As parity with MD and DO colleagues becomes increasingly important, these second-year resident panelists discuss their experiences with non-podiatric rotations and their associated challenges and triumphs. Additionally, they share advice for fellow residents on how to maximize their off-service time.
Q: What non-podiatric rotations does your program include during residency training? Which rotation is the most demanding and why? In general, what fraction of time is spent on off service rotations?
A: Each of the panelists’ programs include rotations in Emergency Medicine, Infectious Diseases, Behavioral Health/Psych, Pathology, Radiology, Internal Medicine, Anesthesia, General Surgery, Vascular Surgery, Orthopedics, and Dermatology. Other off-service rotations of note include Wound Care, Research, Pediatric Emergency Medicine, Hand Surgery, Endocrinology, Geriatrics, Neurology, Orthopedic Oncology, Plastic Surgery and Vascular Lab.
The amount of overall time spent on these non-podiatric rotations does vary by program and training year. Joseph Altepeter, DPM relates that his program spends more time off-service in the first year of residency and steadily less as training progresses. Sahab Danesh, DPM relates an average of one-third of a resident’s time being off-service, and Nicole Zahn, DPM estimates closer to one-half of her time being spent on these non-podiatric rotations.
Both Dr. Zahn and Dr. Danesh say the rheumatology rotation is particularly demanding.
“As foot and ankle surgeons, we tend to manage these complex rheumatoid patients from a surgical perspective, much less so medically. Our rotation supervisor is aware of this and requires our month with him be taken very seriously. We are assigned literally hundreds of pages of literature to study each night (and the rotation supervisor) holds us accountable for that information by reviewing it with us prior to the start of clinic the next day,” relates Dr. Zahn.
Dr. Danesh agrees that rheumatology rotations require extensive review and preparation.
“The answer is never right in front of you. The department expects residents to know a lot of information before starting the rotation … and tests the resident’s skills in (obtaining) a through history, performing a physical exam and understanding which labs and imaging are required to guide the diagnosis,” shares Dr. Danesh.
Dr. Altepeter shares that at his program, the internal medicine rotation challenges residents the most due to the time demand and expectations of medical knowledge and decision making.
Lastly, Dr. Danesh maintains that the general surgery rotation is the most physically demanding rotation in his experience due to long hours and high expectations for academic and patient-related performance.
Q: How does your program juggle coverage of podiatry patients, cases, clinic, etc. when you are on a non-podiatric rotation? Do you take calls for podiatry or participate in emergency surgery after hours, even when you are not rotating on the podiatric service? What advice would you give to junior residents as far as balancing podiatric and non-podiatric responsibilities?
A: Most commenters related that when they are on an off-service rotation, the resident is dedicated solely to that rotation. The resident may take podiatric calls at night or on weekends if on-call duties overlap, relates Dr. Danesh.
Dr. Zahn explains that her program has two teams of three residents each. If team “A” is on podiatric surgery, team “B” is on an off-service rotation. This usually provides for podiatric case coverage by team “A.” All residents, regardless of rotation take calls and participate in scheduled and/or emergent surgeries, but from 8:00 a.m. to 5:00 p.m., the on-service team provides the primary coverage.
At his program, Dr. Altepeter says residents do not cover podiatry call when they are off-service. He adds that there is no requirement to cover emergency cases but says some off-service rotations are more flexible. However, when a resident is off-service, he or she is expected to be responsible for podiatric academics such as weekly didactics, monthly board review, cadaver lab and online journal club.
Dr. Danesh encourages junior residents to learn as much as possible while on a non-podiatric rotation.
“As residents, we have the privilege to learn from other medical specialties and it is our responsibility to take full advantage of this opportunity,” explains Dr. Danesh.
Off-service rotations can also be an exercise in time management and prioritization of responsibilities for the whole team, according to Dr. Zahn.
“Junior residents should always keep in close communication with their co-residents. The on-service team should work collectively to cover all the in-house demands so as not to disturb those residents off-service,” notes Dr. Zahn. “Utilizing your senior residents as a resource … can help you learn to recognize and manage the highest priority tasks first,” she shares.
Q: What do you feel is the value of non-podiatric rotations in your residency education and for your future career? Can you give examples of how or when these rotations made an impact for you?
A: All of the commenters agree that non-podiatric rotations are an invaluable part of podiatric residency education, contributing to a more well-rounded physician and better ability to participate in multidisciplinary care.
“Being involved with other specialties also helps build inter-specialty relationships within the hospital, allowing for more efficient patient care. This is obviously helpful during the residency experience but will provide a solid base to create those relationships (again) during practice,” says Dr. Altepeter.
The commenting residents cite improved patient workup, development of patient-specific care, familiarity with pertinent referrals and enhanced empathy toward patients as benefits of non-podiatric rotations.
Dr. Danesh cites a reciprocal learning experience being possible during off-service rotations. For example, while learning key techniques and information during these rotations, the podiatric resident may also share aspects of his or her training, leading to a better understanding of both specialties for all.
Dr. Zahn also adds that understanding the consulting physician’s perspective can be a vital asset to successful care.
“I feel off-service rotations are invaluable assets to both my education and career. Coordinated care amongst multiple specialties can be difficult at times. By participating in these off-service rotations, I have gained a unique understanding of various consulting physician’s perspective and approach to patient care. As foot and ankle surgeons, we work very closely with multiple specialties including vascular surgeons, cardiologists, endocrinologists and rheumatologists when managing patients. I believe it is dangerous and detrimental not to have had some form of hands on experience in these fields. These rotations not only provide you with specific specialized perspectives, they also provide you with a mentor/contact in the field with whom you can use as a resource for years to come.”
Dr. Bernstein is the Director of the Podiatric Residency Program at Bryn Mawr Hospital in Bryn Mawr, Pa. He is a Fellow of the American College of Foot and Ankle Surgeons.
Dr. Altepeter is a second-year resident with the St. Vincent Hospital Podiatry Residency Program in Indianapolis.
Dr. Danesh is a second-year resident with the Phoenix VA Medical Center Podiatric Residency Program in Phoenix.
Dr. Zahn is a second-year resident with the Bethesda Hospital Podiatric Residency Program in Boynton Beach, Fla.