____________________________________________________
Steven F. Boc, DPM, FACFAS, FACFAOM
Director, Podiatric Medicine & Surgery Residency Program
Goals
To participate in a “Core Surgical” residency program based in a large teaching hospital and to develop skills necessary for patient care.
Objectives
To become competent in the medical and surgical skills necessary to diagnose, manage and treat patients with lower extremity pathology in a private office and hospital setting.
To become competent in the requirements needed to become a house staff resident.
To become competent in developing the skills needed to practice “Evidence Based
Medicine.”
Rules and Regulations for HUH/DUCOM Externs
Extern Orientation
Call prior to the start of the externship program.
Contact the on-call resident @ 215.762.7000 and ask for beeper #42451.
Attire
No jeans or shorts.
Professional attire must be worn to all out-patient offices and conferences.
Scrubs may be allowed on surgical days.
Short white coats are to be worn at all times.
Medical school ID badge or hospital ID badge must be displayed at all times.
9/28/2013

Medical Instruments
Externs are required to have the following instruments on them at all times:

Bandage scissors

PDR (phone app or hard copy)

Stethoscope
 Tractograph
Extern Responsibilities
Externs are primarily responsible to and under the jurisdiction of the 1 st ultimately to the 2 nd
and 3 rd
year resident.
year resident and
Externs shall observe the Rules and Regulations governing the Podiatric Surgical Residents on staff at HUH/DUCOM.
The extern, in conjunction with the 1 st
year resident, is responsible for:
Comprehensive history and physical (H&P) for admission if the patient is admitted through the out-patient office or Emergency Room.
Analysis of Pre-Admission Testing (PATs), including handout on the lab values.
Lower extremity exam for H&P to include:

Vascular

DP, PT, popliteal, femoral

Capillary refill time
 Homan’s sign

Telangiectasias and varicosities

Digital hair
 Dermatolgic

Texture
 Turgor

Temperature

Scars

Lesions

Ulcer Evaluation (include size, exudates, odor and location)

Neurologic

Deep tendon reflex (DTR)
 Sensory (light touch, sharp, dull)

Muscle strength, using 5 grades

Orthopaedic (Biomechanical)

HAV/1 st
ray deformities

Lesser metatarsal deformities

Digital deformities

Range of motion of joints (rearfoot and ankle)

Gait analysis

Limb length discrepancy
Medical Educational Experiences
Pre-op and post-op x-ray evaluations (see surgical patients).
Participation in rounds with residents and Attending Physicians. Externs are expected to be familiar with the patient’s conditions and labs when rounds start. Externs should update knowledge of labs, cultures and consultation notes.
Measuring and charting all biomechanical angles as needed. All information should be documented and readily available to be discussed by the extern with residents and attending.
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Medical Records
Externs assigned in-house patients and surgical patients will be responsible for the following:

In-House Patients
 These patients are “in-house” and admitted for chronic problems, such as infections, ulcerations, PVD and gangrene.
 You must demsonstrate competency to write a SOAP note (when required by the resident) to include vital signs (temperature, blood pressure, pulse and the condition of the dressing, which you are not to open or change), any pertinent information from the nurses’ notes and the patients’ subjective opinion and/or other complaints.

Also required to know for rounds: recent culture results, special study results, x-ray results, lab results and drug levels, as needed.

Check meds daily to know what medications the patients are on and if they are being dispensed.
If there is a problem or change in a patient’s condition, notify the resident immediately.

Surgical Patients
 There are two types of surgical patients; short procedure unit (SPU) and in-house patients.
In-House surgical patients
Pre-op notes are to be written the morning of surgery
SPU patients
Pre-op and post op notes are to be written

Notes consist of three paragraphs
Chief complaint - HPI
Lab values (include what test and only the abnormals, , if any)
X-ray results
CXR (appropriate nomenclature should be used)
Proposed treatment, surgery, prognosis, no guarantees
Medical clearance (pending/complete)
Consent (pending/complete)
Pre-op x-rays
Must be knowledgeable and draw angles for the 1 st
ray,
IMA/HAA/MA/PASA/DASA, and any other pertinent angles related to the surgery

Post-op notes written in the SPU or in the Recovery Room, will include the following:
SAPPPPAHEMICC
Surgeon
Assistant
Pre-op Dx
Post-op Dx
Procedure
Pathology
Anesthesia
Hemostasis
EBL
Materials
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Injections
Condition
Complications
Patients tolerated the procedure and anesthesia well and without complications to
RR and VSS, vascular status intact at baseline
Sign your name as follows:
Your name, MS 3 or 4 (Medical Student 3 rd
or 4 th
year) – make sure the date is present, as well as the time (am or pm)
Externs will draw labs as needed
Extern Duties
Extern’s work hours are designated by the 1 st
year resident (or Chief Resident) and usually include the following:

Externs are required to be in the hospital each morning with enough time to allow them to perform their required duties, including vital signs, progress notes in a SOAP manner, and pre-op notes.

Externs should arrive early enough to familiarize themselves with the updates on inhouse patients prior to rounds.
Morning rounds with residents
Evening rounds with residents
Grand rounds with Attending Physician and residents as needed

Externs are permitted to leave the hospital or office only after permission has been given by the resident.

Externs are required to work one weekend during the rotation. The hours, for that particular weekend, will be designated by the resident.
 Leaving at times other than specified in this manual may be granted under reasonable circumstances by the Chief Podiatric Resident and/or the Residency Director. Days missed will be made up on a 1:1 basis. Unexcused absences will not be tolerated.
Academic Educational Experiences
Externs are required to present topics and participate in weekly lectures and x-ray conferences.
Journal Club will be held monthly.
Externs are required to read up on cases and will be quizzed frequently during cases.
Externs are highly encouraged to ask questions.
Small group discussions will be held during any free time among externs and residents and externs should be knowledgeable of the acute and chronic patients’ conditions for any questions and answers.
Externs will be required to make one 15-minute formal presentation per month, as well as weekly 5-minute mini-presentations.
Externs will have access to the Podiatric Medicine & Surgery Clinics and Journals which are on a reserve listing in the Drexel University College of Medicine’s Library located on the 2 nd
Floor, New College Building (15 th
Street entrance).

View reserve listings:
 http://innoserv.library.drexel.edu/search/p?SEARCH=boc

Search reserve listing in library catalog:
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
Course Reserves Module [http://innopac.library.drexel.edu/search/r] by Professor:
“Boc;” Course Number: “PMTS 36;” or Course Title: “Podiatric Medicine and
Surgery.”
No extern is to be abused or harassed during his/her rotation. Any violation is to be reported to the Chief Resident or Residency Director ASAP.
Surgical and Office Experiences
Externs may scrub in at the discretion of the resident and/or the Attending Physician.

Every effort will be made to allow the externs to scrub

Surgical prep of the foot and leg will be required
Externs may also attend outside surgical centers as per resident’s discretion.
Externs will be required to attend out-patient office sessions at the Foot and Ankle Center of
Philadelphia (close proximity to Hahnemann University Hospital), which offers a comprehensive would care component, where you will diagnose, manage and treat patients with multiple pathologies, both medically and surgically.
Externs are not to discuss treatment course, prognosis or expected results with the patients.
If asked, explain, “Dr. ____________ will be around later today and he/she will be better able to answer your questions.”
Externs are required to research on their own (patient’s condition, treatment options and prognosis, as well as any other involvement) and be prepared to discuss these findings with the resident and/or Attending Physician.
Externs should keep a daily log of surgeries and patients treated.
Externs will also learn the vital aspects of managing a practice.
Suture Workshop
Workshop will be held as needed once per month, time permitting.
The workshop is required if externs desire to do any type of suturing on patients.

Needle holders, forceps, scissors and gloves required
General Topics
Externs will have a written evaluation sent to their medical school as part of their permanent educational record. It is the externs’ responsibility to obtain evaluation forms from their respective medical school.
Externs are encouraged to offer constructive criticism and participate whenever possible
(without being overbearing or obnoxious) with case discussions.
Residents will conduct uncomplicated study/slide presentations as time permits.
Your externship should be an enjoyable and educational experience filled with hard work and dedication. Remember, you only get out of your externship what you put in.
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