If you have been involved in a really good grand rounds, you know what it means to prepare well for a surgery, a care plan or a discharge.
As a first-year resident in Connecticut a long time ago, I remember facing Gary Jolly, DPM, and proposing a surgical procedure for one of his patients. I gave him a typical “NLDOCAT” breakdown of the patient’s problem. After describing the nature, location, duration, onset, course, aggravation and treatment for the patient, I was proud of my presentation to this brilliant surgeon.
Dr. Jolly had a self-described “allergy to biomechanics” so I did not go there. However, I soon learned that he knew more about the subject than many who studied it for decades. He just called it “foot function.” Dr. Jolly never took anyone to the OR without knowing how the foot functioned abnormally beforehand and how the correction would allow it to function afterward, and in concert with the contralateral limb in ambulation.
“I can teach a monkey to do the actual procedure,” he would say with a laugh. He assured his residents and students that he did not see us as those caged primates because we would understand foot function by the time he got through with us. Indeed, we did. We never operated on a “foot in isolation.”
This is why I am concerned when I read the new CPME rewrite of Documents 320/330. These proposed documents reduce the number of biomechanical cases and de-emphasizes the medicine component of our training.
It was my personal understanding that by developing a comprehensive model of residency training, we were doing just that. We had a shot to do it with the rewrite and I think we are missing the target. The goal was to make residency training more comprehensive, not less.