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St.

John Hospital and Medical Center Podiatric Surgery Clerkship Manual

St. John Hospital and Medical Center Podiatric Surgery Clerkship Manual
TABLE OF CONTENTS Program Introduction and Description..2 Clerkship Student Duties and Responsibilities3 Clerkship Rotation Goals5 St John Hospital Foot and Ankle Surgery Locations..8 Surgery Paperwork and Preparation.9 Useful Skills, Topics to Know, Suggested Readings...10 Clerkship Checklist11

INTRODUCTION
The purpose of this Clerkship Manual is to present a relatively detailed description of the St. John Hospital and Medical Center Podiatric Surgery Residency Program, so that the podiatric student selected for the Clerkship, or Core Clerkship, may adequately prepare for the rotation. If there are any questions that are not addressed by this manual, do not hesitate to call or e-mail.

Stuart J. Wertheimer, DPM Podiatric Program Director 313-343-6396 stuart.wertheimer@stjohn.org

Anne Dwyer Podiatric Residency Clerkship Coordinator 313-343-3878 anne.dwyer@stjohn.org

GENERAL PROGRAM DESCRIPTION


The Podiatric Surgery Clerkship is sponsored by St. John Hospital and Medical Center. The program is designed so that the podiatric medical student is exposed to and participates in state of the art diagnostic, therapeutic, and surgical techniques. The degree of the clerks participation is primarily left to the discretion of the residents during inpatient rounding, Emergency Medicine, and Podiatric Surgical Clinic. With regard to surgical procedures, the discretion is that of the attending physician. For non-podiatric rotations during the Core Clerkship, discretion is that of attending staff physicians. In the past, maximum participation has been granted to those clerks who display competency, as well as eagerness, in assisting the residents in their daily duties. Housing for clerkship students may be available on a first come, first serve basis at nominal charge within 5 minutes of the hospital. Please contact Anne Dwyer, Clerkship Coordinator, for arrangements.

CLERKSHIP STUDENT DUTIES AND RESPONSIBILITIES


1. Each clerk will alternate between two weeks of ER/Clinic/Floor and two weeks of Podiatric Surgery. This will allow the podiatric clerk to scrub interesting cases and gain ER/Clinic exposure. Multi-month Core clerks will also be assigned to medical and surgical rotations. All clerks duties and responsibilities may be modified at the discretion of the Program Director. Each Core Clerk will alternate between ER/Clinic/Floor, Podiatric Surgery, and the aforementioned medical and surgical rotations. All clerks duties and responsibilities may be modified at the discretion of the Podiatric Program Director. 2. When on ER/Clinic, clerks shall report to hospital Monday through Friday, at a time designated by the supervising podiatric ER/Clinic/Floor resident, in order to round on in-house patients. Rounding will be followed by clinic coverage and academics, as well as ER consults as they arrive. The clerk will inform the first year residents of any change in the patients condition. 3. When on Podiatric Surgery, the clerk should arrive to the scheduled case location at least 30 minutes prior to case start time to meet with the covering resident. A list of surgery locations is included in this packet. The clerk participating in surgery will assess preoperative radiographs and may also assist in other duties as directed by residents. The clerk shall attempt to follow the podiatric surgical cases which he/she assisted on, both preoperative and postoperatively, on a daily basis. When scheduled for Podiatric Surgery, the clerk will participate in Podiatric Clinic if no Podiatric Surgical cases are scheduled. 4. Clerks will receive St John Hospital name badge, which must be worn during all duty hours. Attire should be task appropriate: -It is suggested that clerks carry black pens, bandage scissors, and tape in white lab coat while on ER/Clinic/Floor. Please keep white coat clean and presentable, while rounding in the hospital and attending clinic. -While on podiatric surgery, the clerk wears scrubs required by the individual hospitals or surgery centers they are visiting; please consult with supervising residents for advice. Please use eye protection when in the operating room, and return all scrub sets to proper locations upon completion of clerkship rotation. 5. The clerks remain in the hospital until 5:00 p.m. on weekdays. To stay up to date on schedule of surgery and academics, clerks are to provide their contact information to residents. Please respond to calls and emails in a timely manner.

CLERKSHIP STUDENT DUTIES AND RESPONSIBILITIES (Continued)


6. Clerks will be required to attend all lectures. Traditionally, every Friday afternoon is a designated time slot for academic activities, including radiology conference, textbook review, and/or residency program meetings. Journal Club is regularly held the second Tuesday morning of each month, and Clinical Pathology Conference the third Tuesday morning. Email notification of upcoming topics is provided. Other academic activity may be scheduled, so clerks are to consult with residents and review their emails to stay up to date. 7. Medical Library facility in SJH is available to clerkships 24/7. Hospital badge is required for evening, overnight, or weekend entrance. Clerks may use library materials and copying as required for scheduled academic activities. Clerks are welcome to read library journals and textbook materials, but clerks may not check out any materials. 8. Clerks are expected to conduct themselves with professional dignity and courtesy in their relationships with patients, nurses, attending physicians, and any other hospital employees. Insubordination, theft, harassment in any form, or other activity which is in violation of St John Hospital policies cannot be tolerated. Clerkship students are to contact the Chief Podiatric Surgery Resident or the Program Director for clarification or concerns regarding any clerkship policy. 9. Clerks are directly supervised by the residents and the Podiatric Program Director. The clerk will not treat any patients without direct observation by a resident, attending physician, or the Podiatric Program Director. All progress or operative notes which the clerk assists with must be co-signed by a resident or attending physician. Clerks are not to generate any patient orders or prescriptions. 10. Clerks are required to take two weekends of call during the clerk month.

CLERKSHIP ROTATION GOALS


A. To provide the clerk with the exposure to Hospital protocol and services offered by various hospital departments so that he/she may be better prepared to eventually function as a competent member of the health profession. To provide the clerk with exposure and/or experience in the areas of podiatric diagnosis, therapeutics, and surgery so that he/she may be better prepared to function as a knowledgeable and experienced podiatric physician and surgeon. General Surgery, Radiology, Vascular Surgery, Family Practice, Medical Imaging, Anesthesia, Emergency Medicine (non lower extremity), and Infectious Disease are rotations that are available to students enrolled in the Core Clerkship. The goal is to provide the clerk with exposure and/or experience in these specialties during their rotation in these disciplines.

B.

C.

PODIATRIC SURGERY
Objectives a. To provide the clerk with the knowledge and experience involved in evaluating a podiatric surgical patient b. To provide the clerk with exposure to operating room protocol. c. To provide the clerk with experience in sterile technique, familiarity of instrumentation, and podiatric surgical assistance. d. To provide the clerk with exposure to surgical anatomy. e. To provide the clerk with exposure to general surgical anatomy, surgical technique, and tissue handling. Implementation a. The clerk will assist the resident in the performance of history and physical examination of the podiatric surgical patient. b. The clerk will review preoperative laboratory studies, prior to participating in surgical procedures. c. The clerk will scrub on podiatric surgical cases and assist in the procedure at the discretion of the resident and attending surgeon. d. The clerk will assist the resident with postoperative orders, postoperative notes, and dictation of the operative reports. e. The clerk will follow the patient postoperatively on a daily basis.

PODIATRIC ROUNDS AND FLOOR DUTY


Objective a. To provide the clerk with knowledge in the management of postoperative podiatric and podiatric medical patients. Implementation a. The clerk will assist the resident with podiatric rounds for the purpose of evaluating and managing all in-house patients. b. The clerk will assist the resident with podiatric consultations. c. The clerk will accompany the residents on daily preoperative history and physical examinations, in order to clinically evaluate each podiatric surgical patient prior to radiograph rounds.

MEDICAL IMAGING
Objectives a. To provide the clerk with the opportunity to evaluate podiatric radiographs, to be exposed to advanced radiograph technique, and interpretation of these modalities. b. To provide the clerk exposure to non-podiatric radiographs. Implementation a. The clerk will be responsible for drawing biomechanical interpretation on podiatric radiographs, as well as quantization of these angular relationships. b. The clerk will attend daily radiographic rounds with the residents and will be involved in the evaluation and interpretation of postoperative and preoperative podiatric x-rays, C.T. scans, post-traumatic radiographs, arthrograms, and tenograms.

EMERGENCY ROOM AND CLINIC


Objectives a. To provide the clerk with knowledge and exposure in dealing with the diagnosis and management of podiatric emergencies. b. To provide the clerk with exposure in diagnosing and managing podiatric patients in an office environment. Implementation a. The clerk will be exposed to the diagnosis and treatment of emergent pathologies in the Emergency Room, such as fractures, dislocations, lacerations, foreign bodies, puncture wounds, and ankle traumatology.

b.

The emergency room patient will be followed by the resident and clerk in the outpatient podiatric clinic for continued evaluation and treatment when other priorities are fulfilled and scheduling permits.

VASCULAR SURGERY, GENERAL SURGERY, FAMILY PRACTICE, RADIOLOGY, ANESTHESIA, INFECTOUS DISEASE, AND EMERGENCY MEDICINE SERVICES
Objective a. To provide the clerk with an exposure to the diagnosis, evaluation and management of patients in the Vascular Surgery, General Surgery, Family Practice, Radiology, Anesthesia, Infectious Disease, or Emergency Medicine services at St. John Hospital and Medical Center. Implementation a. Participation in these services is primarily observational with clerkship student involvement level at the discretion of attending physicians; no direct patient contact will necessarily be provided for the clerk. b. The clerk will attend all conferences and lectures when participating in the non-podiatric service rotations.

LECTURE SERIES AND JOURNAL CLUB


Objective a. To expand the clerkship students knowledge of established techniques, theories, and findings in the field of podiatric medicine and surgery, as well as, allowing the clerk to remain current with new techniques and theories. Implementation a. Periodic lectures will be provided by the podiatric surgery staff, as well as the general medical staff. b. The clerk will prepare a presentation for the residents and available podiatric staff. The topic will be selected by the clerk, after consultation with a senior podiatric resident. A copy of the papers and/or outline will be dispensed to all residents. c. The clerk will participate in Journal Clubs when applicable.

St John Hospital Foot and Ankle Surgery Locations


St John Hospital and Medical Center (Main) 22101 Moross Detroit, MI 48236 313-343-4000 *Important phone numbers SJHMC Clinic 313-343-6393 Spectralink 313-343-3345 On call resident: 313-343-7545 Enter 2822, 1 urgent to page, enter callback number

St John River District Hospital 4100 River Rd East China Township, MI 48054 810-329-7111 St John St. Clair Shores Medical Center (12 Mile Surgery Center) 21000 12 Mile Road St. Clair Shores, MI 48081 (586) 447-5000 St John Macomb Township Medical Center (23 Mile Surgery Center) 17700 23 Mile Rd Macomb Township, MI 48044 586-416-7500 Beaumont Grosse Pointe Hospital (Bon Secours) 468 Cadieux Road Grosse Pointe, MI 48230 313-343-1000 Crittenton Hospital 1101 West University Drive Rochester, Michigan 48307 248.652.5000 Henry Ford Cottage Hospital 159 Kercheval Grosse Pointe Farms, MI 48236 313-640-1000 Henry Ford Medical Center - Lakeside 14500 Hall Road Sterling Heights, MI 48313 (586) 247-2700 McLaren - Macomb 1000 Harrington Blvd Mount Clemens, MI 48043 (586) 493-8000 Utica Surgery Center 11051 Hall Road Suite 230 Utica, Michigan 48317 586 254 2280

Same Day Surgery Paperwork and Prep


***All tasks and notes described are to be done by clerks only by resident request, supervision When you get to pre-op: -View consent, ask pt what procedure theyre having, pt should confirm (bunion on my left foot) -Mark your initials in marker on the skin site where incision(s) will be made -Perform brief, focused H&P CC that the operation will correct, medications, allergy, past surgeries, etc -Ask pt what analgesics have worked well after previous surgeries, if they have f/u appt scheduled Pre-op note: (in progress notes section) Pt is 39yo female who presents with painful left foot bunion deformity x8mo duration which has been resistant to conservative treatments. [Brief H&P focused on problem the surgery will correct (eg: for HAV surgery, comment on equinus, callus, bump pain, etc)] Pt confirms NPO past midnight. Medical H&P was reviewed with no apparent contraindications to the planned procedure, left foot bunion deformity correction. Benefits and goals of this procedure, the general risks of foot and ankle surgery, and alternatives were discussed with patient. All questions were answered, no guarantees given or implied. The signed, witnessed procedure consent was reviewed and surgical site initialed left foot. sign and date, resident co-signs Written discharge instruction form: (must be in terms pt will understand, avoid abbreviation) -WB instructions cast/crutch or shoe gear limitations -Rest/Ice/Elevate as appropriate, keep wound dressings clean/dry/intact, etc -Take Rx analgesic, antibiotic, etc as directed, resume normal diet as tolerated -Follow up appt (provide either date/time if they have appt set, or Drs office phone if they dont) -Call the office with any questions or concerns Post-op nursing orders form: (all orders must be written by resident or attending, not student) -Rx for pain, antibiotic, sleep, etc per attending preference -Ice, elevate foot 2 pillows (unless ischemic patient, geriatric patient, plastic surgery, etc) -Discharge home when VSS per anesthesia protocols, may provide snack or beverage as tolerated -Dispense shoe/CAM/crutches/etc -X-rays if needed, etc (any misc orders based on the specific procedure) In the OR: X - TAGS: X-rays, Tourniquet, Anesthetics (locals drawn, label), Gloves, Special (fixation, cast, etc) Post-op note: (write in progress notes section, or this may be a pre-made form in chart) SAPPPPA - HEMI: Surgeon/Assistants: DPM; PGY-1 Pre-Op Diagnosis: Post-Op Diagnosis: (same as pre-op) Procedure: Pathology specimen: Anesthesia: Monitored anesthesia care + local anesthetic (state type and cc) Hemostasis: ankle tourniquet 250mmHg Est. Blood Loss: <10cc Materials: anything left in screws, k-wires, implants, suture, etc Impressions

Useful Skills, Topics to Know, Suggested Readings


All are available in SJHMC Medical Library; contact librarian or residents for assistance) Journal Articles:

-Perlman et al. Traumatic classifications of the foot and ankle. J Foot Surg. 1989 NovDec; 28(6):551-85. -Frykberg et al. Diabetic foot disorders. A clinical practice guideline (2006 revision). J Foot Ankle Surg. 2006 Sep-Oct; 45(5 Supply):S1-66. -Lee et al. Diagnosis and treatment of adult flatfoot. J Foot Ankle Surg. 2005 Mar-Apr; 44(2):78-113. -Vanore et al. Diagnosis and treatment of first metatarsophalangeal joint disorders. Section 1: Hallux valgus. J Foot Ankle Surg. 2003 May-Jun; 42(3):112-23. -Vanore et al. Diagnosis and treatment of first metatarsophalangeal joint disorders. Section 2: Hallux rigidus. J Foot Ankle Surg. 2003 May-Jun; 42(3):124-36. -Mayle et al. Current concepts review: venous thromboembolic disease in foot and ankle surgery. Foot Ankle Int. 2007 Nov; 28(11):1207-16. -Desmond et al. Current concepts review: Lisfranc injuries. Foot Ankle Int. 2006 Aug; 27(8):653-60. -Schoenhaus et al. Etiology of the bunion. J Foot Surg. 1992 Jan-Feb; 31(1):25-9. -Yablon et al. The key role of the lateral malleolus in displaced fractures of the ankle. J Bone Joint Surgery Am. 1977 Mar; 59(2):169-73. -Bratzler et al. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clinical Infection Dis. 2004 Jun 15; 38(12):1706-15. Textbooks:

-McGlamrys Comprehensive Textbook of Foot & Ankle Surgery by Alan Banks et al* -Surgery of the Foot and Ankle by Michael Coughlin et al -Master Techniques in Podiatric Surgery: The Foot and Ankle by Thomas Chang -Reconstructive Foot and Ankle Surgery by Mark Myerson -Functional Reconstruction of the Foot and Ankle by Sigvard Hansen -Skeletal Trauma by Bruce Browner et al (pilon, ankle, calc, foot fractures are in Vol 2) *2010-11 residents textbook review selection (residents read and present on chapters)

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Clerkship Checklist
Prior to Arriving at St John Hospital [ ] Contact Anne Dwyer, Podiatric Clerkship Coordinator, regarding clerkship housing, arrival date, and resident contact information [ ] Contact residents by telephone one month prior to introduce yourself, arrange time and location to report on first day of clerkship. 313-343-6395 Upon Arrival at the Hospital [ ] Contact Anne Dwyer regarding St John Hospital ID badge, scrubs, tour [ ] Provide your email and phone contact information to residents, especially the ER/Clinic/Floor resident, if you have not already [ ] Review the schedule of upcoming academic events during your rotation

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