What You REALLY Need To Know

I'm going to risk getting myself in some trouble with my Western University College of Podiatric Medicine bosses.

As the newest podiatric college, we've been looking for new faculty members just about since we started (we never seem to have enough faculty). One of the tasks we ask of our faculty applicants is to give a lunch hour lecture on some topic. Initially, I found these lectures interesting, but as time has gone by, I've become increasingly bored with the lecture topics.

Some of the recent topics have included Charcot reconstruction, lower extremity reconstruction with external fixation, and limb salvage. Except for our most recent hire, Dr. Francis Chan, who spoke on DVT of the lower extremity, almost all of the lectures have been surgical in nature.

Bo-ring!

It's pretty obvious why someone would pick surgical subjects to lecture to our faculty. First, it gives the applicant a chance to strut his or her stuff. "These are the bad ass cases I did during my fellowship." "I'm such a good surgeon" they try to show us. Second, podiatry is a surgical subspecialty (like it or not) to some extent. Third, they think these topics are interesting.

Wrong!

Here's what's wrong with this thought process. First, if you show me your cool fellowship cases, then I'm only impressed with your attending, not you. Show me how you dealt with your own complications successfully and I'll be impressed. Second, I already do surgery. I've personally been doing surgery for eight years after residency. I've seen almost everything, and I'm not impressed that easily. Neither are the rest of my faculty colleagues. Third, I want to see two things: your ability to teach (since that's what your job will focus on – students and residents) and your ability to think.

I know what you're thinking right now. You want to know what topic I lectured on when I applied for this job, since I'm criticizing others' choices. Before I tell you my topic, let me explain my strategy.

First, I knew who my audience would be and that it would include Lawrence Harkless, DPM, one of the most knowledgeable physicians on diabetic limb salvage in our profession. What could I possible say that he didn't already know? That left out the entire diabetic/wound/limb salvage part of the profession.

I also knew the rest of the faculty were high quality surgeons and would be bored by the same old resident-style surgical topic review. Yawn.

Tonight's Premier Lecture is
The New Frontier in Foot and Ankle Diagnosis: In Office 3D Weight Bearing Imaging
Stanley R. Kalish, DPM, FACFAS

What to Speak About Then?

I picked a topic that fewer people would know about, allowing me to teach them something potentially new. I wanted to demonstrate my ability to use current research literature to answer clinical questions while speaking about a humanistic part of medicine (one of the driving concepts of the University as a whole). I wanted a topic that would also allow me to throw in at least a little of my personality to show the staff who I was.

So, what did I lecture about? The World Health Organization's 19-point surgical checklist and error reduction in surgery.

It may not sound like the sexiest topic in the world, but it satisfied all of my criteria. I discussed the horrible statistics about surgical errors (and, yes, they still needlessly occur today), the ways in which other professions have used checklists to reduce errors (specifically the airline industry), and the surgical checklist research project popularized by Dr. Atul Gawande and published in the New England Journal of Medicine. During the lecture, I managed to add in some medical history (a personal love) as well as my own personal history instituting the checklist at a prior hospital.

Since I got the job, I guess I was reasonably successful.

My point in bringing up this long-winded complaint about our faculty applicants' lecture choices is actually to emphasize a point about our profession. We've become so overly focused on surgery that it's as if we're a bunch of peacocks strutting our giant overgrown tails or – maybe more appropriately – a bunch of turkeys bred to have breast muscles so large we can no longer walk. We're surgery heavy.

These faculty applicants are simply parroting the rest of us (yes, me included) thinking about nothing but surgery. What ever happened to the nonsurgical side of podiatry? Biomechanics, physical therapy, taping, strapping, orthotics, prosthetics, medications, dermatology, rheumatology, etc – what about these topics and others? How many residents graduate knowing how to handle a clinic full of patients who want to try something before going under the knife? How many graduating residents know how to code and bill appropriately, if at all? I'll bet most of them don't know a 99213 from a hole in their head.

This is what you REALLY need to know: How to handle patients outside of the OR. Those of you in practice will attest to the importance of having strong practice skills: a friendly, caring, honest bedside manner; an ability to steer a busy clinic to completion on time with profitability; an ability to handle the variability of complications that occur; and an ability to teach (in this case teaching patients). And, most importantly for me: an ability to question and find your own answers.

Yes, I love surgery. Yes, I want it to remain an important part of my practice. No, I don't think we should do less surgery in residency. But I also think it's time for us to re-embrace the other, larger, side of our profession with pride.

Residents, you'll learn how to do surgery. Don't worry. If you learn the above skills, you'll have a truly high quality residency experience that will prepare you for the reality of podiatric practice.

For those of you interested in applying for jobs teaching our future colleagues, consider this conversation when picking your topic. Demonstrate to us your complete knowledge of podiatry's many facets and the job will be yours. Or don't. I'm sure Dr. Harkless really wants to hear another diabetic foot ulcer or Charcot lecture...

Best wishes,

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]