Follow along as I start the next chapter in my life! Also featuring anything interesting I stumble upon that I want to share.
what are the pros and cons of going into podiatry? If you could start over, would you choose to go into podiatry again?
I would absolutely go into podiatry again, but it’s also too early to make that decision :P if I don’t get a residency because of the shortage, obviously I’m not going to say that. If everything goes as planned though, I am very excited for my career.
Pros: versatile, nice mix of surgery and clinic with mix of trauma and elective surgery, long term relationship with patients, easier call schedule once out of residency compared to other surgical specialties (unless you’re like a residency director or something)
Cons: get paid less than most medical specialties, not always respected by old school docs or patients, no prep books for boards and therefore no real direction on how to study for them, residency shortage
Where do most podiatrists get jobs after they finish school and what are your plans for employment?
If you mean geographically, that can obviously vary depending on the person. Certain parts of the country (like where there are podiatry schools) are more saturated. If you meant what type of job, most common options nowadays are associate at a podiatrist’s group office, a multi-specialty group, or an ortho group. No one goes into solo practice anymore. I would hope to join an ortho or multi-specialty group, provided I can still do other podiatry things besides just straight surgery. I also want to be an attending at a residency program.
So I’m not reinventing the wheel here, but I kind of compiled a list of tips I’ve read from several different sources about how to be a great podiatry extern. I’m in a posting mood today, so I figured I’d share in case anyone actually reads this blog :P
- Before attending a program, know who the residency director is. Is there a separate chief of podiatry? Know who he or she is, as well. If they have any publications, try to read them before hand or throughout the month, especially if you will be scrubbing in on a case with them that is related to their prior research.
- When you begin the month, ask one of the residents (usually the student coordinator) what your exact responsibilities are for the month. It shows you are interested and there will be no question of what you can and cannot do.
- For a more timid person like myself, I have to be constantly focusing on asking questions to look interested. This may not be a problem for everyone, but if you don’t ask questions, you probably look a little bored. As a 4th year, you definitely don’t know everything so there’s always a question to be asked about a case or a treatment plan for a patient in clinic. But also, I guess don’t ask a million billion questions either because that’s probably annoying?? And don’t ask something that can easily be looked up like, “Oh wait what’s the classification for calc fractures again?”
- If you get pimped, try to have confidence in your answer. I still struggle with always answering where it sounds like I’m asking a question based on the inflection of my voice. But I’ve been working on sounding more assertive.
- I’ve heard of students crying. Yeah, don’t do this.
- "First one there, last one to leave." This is something I keep hearing over and over. Take it with a grain of salt. You don’t want to have a competition with your fellow externs about who can stay the latest if there’s no need for it. If the residents say "Go home, we don’t need your help," don’t just stick around. Go home! I usually give one sentence of "Are you sure?" first, and then when they say "yes" (which they always do) then I go home and it’s fine. Similarly, if a resident tells you to get lunch, get lunch.
- When you’re scrubbing in the next morning, read up on the procedure in McGlamry’s the night before. Sometimes, the attending will do a completely different procedure, though, and that’s fine. You’re not expected to know step-by-step details as a student. Just know a little about the pathology and the most common procedure done for it. It’s more likely the attending will pimp you on anatomy, but it’s still good to know what’s going on!
- If you’re expected to help out in clinic and with rounding, it’s always good to have some supplies in your white coat. Culture tubes, blades, nail nippers, skin markers are a few items that are good depending on the environment and the program. I guess ask the residents first what would be good to always have on you.
- Where ever you travel to, always have your paperwork with you. HIPAA certificate, immunizations, malpractice insurance, and letter of good standing are all things I’ve been asked for. This more applies to if you visit a program while you’re in the area, because the externship should have already asked you for your stuff at that point.
- Speaking of visiting, it’s okay to visit. Most programs, especially with this shortage, will be okay with you taking a day or 2 off. Try to do it on a day that’s less busy, obviously, and one that the director won’t be there. The residents should be cool with it. If you can’t visit a program that you are interested in, contact one of the residents (you will probably have to go to the contact number or email on the CASPR sheet first and then that person will get you the resident’s info) and let him or her know you are interested in the program but you are sorry you were unable to visit. Ask questions about the residency.
- Presenting a patient as an extern may be a little different from being in clinic at your school. The attendings are used to resident-level speed and efficiency, and as a student at a program you are kind of expected to be that way as well. Go over the pertinent stuff only. When was their last visit? Has it gotten better or worse? What did we do last time? What do you want to do today? I know at school I have to write in the chart that the patient has hammertoe deformities every single time. If you’re not doing surgery on it, don’t bring it up. Even if they are a diabetic, don’t bring it up. It’s probably in their initial visit note.
- I have not had to write an in-patient progress note yet, but I’ve been told similar things for that. Pertinent stuff: labs/vitals, any change since yesterday (getting better or worse), what have we been doing, etc.
- OR responsibilities for students are pretty much universal. You may get to do the H&P before the surgery, you may not. When you get there in the morning, start setting up the room. Draw up the local, usually a Marcaine/Lidocaine mix but they will tell you what they use. If anesthesia is doing a higher block or general, you probably don’t have to do a local as well so double check. Make sure the lights are above the foot of the table. Make sure there is an appropriate tourniquet (ankle for most stuff but thigh for any proximal surgeries like achilles, ankle fractures, etc) in the room with webril that would fit the ankle or thigh. Some programs use the stockinette that comes in the package instead of webril. Usually you need foam tape to secure the thigh tourniquet, as well. Pull your gown and gloves for yourself. Usually the residents pull their own gloves, and the scrub tech knows the attending’s glove size. Put up x rays if you have access to them. Get cast material ahead of time (ask the resident exactly what they use). Help moving stretcher and moving patient. Once you get comfortable, you can help the circulator do a couple of other things like hold the leg while she preps. Always tie up someone’s gown if you’re not scrubbing and the circulator is busy.
- Be nice to all staff members. This should go without saying, but everyone is an important part of the team. Try to introduce yourself to the circulator and scrub tech and CRNA when you walk in the room. At the very least, write your name and your student year on the white board.
- Do not complain about anything. Do not say “I”m hungry” or “I’m tired” in front of the residents because chances are, they have it a lot worse than you do. Do not talk negatively about other students, residents, programs, attendings, you name it.
- After your month is over, promptly send a thank you HAND WRITTEN note to the residency director. I bought a box of thank you cards for not that much money. It looks so much nicer to do this than send an email. I also plan on sending a thank you email to the programs I’ve visited a little before I have to designate programs in October as not only an appreciation of my visit, but as a reminder that I’m still interested in the program. I really didn’t meet any directors at my visits, so I don’t think it’s necessary to send a hand written note for those.
- Try to revisit the programs you liked (that you visited before or even externed at), but of course this is very difficult. Just keep in contact with the programs you like around application time.
- After every visit and externship, I have written a pros and cons list. This way you won’t forget anything when you rank programs. Write down your favorite case you saw at every externship, in case they ask in interviews.
- Always have someone’s contact info on you, in case you are running late. But obviously don’t be late :P A good rule of thumb is to see how long it would take you to get there assuming no traffic and then subtract 15 minutes.
- Every program will make you do a powerpoint at the end of the month. Do NOT make it long, unless they specifically request it. No more than 10 minutes. These presentations are probably really boring for the residents and attendings, honestly. But it’s part of the curriculum. Try to pick a topic related to a case you saw/scrubbed, particularly with the director. Another option is to do a surgical topic that would be a nice review for residents for their boards.
- BE YOURSELF. Unless you’re a bad person. Then you probably shouldn’t be in the medical field anyway :P
Wow that took a lot longer than I expected.
This year is FLYING. Holy moses. It kind of makes me nervous for boards and interviews coming way too quickly, but I’m kind of happy it’s going by quickly as well. It’s difficult being apart from David. We were apart in July, together in Detroit in August, now apart again for September. Then we’ll see each other 1 day this weekend and be apart for another 5 weeks :( It is so incredibly hard but worth it in the end if we can match in Detroit together.
So I guess I’ll first talk about living in Detroit. I’ve gotten used to driving around a lot. 20-30 minutes is nothing for me anymore, because everything is highway here. It is the motor city after all, so even the surrounding Metro area was built for driving. The drivers here are effin’ crazy though. They’re really reckless and I’m from NJ! And there are also a good amount of drivers that love driving like 10 under the speed limit, which is awkward. It makes no sense to have such a dichotomy in the same city.
While I was with David in August, we did a few fun things on the weekends. Played frisbee golf every Saturday, went to the zoo, went to the first preseason Lions game. The only other time we actually went to Detroit was to go to Slows BBQ:I thought it was delicious, but honestly nothing I couldn’t get in Philly :/ But it’s good to know I can get great food here as long as I actually go into the city. Here’s some more delicious food ahhhh:This is Buddy’s Pizza, which is “Detroit style” pizza. Very yummy!
Anyways, I’ll talk about my externships. So after I had that horrible visit, that Monday I started my 1st externship. It was very laid back and kind of a good program to ease me into starting externships. I never stayed later than 4 or 5 unless we had a cadaver workshop late at night which only happened twice. The residents were super super nice and helpful, and the director was a good teacher. Their academics were definitely the shining point of the program, as well as a lot of clinic time. I think the month went well and I would be happy to do my residency there. They seemed to think I did a good job.
My 2nd externship will be finished this Friday. This program is a great balance of elective and trauma surgery. The residents are very efficient and can leave once their shit is done, which is nice. It’s a pretty busy program, but not so busy that they look miserable. The director kind of breeds them into speedy surgeons, which I love. The externship itself unfortunately is very hands-off, but it’s worth it if it gets me a chance at going there for my residency. I have no idea how well I’ve been doing since I’m kind of judged solely on how helpful I am to the residents (they don’t even pimp at all), but I try to be as hardworking and helpful as I can so hopefully that’s enough.
So I’m off to Philly soon to be in clinic! Then 3 more externships, boards, and CRIP before I can relax.
How much does Temple offer in scholarships and what MCAT/GPA would make you eligible?
I’m sorry, I really have no idea how things have changed as I am 4 years out from applying. When I applied, I had low MCAT with like a 3.35 GPA I think and got a few thousand dollars for the first year but nothing after that.
Is having research experience essential to getting into podiatry schools? I know it's the case for med schools.
No, not at all.
So where did I leave off? I finished my IM rotation for July. It got a lot better the latter 2 weeks. We got a new attending who was more straight forward and to the point, but I still learned stuff. Now I’m in Detroit. I visited 3 programs the last week. The first one unfortunately was less busy than normal, or so they say. So I just hung out with the residents the first day and spent a few hours in an attending’s office the next day. The 2nd program I ABSOLUTELY LOVED. It’s a fairly new program so I was hesitant at first, but I can see myself going there. The 3rd one was an absolute disaster. Not the actual program. It sounds like a good program. But the day was ridiculous.
So I get there at 7 and the 1st year resident meets me and explains very clearly that I am allowed no patient interaction because I have no paperwork in (even though I possess all of my immunization records, HIPAA certificate, malpractice, etc). He gave me a tour of the entire hospital (kind of unnecessary in my eyes but w/e) and then answered some questions I had. Then around 10 he said he had to do something for his off-service rotation and he would only be an hour. He plopped me in the library to study. Long story short, he didn’t contact me until SIX hours later. At some point, after lunchtime, he told me to wait for a particular attending who was going to do surgery (even though I wasn’t allowed in the OR). This genius never contacted me again to tell me to stop waiting once he saw this attending IN the OR. I’m sorry, but fucking rude. I don’t care how busy of a resident you are, it takes 5 seconds to send a text to tell me to either come to the OR because I am all of a sudden allowed to shadow there, or to go home because there was nothing else for me to do. So I waited for this attending like, at least an hour after he was already in the OR! Finally, at 5 1/2 hours, the other 2 1st years came and found me and apologized. It wasn’t their faults at all, there was just miscommunication. They had no idea that I was supposed to be with them at all because the other resident didn’t relay that to them. I actually specifically asked the resident a little after I got lunch if I should be following other residents around since he was busy doing other things, and he said “No they wouldn’t want you because that involves patient interaction.” So I’m not sure what was going on with that. So we talked and they were actually normal people. This other guy was kind of a clueless robot, to be honest. It almost makes me not want to apply to this program.
So after I was on the road, 6 hours after making contact with this guy, he texts me “where are you” and I told him the other residents found me and told me to go home. Then he asks how close I was to the hospital. I wanted to go down this ridiculous rabbit hole, so I just texted “30 mins, why” and then he said “do you want to see the OR later” um WHAT. So you want me to come back to the hospital, at like 6PM on a Friday, to just get a TOUR of the OR? When there are no surgeries going on?! It makes me feel like he truly meant well (ex: wanted to give me a tour of the OR for my benefit, wanted me to meet up with an attending for my benefit despite me saying I already met this attending the day before at a different program) but was so out of touch with reality that it was ridiculous. I think he was also taking the whole “no patient interaction” thing WAY too literally. Oh well. I won’t discredit the program at this point, but if I revisit I’m emailing the chief resident and telling him I don’t want this happening again. I feel like as a student, you’re really not allowed to complain, but this is MY education! And I am a prospective resident to this program.
So starting an externship tomorrow. First one eep.
Hiii! Loveee your blog! I'm going to start my second year in undergrad next month and I am seriously considering going into podiatry and specifically Temple! I am looking into their summer "internship" program for next year. Do you know anything about it? How is/was temple? Give me the dirty deets! Haha thanks!
Hi! I honestly don’t know anything about the Temple internship program, but I’m pretty sure you get to shadow in the clinic and maybe get to see a couple of student-given presentations. I’m been pretty happy with my education, although my first externship isn’t until next week so I have no idea how other students compare. That being said, I feel VERY comfortable with patients as a 4th year, and besides NY I don’t think anyone else’s clinic can come close.
It took me a year, but I think I finally understand all the principles of internal fixation. And apparently gas gangrene is type III necrotizing fasciitis. What are these gaps in my education :(
I can’t believe it’s July of 4th year already.
May: I finished up wound care clinic. It was a difficult month but I enjoyed it and learned a lot. Things became routine pretty quickly. I understand dressings a lot better now! The patient population is difficult to handle, though.
June: I helped out the 3rd years as much as was necessary, but my section of the clinic was really just chip and clip so by the 2nd week they were fine. The afternoons were crazy busy because we just had less students as 4th years, but I busted my hump. I got to do a partial nail with a 3rd year unsupervised and did a hallux block by myself :)
July: I’m currently on IM at Temple and kind of hate it unfortunately. The 1st two weeks was with an attending who was mind-numbing. He kept us there till 6 almost every day for pretty much no reason. He would pimp us for hours straight. He made us go to the intern’s conference on top of the student’s conference every day so we got no real break for lunch (we would eat but just grab food for the 2nd meeting). He printed out articles for us to read every day. But now the attending is more reasonable. I like to learn, but not when it’s that many hours straight and I was especially getting frustrating being too tired coming home to study anything podiatry-related. I’m also without David this month…pretty much the first time we’ve ever been apart. It’s been easier than expected, though, since we’ve both been busy.
Beyond: I’m going on my first externship in August. I’m actually visiting programs in Detroit the week before it starts. I’m trying to study Crozer every day and almost have the book read through twice. Then on to PRISM. Then I’m not sure what I’m using officially for boards, but I’ll figure that out in like October!