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) (Start – Nov 2014)

MAV Category SK AM SP JS Average Required

Digital Surgery 10 8 6 2 6.5 80

First Ray Surgery 4 0 3 6 3.3 60

Other ST Foot Surgery 35 20 11 9 18.8 45

Other Osseous Foot Surgery 19 8 2 7 9.0 40

Recon RF/Ankle Surgery 0 1 0 0 0.3 50

Biomechanical Cases 0 0 0 1 0.3 75

Comprehensiver HP 64 69 13 34 45.0 50

All Trauma Cases 16 5 4 6 7.8 50

Podopediatric Cases 7 6 0 1 3.5 25

Logs (2nd Year Averages) (Start – Nov 2014)

MAV Category BC ER RE WL Average Required

Digital Surgery 29 60 57 63 60.0 80

First Ray Surgery 29 36 13 36 28.3 60

Other ST Foot Surgery 31 44 50 58 50.7 45

Other Osseous Foot Surgery 32 42 44 38 41.3 40

Recon RF/Ankle Surgery 38 5 15 0 6.7 50

Biomechanical Cases 41 14 41 61 38.7 75

Comprehensiver HP 118 98 59 63 73.3 50

All Trauma Cases 25 21 43 15 26.3 50

Podopediatric Cases 58 6 23 11 13.3 25

Logs (3rd Year Averages) (Start – Nov 2014)

MAV Category CH LV ST BA Average Required

Digital Surgery 102 125 106 116 112.3 80

First Ray Surgery 90 102 92 80 91.0 60

Other ST Foot Surgery 75 110 93 89 91.8 45

Other Osseous Foot Surgery 63 80 52 88 70.8 40

Recon RF/Ankle Surgery 41 58 48 49 49.0 50

Biomechanical Cases 77 68 95 100 85.0 75

Comprehensiver HP 91 81 88 87 86.8 50

All Trauma Cases 75 97 63 93 82.0 50

Podopediatric Cases 41 61 79 106 71.8 25

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