Foot and Ankle
At the conclusion of the residency rotation on this service, the graduate is expected to be proficient in the management of foot and ankle problems encountered in the sub specialty practice of orthopedic Foot and Ankle reconstruction. It is important to recognize that competency as a physician extends beyond medical knowledge and direct patient care. Therefore, evaluations for the Foot and Ankle Fellow will include not only these competencies, but also demonstration of abilities in medical knowledge and patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice.
The primary goal of the Foot and Ankle Service is to provide the fellow with an educational experience that maximizes the opportunity to understand, evaluate, and treat orthopaedic foot and ankle conditions. This is achieved by combining a structured study program that utilizes an extensive recommended reading list with a clinical experience that has an appropriate balance between office evaluation and surgical treatment of foot and ankle related conditions. Junior and senior level residents rotate through the Foot and Ankle Service for three-month blocks and assume responsibility based upon demonstrated knowledge, previous experience and clinical skills.
The Reading List can be found on the Department of Orthopaedics and Rehabilitation Intraweb under the Residency/Curricula section.
Residents at both the junior and senior level are expected to complete the reading list. A weekly pre-operative conference is held and active participation by the faculty and residents is required. Prior to the OITE, a review is given to all residents utilizing the Foot Review course as a basic guideline. The residents will utilize a Foot and Ankle manual produced by the AOFAS (copy available in the Orthopaedic Library) and is a supplement to the reading lists, as is Orthopaedic Update – Foot. Senior residents also utilize the Advanced Reconstruction of the Foot and Ankle.
All residents are encouraged to engage in ongoing or original research on the Foot and Ankle Service rotation, in conjunction with the faculty in this section.
Goals and Objectives
Medical Knowledge and Patient Care:
It is expected that junior level residents on the Foot and Ankle Service will:
- Learn/know the appropriate applied anatomy.
- Become proficient at performing a history and physical exam.
- Learn/know the indications for obtaining radiographs and other imaging and diagnostic studies and develop early interpretive skills.
- Develop the ability to formulate a broad based differential diagnosis.
- Understand the concepts of non-operative treatment and indications for surgery and be familiar with simple principles of rehabilitation.
- Know surgical approaches, arthroscopic portal site anatomy, and risks of surgery.
- Understand the indications for conditions of the fore foot, mid foot, hind foot, and ankle: Hallux Valgus, Hallux Rigidus, Lesser toe deformities, heel pain, chronic ankle instability, interdigital neuromas, diabetic ulcers and Charcot Neuroarthropathy. (A complete list can be found on the Foot and Ankle Curriculum learning map)
It is expected that senior level residents on the Foot and Ankle Service will:
- Be familiar with all of the above and at a more sophisticated level.
- Have advanced diagnostic skills as well as a clear understanding of surgical indications and conditions amenable to surgery.
- Develop advances surgical skills, to include but not limited to: Arthroscopy of the Foot and Ankle, Fore- foot, mid foot, and hind foot arthrodeses, Total Ankle Arthroplasty, Diabetic Foot reconstruction, neuromuscular patients, as well as complex trauma (Calcaneus, talus, and Lisfranc fractures. (A complete list can be found on the Foot and Ankle Curriculum learning map)
- Have a strong understanding of biomechanical and biological principles guiding surgical techniques and rehabilitation.
- Be familiar with emerging technologies, options and controversies of surgical management , and demonstrate familiarity with the literature
- that governs treatment
Interpersonal and Communication Skills – Goal: Both junior and senior level residents will be expected to be respectful to patients and all members of the health care team at all times. This includes the following objectives:
- Both junior and senior level residents will demonstrate the ability to discuss difficult matters with patients and families in a compassionate manner. The level of discussion should be commensurate with the medical knowledge and experience of the resident.
- Both junior and senior level residents will demonstrate the ability to allow patients and families to fully express their concerns and/or symptoms.
- Both junior and senior level residents will demonstrate the ability to explain operative procedures, risks and post-operative care to the patient/family, commensurate with their medical knowledge and experience.
- Both junior and senior level residents will demonstrate the ability to develop a professional relationship with the patient/family.
- Both junior and senior level residents will maintain professional communications and relationships with ancillary staff and medical colleagues.
- Both junior and senior level residents demonstrates effective communication in the informed consent process.
Professionalism – Goal: Both junior and senior level residents will be expected to act professionally toward patients and all members of the health care team at all times. This includes the following objectives:
- Both junior and senior level residents will demonstrate sensitivity and responsiveness to differences in culture, gender, age and impairments.
- Both junior and senior level residents will demonstrate sensitivity to the needs of patients/families.
- Both junior and senior level residents will respect the need for confidentiality of patient information.
- Both junior and senior level residents will always demonstrate honesty in written and oral communications.
- Both junior and senior level residents will demonstrate awareness of limitations and seek advice when appropriate.
- Both junior and senior level residents will accept advice without personal offense and use it constructively.
- Both junior and senior level residents will assess their performance with objectivity and accuracy.
Practice-Based Learning and Improvement: - Goal: Both junior and senior level residents will demonstrate commitment to continuous learning and improvement in their patient care, benefiting from previous experiences and ongoing review of the literature, and contributing to the education of those around them. This includes the following objectives:
- Both junior and senior level residents will contribute to the education of residents, medical students and other health care professionals. Although senior level residents will provide the leadership in this, the more junior level residents can play a meaningful role as well.
- Evaluate medical research/scientific evidence and apply findings to patient care. The fellow will actively seek out more recent and perhaps “cutting edge” manuscripts that are applicable to patient care.
- Both junior and senior level residents will monitor their own practice of medicine to identify opportunities for improvement.
- Both junior and senior level residents participate in the morbidity and mortality process.
- Both junior and senior level residents will effectively utilize information technology to manage and access medical information.
- Both junior and senior level residents, during their entire residency training, gradually assumes increasing levels of independence with decreasing need for faculty supervision, commensurate with the medical knowledge and patient care competencies outlined previously.
Systems-Based Practice – Goal: Residents will recognize their role in a complex and financially challenged health care system; identify resources available to them to contribute to patient care, and demonstrate familiarity with internal and external regulations and policies that impact care delivery. This includes the following objectives:
- Both junior and senior level residents will complete medical records accurately and in a timely manner.
- Both junior and senior level residents will effectively utilize health care system resources to provide optimal patient care.
- Junior level residents should be aware of the need to provide cost efficient patient care, and have a basic understanding of the factors that impact this. Senior level residents should have an advanced understanding of the costs associated with their treatment recommendations, and be able to justify treatment not only on medical decision making but cost considerations as well.
- Both junior and senior level residents will assist patients in dealing with health care complexities and serve as advocates for patients within the health care system.
- Both junior and senior level residents are attentive to the manner in which the health care system may impact patient safety and take steps to prevent errors. This includes awareness of National Patient Safety Goals and federal and hospital quality improvement projects.
- Both junior and senior level residents are attentive to medication errors, surgical site infection and venous thromboembolic disease.
- Both junior and senior level residents adhere to the standards of surgical site identification, awareness of wrong site surgery and adherence to surgical time out.