In this lecture, Dr. Solomon shares his definition of what makes a great residency program. He describes the necessity of a symbiotic relationship between the program and the resident in order for the program to strive. **** This lecture is not available for CME ****
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Release Date: 03/16/2018 Expiration Date: 12/31/2020
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Marshall Solomon has nothing to disclose.
Male Speaker: Next speaker is Dr. Marshall Solomon who’s going to be dealing with how to run a great residency program. I’m sure everyone here think you’re in a great residency program. He’s just going to highlight what you’re already experiencing. So please welcome Dr. Marshall Solomon.
Dr. Marshall Solomon: Good morning, everybody. I would first like to thank PRESENT E-Learning for this opportunity to address you this morning. I want to just say that I want to have a disclosure here that I’m biased. 35 years of residency directing, as a director, has brought me the experience to see what has evolved in podiatric residency training over these number of years. Many directors would love to just start all over and be a resident just like all of you in this new paradigm that we teach in. But this certainly is biased but it is evidence-based. I’ll tell you why it’s evidence-based. It’s based on the graduates that come out of our programs. I can only direct the program that I administer. I am very proud to see the success of the graduates that have come out of my program that have become great practitioners, academicians, and leaders in our profession. To me that is what makes a great program. If I can move this along. No program is a utopia. No matter what, no program can provide a hundred percent of all of the core competencies and MAVs that are required in CPME 320. Some programs emphasize reconstructive surgery, trauma. Other programs have fantastic foot and rear foot experience or they have excellent medicine in biomechanic rotations. But a great program can balance both medicine and surgery together. Let’s take a look at what I feel makes a great program. These are some of the requirements. It must provide that medical and surgical core competency experience based on its resources. Resources are an important component of any great residency program. They must meet at least the requirements of CPME 320. It must have the core competencies that our document makes us adhere to. Of course we want that the program to meet at least the qualifications so you can sit for a board qualification in ABPO, PPM, and ABPS. Of course, we want to make sure that the great programs do have competencies that are over and above the requirements in 320 and that those are accomplished. Currently these are the new competencies that are seen in the podiatric medicine surgery residency program. It’s broken down between case activities and procedural activities. A thousand encounters and case activities, 300 surgical cases, trauma cases of 50 of which 25 need to be lower extremity. They don’t need to be all surgical. Podopediatric cases of 25. Biomechanical cases which have been redefined by the Council of Podiatric Medical Education to include examination including gait analysis, diagnosis and treatment, 75 cases. And of course there’s been an increase in comprehensive medical histories and physical examinations, not problem-focused but comprehensive. The procedures include they’ve changed from letters to numbers, were no longer Bs and Cs, were first and second assistance. A total of 400 of those procedures followed by being a first assistant in the following numbers include diversity within each of these numbers. AD digital 60 first ray which include hallux valgus, hallux limitus, and other first ray, 45 soft tissue procedures of the foot, 40 osseous procedures of the foot.
Then for added credentialing our RRA 50 reconstructive cases of the foot and ankle. Now the medicine experience is changed also in the program. To have a great program, the minimum amount of internal medicine is three months including infectious disease. But these are the core rotations that are required within 320. Internal medicine and family practice, infectious disease, diagnostic imaging, behavioral science, clinical and anatomical pathology, emergency medicine, and of course podiatric medicine. There are other additional electives which there are two which composed three months of medicine. It could be rehab, PMnR, rheumatology, pediatrics, endocrinology, neurology, dermatology, wound care, and also pain management. The surgical experience, the course, include anesthesia, general surgery, and podiatric surgery. You can have one additional elective or you can have more of course. I think in a great program you want to have as much exposure to surgical sciences as possible; vascular surgery, orthopedic, and plastic surgery. If you have an opportunity, pediatric orthopedic surgery and traumatology. So what other things make a great program? I think it’s important to have a hospital-based podiatric clinics that are supervised by core physicians. I think you should definitely experience private practice under supervision. And that the program should have an active podiatric consultation service. I think that what makes the difference in a program or a great program, though it is not required by the council, only research methodology, is to understand and conduct IRB research. I think that does several things. It allows the resident to critically review the literature that’s involved in medicine and in surgery. What it does is essentially adds to the science of podiatric medicine and surgery. I think research is an absolute must. Now let’s talk about few of those things that I feel that are inherent in a program. Really sort of take it over the top. One of those things is the ability to empower the resident. The key here is to improve their didactic knowledge, to raise their level of clinical and surgical skills, improve their professional and positive attitudes, and development of judgment through exposure of experience and teaching. Ultimately what we want to do is take our residents from the introduction of their residency training from the base in Miller’s Triangle to a level of above competency. I think great programs. I don’t think any program in the United States takes anybody to the level of expert physician. I think that comes with years of experience and continuing lifelong learning. Another component I think is the concept of team play, being a team player. Part of this is to the importance that no one within the residency program is left behind, and to support the academic, clinical, and surgical wellbeing of every resident, even if it means residents need to have some form of remediation during their training to accomplish that. Of course residents to support each other, so they understand that the success of the program is dependent on all of them is part of the team. I think it’s important to have a core teaching faculty that are committed to the education and skill training of your residents. This includes the ability to give constructive feedback and assessment, the ability to mentor clinically and surgically, to provide or exemplify professionalism in both attitude and communication, and always showing that the way to succeed is to take the high road.
That the importance of being actively involved in faculty development to enhance resident education is important, and then to have a supportive medical education department at the hospital which will help give you the resources that you need to educate your residents. I think it’s important for the resident goals in a great residency program to use the program’s resources, and to be a self-starter and be committed to their education by funding their didactic knowledge, and being both active clinically and surgically so they can enhance their ultimate practice. They in turn also mentor their fellow residents and their students. The most important thing is to enhance and develop a good portfolio of research, in-training examinations, and clinical exposure so you can ultimately get a good job. What is a great program director? Simply one who is committed to the knowledge, skills, and attributes, professional attitudes of the resident. Provides resources to meet both the core competencies and the MAVs or exceed them in 320. Provide assessment and feedback to the residents so they understand what their strengths and what their weaknesses are and how they can improve on their weaknesses. To be a mentor and a colleague and a friend to residents in a professional manner. This is my philosophy. It’s been my philosophy since I’ve been actively involved in resident training. I feel that 90% of the knowledge to provide the program, we should provide 90% of the knowledge, skills, and assessments and judgment. The remaining 10% is lifelong run. If there’s anything that we try to impress to our residents is that this 10% is the fuel that continues. It’s the life, blood, and it’s a reward in life that you have for education and for good patient care. I just would like to end because I’m real big on attitude. My residents know about it. I have this little sign. It’s not so little. It’s a little bit bigger sign on the wall in our resident office. I’d like to take just this quick moment to read it to you. It’s called Attitude. The longer I live, the more I realize the impact of attitude on life. Attitude to me is more important than facts. It is more important than the past, than education, than money, than circumstances, than failures, than successes, than what other people think or say or do. It is more important than the appearance, giftedness, or skill. It will make or break a company, a church, a home. The remarkable thing is that we have a choice, everyday regarding the attitude we will embrace for that day. We cannot change the inevitable. The only thing we can do is to play on the one string we have, and that is our attitude. I’m convinced that life is 10% what happens to me and 90% how I react to it. So it is with you. We are in charge of our attitudes. Thank you.