Podiatric Surgery Santa Clara - Curriculum & Rotation Schedule

Medical Imaging

At the end of this rotation the podiatric resident should understand the basic physics, indication and capabilities of various medical imaging modalities. Additionally a basic functional ability to read extremity x-rays and chest x-rays are expected.

Pathology

Residents should expect to understand the need for microscopic examination of human tissue, recognize the features of normal and abnormal tissue.

Internal Medicine

The residents work with the Internal Medicine Attending staff / Resident teams where they learn to manage both healthy and medically ill inpatients in a safe fashion. The resident should understand the indication for specialist referral as well as the need for communicating with the attending physician. Residents become proficient in the management of patients in an in-patient setting.

Anesthesia

This is a 4-week rotation for first year residents under the direction of Dr. Richard Cummings. The goal is to educate the resident in the application of general, spinal and local anesthesia. The level of education should allow a podiatric resident or practitioner to functionally interact with anesthesia services. This level of knowledge requires that familiarity with risk stratification, with all aspects of anesthesia application and pre and post anesthesia care.

Infectious Disease

A functional understanding of infectious disease in the setting of a suburban hospital is expected. The resident should understand the indication for an infectious disease consult in both the medical and orthopedic setting. The residents will gain a fundamental knowledge of infection management in both out-patient and in-patient settings.

General/Vascular Surgery

The resident should understand the nature of the general and vascular surgeon and the indications for referral to this service. The resident should have a functional understanding of the common surgical disorders and their management in the medical milieu. A functional understanding of vascular reconstruction gained from surgical assisting or observation is expected. The residents will also be exposed to interventional radiology re-vascularization techniques, non-invasive vascular studies, and wound care.

Dermatology

The goal of this rotation is to functionally orient the podiatric resident to skin disorders and their management. The resident will understand the indication for dermatology referral, and be able to manage common dermatologic disorders of the foot.

Emergency Department

Goals include a functional understanding of triaging, and treating urgent/emergent disorders in the suburban setting. The podiatric resident should develop a functional understanding of the relationship of lower extremity trauma, infection and other disorders to other medical conditions commonly encountered in the suburban setting.

Wound Care

This rotation takes place at Santa Clara Kaiser Permanente and it is on any ongoing basis.  The wound care clinic is located within the department of Foot and Ankle Surgery where lower extremity wounds are being managed on a daily basis.  As such, residents will be assigned to wound care on a regular basis/weekly in order to allow exposure to acute and chronic wounds as well as continuity of care.  During this rotation, residents will learn to identify venous versus ischemic versus neuropathic ulcerations, apply accepted forms of classifications, become proficient at partial and full-thickness wound debridement as well as familiarize themselves with products utilized in wound care as well as edema management of the lower extremity.

Rheumatology

Rheumatology is a 2-week rotation at Kaiser Santa Clara.  During this time period, residents will learn and review pathological processes leading to rheumatological disorders.  In addition, they will familiarize themselves with acute and chronic medications utilized in management of rheumatological disease, become proficient at performing a thorough whole body examination, evaluate and understand role of serological markers and become skilled at performing articular injections.

Behavioral Science

This is a one week rotation in the Department of Psychiatry in Union City. This rotation is under the supervision of Michael Sands, MD., Assistant Chief. This rotation exposes the podiatric resident to behavioral science in a multi-specialty group practice. The podiatric resident may function in any capacity that the psychiatrist in charge directs, provided that the resident is supervised. Goals include a functional understanding of behavioral science as it relates to podiatric medicine and surgical patients, as well as general medicine and surgery patients.

Orthopedic Surgery

The podiatric surgery resident will spend time with various members of the orthopedic department in the clinic as well as the operating room. They are expected to do morning rounds with the orthopedists, assist in surgery, and see clinic patients. The resident should have a functional understanding of general orthopedic surgery and trauma, and their medical management.

Podiatric Clinic and Surgery

This is a focused rotation in foot and ankle surgery and podiatric foot and ankle clinic under the supervision of the attending staff. The residents assist in scheduled surgical cases as well as urgent cases. The third year residents assist in all reconstructive rear foot and ankle cases.

The goals of this training is to provide a skill development in clinical practice and surgical management. Co-management of patients with attending podiatric physicians in all aspects of patient care (medical and surgical) is encouraged and expected. The resident manages their own clinic schedule under the supervision of the attending staff.

PGY-2 Objectives

• Diagnose, manage and treat common foot and ankle disorders presenting to the outpatient clinics of the foot and ankle clinic.
• Manage an outpatient podiatric clinic schedule.
• Develop and demonstrate competence in “routine foot care”.
• Develop and demonstrate competence in routine strapping, and padding.
• Develop and demonstrate competence in a biomechanical examination.
• Develop and demonstrate competence in casting and application of other immobilization devices.
• Develop and demonstrate competence in a gait analysis.
• Gain skills in supervision and interaction with support staff.
• Demonstrate and maintain competence in an appropriate orthotic prescription.
• Develop and demonstrate competence in routine office surgery (onychoplasty, biopsy, skin excision etc.)
• Recognize patients that are at risk for morbid change of life or limb and deal with them appropriately.
• Instruct patients appropriately in strategies of managing their disorder(s)
• Develop and demonstrate competence in complete preoperative work-up including H&P, admitting orders, rationale for admission and treatment plan.
• Order and assess appropriate admitting labs, radiographs, and physical condition of the patient.
• Understand the fundamental surgical considerations in reconstructive surgery of the foot and ankle.
• Develop and demonstrate competence in forefoot surgery.
• Develop and demonstrate competence in management of the post-operative patient including analgesia, wound management and supportive care.
• Develop and demonstrate competence in as an able assistant in foot and ankle surgery.
• Understand all aspects of sterile technique, instrumentation, and OR protocol.
• Develop and demonstrate competence in all aspects of wound closure including layered closure, suturing, staples, tapes and related devices.
• Develops and demonstrates competence in communication and presentation skills.
• Understands and actively participates in the academic environment: Stimulates case discussion, engage cohorts and students in academic discussion, understands scientific inquiry and method, understands the goals and participates effectively in journal club.
• Gain understanding of trauma management, including splinting, casting and immobilization techniques.
• Understand orthopedic surgical principles including open and closed fracture reduction, and internal fixation principles.
• Affectively assist in orthopedic surgery.
• Participate and gain an understanding of peri-operative management of the orthopedic patient.

Podiatric Surgery and Clinic

This is a focused 3rd year rotation in foot and ankle surgery and podiatric foot and ankle clinic under the supervision of the attending staff. As chief resident this resident is assigned the primarily the hospital OR and to the larger cases that are scheduled at the surgical center. This allows the resident to focus on collecting rearfoot reconstructive ankle cases. The day to day management of residents in this rotation is the responsibility of the residency director.

The residents activities are supervised by attending staff located at the respective facilities. Senior resident may be responsible for performance and behavior of junior residents, and students in patient care at the discretion of the attendings at that facility.

The goals of this training is to provide a mature podiatric surgeon with skills enabling him/her to perform most types of forefoot and simple adult hindfoot surgery. Additionally it is expected that at completion of training that this individual will have substantial experience and training in management of all phases of diabetic foot care including prevention, risk identification, incision and drainage, reconstruction, pedorthia and prosthetics. Exposure to pediatric foot surgery, complex reconstructive surgery of the ankle and hindfoot, arthroscopy and endoscopy should be expected. Competence in any kind of surgical practice is based on many variables including but not limited to knowledge, motor skills, execution, common sense and patient management skills.

3rd year elective rotations: Time on other surgical services and private office rotations are available as electives during the PGY-3 year.

PGY-3 Objectives

• Diagnose, manage and treat common foot and ankle disorders presenting to the outpatient clinics of the foot and ankle clinic.
• Manage an outpatient podiatric clinic schedule.
• Become competent and maintain competence in “routine foot care”.
• Become competent and maintain competence in routine strapping, and padding.
• Become competent and maintain competence in casting and application of other immobilization devices.
• Become competent and maintain competence in a biomechanical examination.
• Become competent and maintain competence in a gait analysis.
• Gain skills in supervision and interaction with support staff.
• Demonstrate and maintain competence in an appropriate orthotic prescription.
• Become competent and maintains competence in complete preoperative work-up including H&P, admitting orders, rationale for admission and treatment plan.
• Order and assess appropriate admitting labs, radiographs, and physical condition of the patient.
• Understand the fundamental surgical considerations in reconstructive surgery of the forefoot hind foot and ankle.
• Develop and become competent in basic rearfoot and ankle surgery.
• Become competent and maintains competence in post-operative patient care including analgesia, wound management and supportive care.
• Become competent and maintains competence as an able assistant in foot and ankle surgery.
• Understand all aspects of sterile technique, instrumentation, and OR protocol.
• Become competent and maintains competence in all aspects of wound closure including layered closure, suturing, staples, tapes and related devices.
• Become competent and maintains competence in all aspects of application of drains, dressings and casts.
• Become competent and maintains competence in hammer toe repair, simple bunionectomies, metatarsal osteotomy, heels spur procedures, soft tissue excision, simple lump and bump procedures of the hind foot, osteotomies of the first ray segment, forefoot joint implants.
• Become competent and maintains competence in bone stabilization techniques (wire suture, kirschner wire, screw, staple).
• Become competent and maintains competence in simple osteoplastic maneuvers (exostectomy, arthroplasty, simple osteotomy).
• Become competent and maintains competence in communication and presentation skills.
• Understand the fundamental surgical considerations in reconstructive surgery of the forefoot, hind foot and ankle.
• Maintains competence in patient management aspects of the perioperative period.
• Maintains competence in as an able assistant in foot and ankle surgery.
• Become competent and maintains competence in closed reduction of fracture dislocations of the ankle and foot.
• Become competent and maintains competence in infection management including complex incision and drainage, amputation of the foot and ankle, and antibiotic selection.
• Become aware regarding the principles and application of transfer of major muscle – tendon units if the foot and ankle.
• Become aware regarding the principles and application of surgical repairs of complex acquired and congenital foot and ankle deformities (flatfoot, cavus foot, TEV, etc.).
• Become familiar with the principles and application of basic skills of small joint arthroscopy.
• Develops management skills: assigns and manages student assignment, reports to the director. Manages residents schedule, assigns cases, identifies and manages discipline problems, in cooperation with the director.

Podiatric Surgery and Podiatric Outpatient Clinic – 4 months
Internal Medicine – 2 months
Emergency Medicine – 1 month
Anesthesiology – 1 month
Infectious Disease – 2 weeks
General Surgery – 2 weeks
Vascular Surgery – 2 weeks
Plastic Surgery – 1 month
Rheumatology – 2 weeks
Behavioral Medicine – 1 week
Pathology – 1 week
Dermatology – 1 week
Wound Care – Ongoing
Radiology – 2 weeks
Medical Imaging integrated with Medicine rotation morning rounds with radiologist and joint Orthopedic, Sports Medicine and Podiatry monthly radiology rounds with radiologist

Orthopedics – 2 months
Podiatric Surgery and Podiatric Outpatient Clinic – 10 months

Podiatric Surgery and Podiatric Outpatient Clinic – 11 months
Elective Away – 1 month (Generally used for office based experience at a private practice)
Chief Resident will participate in monthly pediatric foot clinic
Wound Care – Ongoing

All Residents participate in:
Monthly journal club
Monthly Text Review
Monthly Special Case clinic
Monthly podiatric case review / x-ray
Weekly Ortho, Sports med., and podiatric joint Grand Rounds
Hands-on workshops
Monthly Rounds and Ongoing lectures