TURNING LEMONS INTO LEMONADE THREE: GET A BETTER LEMON (PART TWO) by John L. Trench III, DPM (no login) Here's the rest of my long-winded post. I apologize for rambling on and on, folks. I'll really try to keep future posts more concise. *************************************************************************** Concerning the specifics of the preceptorship/fellowship retraining program, I have some ideas concerning what the program should teach and how it should teach it. They are JUST my ideas, however--I don't recognize anything particularly special or authoritative about them. Specifically, I believe that this program should extend over a minimum two year period, preferably a three year period, and provide intensive training in: 1. Basic and advanced palliative care, medicine, and biomechanics/non-surgical orthopedics--adult, pediatric, geriatric. 2. Limb preservation--non-surgical and surgical care, basic and advanced, for diabetic limb, insensate limb, dysvascular limb, and chronic wounds. 3. Forefoot reconstructive surgery (open). 4. Rearfoot reconstructive surgery (open). 5. Select MIS techniques. 6. Peripheral vascular and neurologic testing, pathologies, and treatment. 7. Diagnostic imaging--CT, MRI, nuclear scans, etc. 8. Practice management and practice development. The program would be office-based with hospital experience--the exact opposite of the residency experience, and entirely in line with the REALITY of podiatric practice. It would be part-time, with preceptor/fellows dividing their time between intensive training sessions with instructors and working in their own practices where they will be able to profitably implement the new fruits of their training, and the preceptor/fellow positions would NOT need to be compensated positions--many established practitioners will already have practices and incomes. These COULD be compensated positions, however--in particular, new graduates could be hired into successful established practices as associates by instructors acting as primary mentors, and paid a FAIR wage plus a basic package of benefits while at the same time receiving their training. Just an idea to consider. And yes, I know that the above reproduces some of what each type of residency already provides--so what? The more experience, the better. Besides, training and experience are NOT uniform in residency, and most new podiatrists out of their programs with uneven training and deep levels of ignorance and inexperience in surprising areas. Besides, remember that this program can be tailored to the circumstances and needs unique to each preceptor/fellow. I'm not fleshing these ideas out any further than this here because it is beyond the scope of this post. These are my ideas, subject to change and modification as others put in their two-cents-worth in the matter, and are meant merely to stimulate discussion. I also recognize that there are men and women out there who have had prior experience in the development of post-graduate training programs, both residencies and the older preceptorships, as well as others with far more extensive training than I have to date been privileged to achieve, and far better and clearer minds, and who thus have more to contribute in my opinion. I therefore take this opportunity to request that others weigh in with ideas and suggestions.  Dr. Gale? Dr. Willner? Dr. Neal? Dr. Dranon? Would you gentlemen please comment? Your thoughts, your opinions, and your wisdom would be most welcome here. Anyone else out there with an interest in developing this further, if only as a thought exercise at this point? I would in particular request that students and residents post what they would like to see put into such a program. Remember: whatever is put into it, that is what you will get out of it--and that alone. More soon on this subject, I sincerely hope, as a separate sub-thread of this discussion thread. STEP THREE: BE KIND TO ONE ANOTHER This may seem strange, however, it is another area in which this profession traditionally fails. Certainly there have been many examples of men and women who have gone out of their way to extend a helping hand to their established colleagues and to newcomers in practice, residency, and school. Just as certainly, there have been a great many examples of men and women who have been cruel, abusive, petty, and spiteful to colleagues and newcomers--especially newcomers in residency and school, where their status renders them particularly vulnerable and relatively defenseless. Surgical training is tough enough and stressful enough all by itself. It is outrageous that anyone should feel it their right to make it even more so for nervous and frightened students and residents venturing into the surgical arena for the first time. Putting people on the spot, pressuring them, forcing them to spit out answers to questions machine-gunned at them from several "instructors" while simultaneously performing a procedure or suturing a wound closed, yelling at them, belittling them--NONE of these have ANY place in surgical training. Nor do the people who engage in these abuses have any legitimate place in this or any other profession. Unfortunately, such abuses have been all-too-prevalent for far too long in this profession. Students quickly learn in school that being discovered not to know or understand something is perceived as a "failing" and a sign of "weakness"--and they just as quickly learn, through personal humiliation, NEVER to allow a "failing" to be found out, and NEVER to show "weakness" under ANY circumstances. Residents have these lessons reinforced an hundred-fold in the early weeks of their program. As a result, many questions are never asked, much confusion and ignorance is allowed to persist, and education suffers. How many patients also suffer as a result of this? How many mistakes occur because of pockets of ignorance that practitioners carry around hidden from their "colleagues" rather than risk having their "weaknesses" and "failings" discovered and be subject to extreme humiliation? How many injuries to patients could have been avoided? How many complications--including amputations or even deaths--could have been prevented? The mean-spirited, juvenile "frat boy" attitude that so frequently holds sway in training has many hidden costs. We don't need it anymore. We never did. It's unprofessional in the extreme, abusive, and counterproductive. This is NOT a college fraternity, and the people being trained should never be subjected to frat-style hazing. Instead, a calm and gentle atmosphere should be fostered in the OR. Young doctors should be put at ease as much as possible, and helped to systematically learn the knowledge and skills they need to become good, effective podiatric surgeons. If a preceptor/fellow is frightened, calm and soothe them. If they are having problems mastering certain areas, help them. Remember, they are going to go out and be the first impression many people have of this profession--YOU will be judged by how well or how poorly THEY do, so it behooves us all to make sure that EVERYONE in this profession is well and fully trained, and feels free to ask questions, ask advice, and ask for help about ANYTHING without EVER having to fear being held up to ridicule and contempt by instructors or fellow colleagues. There are those who defend the "enhancement" of stress in the OR as a means of weeding out those who "don't have what it takes", on the basis that a surgeon must be able to respond appropriately and calmly no matter how out-there and stressful the situation gets. While this is true as far as it goes, it is still just a flimsy excuse to justify being a cruel jerk to someone else over whom one has a measure of power and control. How people respond under pressure is learned--NOBODY has the "Right Stuff" for surgery just naturally, because of presumed superior genetics or greater courage or whatever. Every person granted the DPM degree can be trained to respond calmly and appropriately under pressure in the OR. The appropriate way to achieve this, however, is NOT by scaring the beejeezus out of them, throwing prima donna hissy-fits, attempting to trick them into making mistakes, or belittling and humiliating them at every opportunity. There is NO EXCUSE for such behavior toward students, residents--or preceptor/fellows--by any instructor. It is gratuitously cruel and unprofessional, and drives many a potentially wonderful surgeon out of the OR forever. Be a mentor, not an as*hole. A mentor is a mature adult. An as*hole is a juvenile piece of weasel crap. We need good mentors. We need to rid ourselves once and for all of as*holes. We have had far too few of the former and far too many of the latter for far too long in this profession. Again, just ask Brian Gale. He's had 8 long years experience at the hands of some of podiatry's as*holes. Kindness and gentleness is the treatment you deserve from your mentors and your colleagues. It's the treatment current and future colleagues and students deserve from you. Be kind to one another. Sincerely, John L. Trench III, DPM jltrench@gte.net The preceeding represents my personal observations, ideas, and opinions. Take them for what they are worth, or leave them. Posted on Aug 30 2000, 9:42 AM from IP address 216.203.177.227