review for externs - weeblycrozerpodiatry.weebly.com/uploads/2/4/0/3/24036903/new_extern_w… ·...
TRANSCRIPT
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Review for Externs
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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)
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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
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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
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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)
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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
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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
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Sinai Hospital of Baltimore Rubin Institute for
Advanced Orthopedics
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Sinai Hospital of Baltimore - RIAO Attendings (M.D.)
Shawn Standard
John Herzenberg
Janet Conway
Attendings (D.P.M)
Bradley Lamm
Noman Siddiqui
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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)
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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
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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
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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)
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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
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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).
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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
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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
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Logs (1st Year Averages)
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Logs (2nd Year Averages)
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Logs (3rd Year Averages)
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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
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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.
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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
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Student Expectations (Student to resident)
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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
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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.
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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.
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Have Fun
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Resident Logs (As of March 2014)
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Logs – 1st Year (WL)
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Logs – 1st Year (RE)
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Logs – 1st Year (ER)
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Logs – 2nd Year (CH)
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Logs – 2nd Year (ST)
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Logs – 2nd Year (BA)
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Logs – 2nd Year (LV)
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Logs – 3rd Year (SA)
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Logs – 3rd Year (GS)
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Logs – 3rd Year (TS)
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Logs – 3rd Year (CF)