Residency Insight -- A PRESENT Podiatry eZine

Volume 6 - Issue 9

We know that obtaining a “good” residency is a key issue for most podiatric medical students – as it really should, I suppose. With that said, I do hope that obtaining a thorough pre-doctoral education is also high on your list of goals. After all, you need to become a doctor before you become a resident. And part of this process is becoming a good student. We have spoken of this before in terms of learning your Medicine, Pathology, Pharmacology, Biomechanics, Physiology, etc prior to focusing so much on surgery. I believe that the latter needs to be taught in residency primarily rather than having such an emphasis on it during formal Podiatry education. As I’ve Successful Resident repeatedly said, students can more easily recite ten different bunionectomy procedures than they can five antibiotics for treating staphylococcus aureus. You need to become a doctor first and a Podiatric Surgeon thereafter.

In this brief essay, I wanted to take your education to the next level and discuss what it takes to become a good resident. This is not always easy and takes a lot of effort. But it is really common sense and attention to detail that separates the “wheat from the chaff” (from an old Crosby, Stills, Nash and Young album. For those of you who don’t know who I’m talking about – just forget it). I’ll try to draw from my own experience years ago as well as from the very many residents that have come under my direction over the years. Several good characteristics distinguish exceptional residents from their average counterparts (we will not discuss those residents who just perform poorly – by completely missing the boat and not following the lead set by the multitude of good residents).

First, the “good” resident is always enthusiastic about his/her job. This resident is eager to treat patients and help those in need of care (and will stay until that last patient has been treated in clinic). This resident is upbeat and eager to see patients whenever and wherever they present (clinic, hospital, ED, nursing home, etc.). This enthusiastic resident doesn’t complain about the workload, the hours, or that late day admission on top of all the other patients under his/her care. A complaint is rare from this resident (other than for lack of supplies, no OR time, lack of concern from others, etc.). In short, this resident is a pleasure to work with and makes their attendings’ lives much easier. A cheerful resident with a positive attitude will also be given many more opportunities to operate “independently” than those without such characteristics.

Second, the "good" resident pays attention to detail. This means following through on everything. Every detail on every patient is fully addressed – the H&P is done promptly, outside records are called for, abnormal labs are investigated, additional testing to work up new problems is sought automatically, consults and discussions with other services are initiated as appropriate, etc. Phone calls are returned promptly to patients and families. Concerns are addressed as they arise. For surgical patients, consents are drawn up in advance, supplies/equipment are requested prior to the surgery, and potential problems are addressed or better, avoided by proactive intervention (like getting an advance urinary drug screening on appropriate patients prior to the time the patient shows up for surgery). Thinking ahead to solve problems before they occur is a key attribute of a good resident.

Third, and last on my short list, is that resident who always does their homework and is constantly reading and studying – not just for board exams, but to learn more about conditions being treated in the hospital or clinic each day. This resident is taking full advantage of his position and seeks to learn all he can in a learning environment. I certainly appreciate it when a resident tells me about an article they were reading on this or that and what did I think about it. Or, when I make a suggestion about a patient’s care, the resident informs what he had read about the condition and offers an alternative approach to the problem based on the evidence he recently read about. This is not what I would call “challenging” your attendings, but rather, offering an educated suggestion to better patient care. There is a fine line, but the secure attending will welcome (and appreciate) such behavior from their residents. Furthermore, this will make a good impression. SNext, start quoting articles and authors to substantiate your mastery of the given subject matter.

Notice that I have not been talking about “smarts” or grades here – this is a critical point. I’ve seen superlative students become only average residents and I’ve seen average students become superlative residents. While grades are important to getting you into a residency, it is your attitude, initiative, attention to detail, and pursuit of knowledge that will make you an excellent resident and practitioner. Take these comments to heart and take them for a test drive – I’m sure you’ll be pleased with the results!

Robert Frykberg, DPM, The VA PACT Experience: Mortality and First Onset Diabetic Ulcer