Preparing for Residency

During the first two years of podiatric medical school it can be easy to become “lost” in the didactic basic science courses. It is important to keep in touch with the podiatric side of your training as much as possible during this time. One of the easiest ways to do this is to get involved and find mentors, both among the faculty and upperclassmen. Although you may feel like you are in a unique situation, it is almost certain that someone else has been through similar circumstances. Take advantage of their experience.

You should also attempt to start gaining clinical experience during your first and second years. Although your formal clinical training probably won’t begin until the third year, there is nothing stopping you from heading down to the school’s clinic, shadowing a local podiatrist or visiting a nearby residency program. You will quickly find that the majority of your learning will come from direct patient encounters, and not from any class or textbook. The overall goal of your four years should be to learn as much as possible, from as many patients as possible, so that you are better able and more prepared to help the next patient you encounter. This is best accomplished by getting an early start.

It’s never too soon to get started on your curriculum vitae (CV), and it should be continually updated as you progress through school. Don’t overreach. Appreciate that your CV is not a substitute, but rather a complement to you as an individual. Everyone’s CV starts out fairly “bare bones,” and then grows as you grow in your career. It should, however, highlight distinct aspects of your training and experience that may differentiate you from other students

Areas to focus on when writing your CV

Where did you do your undergraduate work and what did you study?

Are you coming straight from undergraduate school or do you have relevant previous work experience?

What is your involvement in organizations? This will emphasize personal interests and initiative.

Have you been involved in any research projects?

While your CV should be kept as professional as possible, it is acceptable to personalize portions of it with your interests and hobbies.

You should also begin to accumulate letters of recommendation and a reference list. This is something that you will need throughout your career, so start out by keeping everything as organized as possible. Be sure to ask faculty members for permission before you include them on any reference list, and ask for letters of recommendation as early in the process as possible.

Podiatric medicine and surgery is a unique field in that there are several potential sub-specialties, although it is a specialty itself. It is likely that you will become interested in some specific aspect – some examples are: 

Research

Pediatrics

Sports Medicine

Wound Care

Reconstructive Surgery

However, the only way you will find out what you are interested in is to actually experience it. Most of these “sub-specialties” have individual clubs or professional organizations within the school in which you can become involved. If you think you may be interested in research, find a mentor and do a research project. If you think you may be interested in surgery, visit residency programs as much as possible to get into the operating room. If you think you may be interested in wound care, find a local wound care center and volunteer. It’s obviously not a complicated formula, but it does involve you taking an active role in the process.

There are obviously a number of things to take into consideration when evaluating different residency programs. One of the most important things, however, is to appreciate that you shouldn’t simply choose a “good” program, but instead a program that will be “good for you.” Every program in the country has individual characteristics and variables that make it unique, just like you should have a unique list of what you are looking for in a program. You should pursue the program that is going to provide the best environment based on the way that you learn. Some things to consider include:

Surgery/Academics
How is this program going to make you a better doctor? You’re going to learn surgery and do some academic events at any program in the country, but is there anything special about this particular program that sets it apart? What is the monthly academic schedule? What meetings and conferences do the residents go to on an annual basis? Do they really seem to care about academics, or are they just done to meet a requirement? (Hint: A good way to tell this is to see how often and how many attendings participate in academic meetings). And although the quantity of surgery is important (you have to be able to get your “numbers”), also consider both the quality and variety of the surgeries at a program. If a strong surgical background is your primary interest, then focus on programs with large surgical volumes. Don’t be fooled by the number of years a program designates. There are many PSR-24 programs available that perform significantly more surgery than PSR-36 designated programs. Furthermore, look at the type of surgery being performed. Some programs may have a large volume of cases but primarily focused on forefoot surgery rather than the rearfoot and ankle. Ideally a strong program will offer a well-balanced number of cases in both forefoot and rearfoot/ankle surgery.

A Good Gauge on the Type of Program and the Volume and Quality of Cases Being Performed
Talk with colleagues who have rotated through the program. Don’t always rely on the comments the current residents have to offer, especially if you do not know them. Their opinions may not always be in your best interest. Most residents will naturally be proud of there program whether it was their first pick or not. Therefore many may try to “sell” their program; but it may in fact not be exactly the program the best fits your needs. Make sure you obtain multiple opinions about the program, particularly from someone you know and trust, before making you decision.

Look at the Surgical Numbers for Residents
Forefoot, rearfoot, and ankle. Do the residents get to work with both podiatry and orthopaedics? How many residents usually scrub in for each case? The more residents in each case, the less each resident will get to do. How many attendings are on staff, and what is the attending to resident ratio? Does the program have good rotations, and how often are the residents in clinic? Surgery is most important, but a quality clinic is necessary as well. What is the pay, and is CME money available? Does each residency have a lot of teaching (ie journal club, board prep, M and M, etc)? Is there a lot of research at the program and how much is it stressed? (Research may not be for everyone.)

Outside Rotations
All programs have the same set of required “core” rotations, but is there anything unique about a particular program that shows that they really care about your complete education and want you to have an outstanding quality and variety to your residency experience?  Are there any rotations that can’t be found at any other program in the country?

Location
There are several things to consider with respect to location. The first is the actual “setting” of the program. Is everything at one hospital, or are you traveling to different hospitals, surgery centers and clinics? Do you work with a small or large group of attendings? There are pros and cons to each of these experiences, and it will be important to consider what you think is the best experience.

You should also consider the “presence” of the program within the specific hospital. Is the podiatric surgery department intricately involved within the hospital, or is it more of an afterthought? (Hint: A good way to tell this is to see how involved the residents and attendings are. Do residents and attendings participate on hospital committees and boards? How well do the residents know the Graduate Medical Education (GME) office? Do the podiatric residents interact with the other residency programs within the hospital?)

Independence
How structured do you want your residency experience? Some people would prefer to get a rigid three-year schedule starting from day one, while others would prefer to have the freedom to vary their rotations based on their interests.

How closely does the degree of freedom of a residency program correlate with how much freedom you want?

Is this a program that fits your personality and learning style?

How do the staff interact/teach residents?

Travel and Expense Requirements
This is important to consider, but should not dictate choices as much as where the best training is for you.

The Future
How is this program going to help you accomplish your professional goals now and after you graduate?