (1 month); Research (1 month); Elective (1 month)

3rd Year = Podiatry Surgery (7 months); Pain Management (1 month); Office Clerkship (1 month); Research (1 month); Elective (2 months)

What We Do – 1st Year “The Dirty Stuff”

Amputations (digital, Ray, TMA) Incision and Drainage Removal of Hardware Bone Biopsy TAL Minor Office Procedures (Laser, Tenotomy, ST Lesion, HT, etc.)

Floor Work Bulk of the rounding / managing inpatients; new consults

Pre/post-op inpatients; wounds (arterial/venous); cellulitis; trauma; nails

ED Consults I&D / Debridement Foreign Body – glass, nails, needles, splinters, bullets Fractures / Trauma – nail lacs, closed reduction/splint toes, mets, ankles Lacerations

What We Do – 2nd Year Floor Work (assist 1st year)

Forefoot Surgery

Bunions, hammertoes, metatarsal osteotomies (Weil, Jacoby)

Soft tissue lesions

Plantar Fasciotomy (Open, Mini-Medial, EPF)

Trauma forefoot

Neuroma

Baltimore

Office Hours

Research

Sinai Hospital of Baltimore Rubin Institute for

Advanced Orthopedics

Sinai Hospital of Baltimore - RIAO Attendings (M.D.)

Shawn Standard

John Herzenberg

Janet Conway

Attendings (D.P.M)

Bradley Lamm

Noman Siddiqui

Sinai Hospital of Baltimore - RIAO Podiatry

TSF / Ilizarov Frame Ankle Distraction Charcot Reconstruction

Flatfoot Reconstruction (Evans, Cotton, Dwyer, Koutz, MC Fusions, Bunion)

Brachymetatarsia w/ ExFix Core Decompression Plastics/Flaps for Wounds G/S or TAL Procedures

Baumann, Vulpius, TAL

Coalition Calcaneal Graft Harvesting CMT Reconstruction

Osseous and Tendon Work

AVN Non/Mal Union Post-Traumatic Deformity TAR

Ortho Limb Lengthening (ISKD, Ex-Fix;

“Precise Nail”) CFD (Congenital Femoral Deficiency) Tibial/Fibular Hemimelia Osteogenisis Imperfecta Dwarfism Clubfoot Reconstruction AVN – Perthes, Blounts Epiphysiodesis (8-plate application)

for Genu Valgum/Varum Joint Contractures

Tendon Release, Botox Injections

Non/Mal Union/Post-Traumatic Infection

THA/TKA Implant Infection Mgmt

RIA (Synthes) Fusions (Ankle, Knee) Some upper extremity (Radial

Clubfoot, AVN)

What We Do – 3rd Year Floor Work* Rearfoot Surgery

Proximal Bunion (Lapidus; C/O-BWO) Flatfoot/Cavus Foot ExFix/Charcot Fracture/Trauma (Ankle, Calc, Talar, LisFranc) Tarsal Tunnel Ligament/Tendon Repair Arthroscopy

Office Hours Research; Study Hours; Find a Job

Daily Routine 1st Year (0600-1700) – Rounds, Office Cases,

Surgery, Consults, ED Call Downtime – update list, re-round on patients, prepare

for following day, RELAX

2nd Year (0700 – 1500) – Rounds, Office Hours, Surgery, Assist 1st Year as needed

3rd Year – Rounds prn, Office Hours, Surgery Call

1st Year – Primary Call - EVERYTHING 2nd Year – Back-Up Call / Assist Weekend Rounding 3fd Year (Pod 1 / Month) – Trauma Level Surgical Cases

Resident Academics Meeting every Thursday 18:15 @ SPH

Journal Club – format varies Radiology Rounds Rep Company Lectures/Workshops (Arthrex,

Wright, Stryker, Santyl, Acell, Oasis, Dermagraft) Resident Lectures / Presentations Attending Lectures (podiatry and beyond) Board Review Topics / Exams Jeopardy Research Presentations (Resident Research)

Resident Perks PMSR/RRA Approved

Accreditation Approval (May 2013 6 year)

Salary - $48,902 / $51,087 / $52,912 CME Benefits - $1800/year Food - $140.50 / $117 / $110 per month. Vacation

1st year = 10 days + 5 sick days + 5 CME days 2nd year & 3rd year = 15 days, 5 sick days + 5 CME days

Gym Membership (Springfield Healthplex) MISC

Academic Money from Crozer (~$1500) for Conference Presentation

Crozer Run Resident Research Fair / Poster Presentation Attendings with research project interest

Advantages / Perks Lots of attendings with varying years of experience

Different techniques, different though processes, varied training background, different fixation techniques.

Mix of cases.

Autonomy Program very resident driven/run regarding expectations and

getting work done correct efficiently, effectively, patient driven, the first time.

Hands-On Majority of attendings let you do the bulk/entire case on your own,

guiding you though.

Office Experience No clinic, but attendings with different office set-ups and styles to

learn from (billing, office efficiency, managing an office, streamlining, business practice tips).

Advantages / Perks Practical

Will teach you how to function in an environment that is common to the vast majority of podiatrists but with an evidence based approach.

Patient Population Varied environments/socioeconomic climes.

Level 2 trauma facility to community hospital. First call for foot trauma First call for all limb salvage 2 Dedicated Research Months (2nd / 3rd year) Baltimore – Sinai Hospital of Baltimore The Attendings (can’t stress this enough) Teamwork

Disadvantages Ortho… (Trauma)

Is first call for most operative ankle trauma/no initial management

Most ankle trauma OR experience is with ortho

Large Rearfoot elective; TSF; Recon

Driving Physical toll; stressful for time commitments

Downtime (?)

Call (?) – no post-call; 1 week at a time

Logs (1st Year Averages)

Logs (2nd Year Averages)

Logs (3rd Year Averages)

Resident Expectations – Hospital (Resident to Student) Floor Work (Assist)

Rounds / Consults / ED Pre-round, break dressings down/gather new supplies, write SOAP notes. Patient List – know your patients.

Surgery Pre-Op/Post-Op Notes; arranging the room; being prepared for the

surgery academically (you may be asked questions…!!!) Office Hours

Physician Private Office Hours or Wound Care Clinic Hours when time permits

Call – 1 week/wknd each During week – prn Weekend – one day (Saturday) rounding with first year.

Values Stressed: Autonomy, self-motivation, quick learning, problem solving, critical

thinking, adapting

Resident Expectations – Hospital (Resident to Student)

Be aware of, and learn about, the medical problems of the patients on our list.

Participate in patient care as active team member

Demonstrate clinical reasoning skills

Demonstrate critical thinking skills

Demonstrate self-directed learning. “Be a learner.”

Feel comfortable and encouraged to speak directly with attendings, consultants, residents.

Resident Expectations – Academic (Resident to Student)

5 Minute Presentations – 2/month; assigned by a resident; given at Thursday meeting

Journal Club*

Radiology Rounds*

End of the Month Presentation – Must clear topic with chief resident (have a few topics to pick from); should be surgically based.

Mock Interviews – Held the last week of your month

Downtime – Ask questions; Make your resident teach you

Student Expectations (Student to resident)

Student Expectations (Student to resident)

Writing Notes – SOAP/Progress, H&P, Pre/Post-OR Notes, Make sure YOU are writing notes. Always sign and date your note. Always leave your note in the chart OR take a fresh page.

Assisting in the OR* Get your hands dirty

Review Imaging – XR, MRI, CT, Vascular Exams (ABI/PVR, Angio), Bone Scan

Take small moments for teaching Take advantage of breaks to ask a question. Don’t be afraid to ask a question.

Be Open Minded

Feedback; both positive and constructive

Side Note – Writing Notes See informati0n / guide from website.

Remember what note is for what, and what hospital

Always start note on fresh page (nothing on front/back).

Labs – DATE all labs that are not of the present day.

Vitals – check T(max)24h, if elevated – note along w/ present.

SIGN all notes, print name, MS-4

Never remove other notes from the chart.

Make sure your resident sees/reads/signs your note if you remove it/carry it with you before placing back into chart.

ASK your resident to SHOW you how it is done.

MISC Driving

There will be a lot of driving for you.

Hours 0600 – 1500+

Days Off Just ask; usually no problem (within reason)

Problems Direct to your resident / chief resident

If it’s something that your 3rd year can resolve, let them before reporting to the chief.

Patient List / Confidentiality DO NOT LOSE THE PATIENT LIST. TRASH LIST AT HOSPITAL WHEN FINISHED.

Have Fun

Resident Logs (As of March 2014)

Logs – 1st Year (WL)

Logs – 1st Year (RE)

Logs – 1st Year (ER)

Logs – 2nd Year (CH)

Logs – 2nd Year (ST)

Logs – 2nd Year (BA)

Logs – 2nd Year (LV)

Logs – 3rd Year (SA)

Logs – 3rd Year (GS)

Logs – 3rd Year (TS)

Logs – 3rd Year (CF)