The Nature of an Educational Residency
The process of teaching podiatric residents the science and art of foot and ankle surgery is commonly referred to as Residency Training. The concept of education stands in contra-distinction to training and it is the aim at University of Pennsylvania Medical Center - Presbyterian to educate the podiatric resident. The fundamental difference is in the issue of quality. The process of training is one of repetitive practice until a skill is finally mastered. The educational effect is an experience which teaches the rational application of principles based on scientific concepts with a documentation of outcome. Practical surgical and clinical training is necessary for a quality podiatric surgical education. An education requires a scholarly ambiance. The trained resident requires only a quantity of practice. Thus, we see a trained resident in the hospital working up three to five admissions daily and assisting in the surgical cases while managing the day-to-day in-patient problems. The patient's diagnosis has often been made in the attending's office. Usually the treatment is decided prior to the admission. The patient is discharged and the outcome of the operation is unknown to the resident when the patient is followed-up in the attending's office. Often, the resident has a number of attendings with whom he/she may make work rounds rather than teaching rounds. The training resident has insufficient experience toward judgmental decisions. It is hard for the resident-in-training and their attendings to recognize the relevance of basic science. In the training environment, speed of hand and dazzling instrumentation stand alone as the ultimate purpose of the resident's training. The training program seeks pride in numbers and overwhelming work loads with little attention to the development of human characteristics. Intellectual stimulation is of secondary concern in the training program. Absorption of thought has little or no time. The concern for facilities is prominent. Case planning and thoroughness are academic trips far out from real foot and ankle surgery.
The educational environment stands in contrast to the pure training environment. In the educational program the resident works the patient up in a hospital based outpatient department, formulates his own diagnosis and treatment plan which is subjected to the Socratic method of educationally oriented attendings. Historical concepts, documented references and pathophysiologic correlation are important part of the learning process. The resident follows-up his/her patient postoperatively and is subjected to rigorous evaluation.
The operative experience has clearly defined educational objectives. There is research opportunity and teaching responsibility woven into the course of the program. Workshops and laboratories are utilized for teaching basic skills by qualified attendings with intense one-to-one teaching. The educational program is mature and capable of instilling the appropriate habits necessary to a surgeon.
During the educational program, excellence, creativity, and intellectual curiosity are nurtured; philosophy and issues are embraced by the educational program. Concerns for science and esthetic judgment, the essentials of good science, economics, ethical attitude, death and theology, the futility of historical repetition, etc., find a place for discussion in the education of the podiatric surgeon.
Finally, it is recognized by the education program that the patient's care in terms of standard and improvement is fostered by the critical mind. Though this discussion can cover considerably greater bounds, the direction for the University of Pennsylvania Medical Center - Presbyterian Podiatric Residency Program should be clear. The success of the program is determined by the degree to which its graduate podiatric surgeons are educated.