Ready To Train Or Ready To Practice? Redefining The Goals And Expectations Of Schools And Residency Programs
Here we are again. Another period of graduates outmatching the number of training programs until the powers that be gear up and produce more slots. Let “quality” be the key word this time please.
Also, residency directors, keep in mind that this is the 21st century and let me introduce a concept: “the handoff.” You may have heard of it but apparently expectations are still mired back in the 1960s and 1970s. I hear it from colleagues around the country all of the time, even on these blogs.
“The kids these days coming out of school don’t know anything,” colleagues say. “Why, they can’t even do a hammertoe!”
You know what? They shouldn’t be able to do a hammertoe. They shouldn’t be able to do any surgery. That is for a three-year residency to train them to do. In the 1960s and 1970s, there were states where graduating DPMs could go down the street, hang out a shingle and see their first patient.
That might mean performing a bunion surgery and dealing with a complication, handling a diabetic foot infection or just debriding a neuropathic patient’s onychomycotic nails every three months. The point is that the podiatric medical school had to ensure a handoff at graduation to the public or to the residency programs of a doctor ready to practice but possibly with as much training as he or she was going to receive.
Here is an important question for you: Does that make any sense in 2010? Unfortunately, residency directors are still expecting the same “product,” the ready to practice model. That would be fine except those students come at a price and it denies our profession the ability to reach the goal of the American Podiatric Medical Association’s (APMA) Project 2015.
The amount of knowledge allopathic/osteopathic medical students get now is so much more than what students got in the 1960s, 1970s, 1980s or even the 1990s. To reach the ideal of Project 2015, our students need to receive the curriculum of the MDs and DOs and get an emphasis on the lower extremity.
Will the schools be able to teach them to be foot surgeons as well? It is my personal opinion that this is the job of the residency programs.
What is the handoff of the MD/DO schools? They are learning their procedures once they hit residency. They do the odd, small procedure as students but they learn the majority of their work as residents. Med school is for first and second order learning: knowledge and comprehension. Residency is for third and fourth order: application and analysis.
Maybe it is time for all of the educators, both in med schools and residencies, to do some advanced learning — synthesis and evaluation — and reconsider the handoffs here. It sounds like a revamp of the Educational Enhancement Program (EEP) of the 1990s and to that, I would say “No!”
We do need to make this subject an important part of Project 2015 because frankly, we have this all wrong for the 21st century. We are not producing ready to practice physician surgeons. We should be producing ready to train graduates.
Our residency interviewers continue to perform the “academic interview,” the code phrase for “We don’t want to teach you the contents of your intern year.”
General medical schools conduct social interviews to assess whether candidates will be compatible with the team. They do not ask them to list the essential amino acids while picking up BB-gun pellets with a pair of chopsticks with a non-dominant hand, and then do hand-ties while they recite the citric acid cycle. They know they have the educational foundation they need in order to be clinically trained to become physicians.
Too bad podiatric residency directors are too selfish to realize what Project 2015 offers our profession: real parity with MDs/DOs.