Podiatric Surgical Residency Program
Sponsor
St. John North Shores Hospital, a 96-bed community hospital is the sponsor of this Podiatric Medicine and Surgery 36 Residency Program. The sponsor is a member of St. John Providence Health System, comprised of eight hospitals, more than 100 medical facilities and a member of Ascension Health. Ascension Health is a national faith-based health ministry sponsored by the Sisters of St. Joseph of Nazareth, the Daughters of Charity, and the Sisters of St. Joseph of Carondelet, and is the largest not-for-profit Catholic Health Ministry in the United States, with acute care facilities in fifteen states and the District of Columbia. St. John North Shores Hospital specializes in podiatric surgical services, emergency medicine services, medical and surgical services as well as rehabilitation services.
History of Podiatric Residency Training at St. John North Shores Hospital
The Podiatric Surgical Residency Program began in 1970 having two residents in a one-year surgical training program. This program was expanded one year later to encompass four residents each being provided one year of surgical training. In 1975 the program expanded to provide training for five first year residents with one of these residents continuing into a second year of surgical training. In 1984 the number of authorized first year residency positions was increased from five to six and in 1987 the program was reclassified into the prior residency classification system being a PSR 24 with three authorized positions for year one of training and three authorized positions for year two of training. With an increase of surgical volume and with an increase with affiliate training sites and the addition of other core rotations the PSR 24 in 1992 was expanded to provide three years of post graduate training with three residents in each year of training. In July 1, 2003 the Council on Podiatric Medical Education enacted the new residency training models being the Podiatric Medicine and Surgery 24 and the Podiatric Medicine and Surgery 36. In the fall of 2003 this institution being one of approximately six institutions nationwide underwent an onsite visit for reclassification to the new residency models. The program was reviewed as a Podiatric Medicine and Surgery 36 with three residents in each year of training. Following this visit the report was considered by the Joint Residency Review Committee and the Council on Podiatric Medical Education. The Council on Podiatric Medical Education granted this residency program full approval without any areas of non-compliance. Presently the program is fully approved through 2008 being authorized to provide training for four residents in each year of training.
Affiliated Training Sites
In addition to training at St. John North Shores Hospital the residency program has numerous affiliate training sites to provide the resident experiences in podiatric surgery and other medical and surgical disciplines. Other training site utilized by the sponsoring institution consists of several hospitals within the St. John Providence Health System. Specifically these are St. John Hospital & Medical Center, St. John River District Hospital, St. John Macomb Hospital, St. John Surgery Center, and St. John Oakland Hospital. Additionally, residents rotate through Crittenton Hospital, Henry Ford Lakeside Surgery Center, Bon Secour Hospital, Cottage Hospital and Mount Clemens General Hospital. All training sites are in close geographic proximity to the sponsoring institution.
Director of Podiatric Medical Education
Stuart J. Wertheimer, DPM, FACFAS, a Diplomat of the American Board of Podiatric Surgery being certified in foot and ankle surgery has been the Program Director of this residency program since July 1, 1978. Dr. Wertheimer’s academic accomplishments include being a member of the Pi Delta National Podiatric Honor Society as well as having received awards from the American College of Foot and Ankle Surgeons for excellence in publications. Dr. Wertheimer is a member of the National Board of Podiatric Medical Examiners and has served as President of this organization. In 1997 he was elected to the Council on Podiatric Medical Education and has served on the Joint Residency Review Committee as well as having served as Chair of this committee. In October of 2003 he was elected to Chair of the Council on Podiatric Medical Education. He is employed full-time by the sponsoring institution to oversee the residency program, the Outpatient Podiatric Surgical Clinic as well as the clerkship sponsored by the institution.
Curriculum
In the first year of the curriculum the resident is actively involved in Podiatric Surgery for four months, Emergency Department and clinic activities for four months and one month within the service of Family Practice, one month in Medical Imaging, one month of General Surgery, two weeks of Infectious Disease, and two weeks of Pathology. Year two of the curriculum consists of active involvement in Podiatric Surgery for eight months, Emergency Medicine (non-lower extremity) for one month, Vascular Surgery for one month, Anesthesiology one month, Infectious Disease two weeks, and Rheumatology for two weeks. Year three of the curriculum provides for advanced training in Podiatric Surgery for a minimum of eight months, a one month rotation in Orthopedic Surgery, a one month rotation in Plastic Surgery, two weeks of experiences in Psychiatry and two weeks in Neurology. The remaining one month is an elective rotation in which the resident may select from various educational resources including podiatric surgical experiences.
In year one of training the resident becomes actively involved in podiatric surgery allowing for a gradual development of knowledge and skills in podiatric surgery. While in this rotation the resident becomes actively involved in the performance of foot surgery and is also exposed to reconstructive surgery of the foot and ankle.
During the residents rotation in the Emergency Department and Podiatric Surgical Clinic, the resident will be called to the Emergency Department for all patients presenting with lower extremity traumatology or diseases. These patients are seen by the Podiatric Surgical Resident under the direction of the Emergency Room physician or the Director of Podiatric Medical Education. The resident is actively involved in the evaluation, diagnosis, and management of these patients. These patients are then referred to the Podiatric Surgical Clinic for follow-up. The resident has the opportunity of following these patients in the clinic until their ultimate discharge.
The rotation in Family Practice is primarily hospital based with an involvement also in the Family Practice Residency Clinic sponsored by St. John Hospital & Medical Center. During this rotation the resident functions as a PGY 1 within the Department of Family Practice. The resident is actively involved in patient management and assessment.
Medical Imaging consists of a four-week rotation involving the resident’s exposure to the evaluation and interpretation of plain film radiography as well as ultrasonography, nuclear imaging, CT scans and MRI’s.
The Infectious Disease rotation is provided in year one for two weeks and is augmented in year two for an additional two weeks. This rotation occurs in close geographic proximity at Mount Clemens General Hospital within the Infectious Disease Service. Residents are actively involved in the evaluation, diagnosis and medical management of patients with numerous infectious disease processes. Emphasis is placed on the management of lower extremity infections; however, the resident is also exposed to the management of Infectious Disease in general.
Pathology is a two-week rotation occurring at St. John Hospital & Medical Center. During this rotation the resident is exposed to gross and microscopic pathology as well as exposure to clinical laboratory medicine.
General Surgery, which is a one-month rotation occurring at St. John Hospital & Medical Center allows for the residents active participation on the general surgical service. He is assigned to a team consisting of approximately five other physicians all in postgraduate training. This typically will consist of the Chief Surgical Resident and other residents in various years of surgical training as well as residents who are in other residency programs who have been assigned to the general surgical service. The resident has patients assigned to him and is responsible for their evaluation, and management under the direction of the chief resident.
Podiatric Surgery in year two in total consists of eight months of training. During this time the resident is refining his skills in the performance of foot surgery and is beginning to develop enhanced skills in reconstructive surgery of the foot and ankle.
Emergency Medicine provided in year two is a one-month block rotation occurring at St. John Hospital & Medical Centers Emergency Department. This active Emergency Department sees in excess of 100,000 emergency room visits per year. During this rotation the resident is assigned to various emergency medicine modules and is actively involved in the diagnosis and evaluation of patients presenting with non-lower extremity emergent conditions.
Vascular Surgery is a one-month block rotation occurring at St. John Hospital & Medical Center. During this rotation the resident will be actively involved in management of patients with peripheral vascular disease. The resident will be involved with the preoperative, intraoperative, post operative management of these patients.
The Anesthesiology rotation occurring in year two of training provides the resident experiences in the preoperative, intraoperative and postoperative management of patients undergoing local, general, and spinal anesthesia. The resident is actively involved in this service under the direction of the Anesthesia Department.
Rheumatology is provided in year two as primarily an office based rotation. The resident receives experience in the diagnosis, evaluation and management of patients with numerous rheumatic diseases.
Year three of training allow for the resident to participate in foot surgery and reconstructive rearfoot and ankle surgery for a total of eight months. During this time the resident assists in the education and training of the first year residents. The resident participates to a major extent in reconstructive rearfoot and ankle surgery and developing the skills to be competent in the performance of all types of surgery of the foot and ankle. By the completion of the podiatric surgical training experiences the resident will be competent in the performance of all types of foot surgery including reconstructive rearfoot and ankle surgery inclusive of major tarsal and ankle arthrodesies, osteotomies, fracture repair, and soft tissue repair. The resident will have been exposed to numerous types of internal / external fixatives including Ilizarov and hybrid type frames. Emphasis during year three once again is placed on reconstructive rear foot and ankle surgery inclusive of surgical management of traumatology.
Psychiatry and Neurology are each provided in year three of training. These are primarily hospital based and are one week and three weeks in duration, respectively. The remaining one month of training in year three is an elective month during which time the resident may select from numerous other medical disciplines or may augment his podiatric surgical experiences by an additional month of training.
Surgical Volume
The Council on Podiatric Medical Education requires the following procedural activities for a PM&S 36. The resident must achieve a minimum of 100 digital procedures, 80 first ray procedures, 65 other soft tissue foot surgery procedures, 60 other osseous foot surgery procedures, and 50 reconstructive rearfoot and ankle procedures. These aforementioned procedures must be at the C level of activity. The C level of activity is defined by the Council on Podiatric Medical Education as “the resident participates actively in performing the procedure." Participation includes performing at least the majority (greater than fifty percent) of the procedure under direct supervision of the attending. In addition to the aforementioned C activities the resident must have a total B & C procedures of 525 procedures. Category B by the Council on Podiatric Medical Education is defined as “the resident participates actively in performing the procedure." Participation may include retracting and assisting, or performing limited portions (less than fifty percent) of the procedure under direct supervision of the attending.
Residents enrolled in the residency program from July 1, 2002 through June 30, 2005 achieved on average the following procedures at the C level activity.
| Digital Surgery |
397 |
| First Ray Procedures |
262 |
| Other Soft Tissue Foot Surgery Procedures |
162 |
| Other Osseous Foot Surgery Procedures |
150 |
| Reconstructive Rearfoot & Ankle Procedures |
206 |
The total of B and C activity level procedures performed from July 1, 2002 through June 30, 2005 averaged 1,556 procedures per resident.
The Council on Podiatric Medical Education requires that residents enrolled in a Podiatric Medicine and Surgery 36 program are involved in 300 podiatric surgical cases (patients). Residents enrolled in the residency program from July 1, 2002 through June 30, 2005 averaged 892 such cases.
Resident Call
During year one of training each first year resident will be on call in-house approximately one weekend per month and one weekday per month. In year two this time will be one day per week and one weekend every twelfth week and in year three the resident is not on call. During the times the resident is on call he is responsible for inpatient management of podiatric medical and surgical patients and is responsible to respond to the Emergency Department when patients present with lower extremity pathologies.
Didactics
Didactic experiences occur on a weekly basis by means of lectures and workshops. These didactic activities are used to supplement the curriculum and are provided by the podiatric and medical faculty member’s involvement in the residency-training program. A monthly Journal Club consisting of resident and faculty participation occurs at which time recent publications are reviewed and critiqued. The residents receive exposure to cadaveric anatomical dissections to augment their knowledge in lower extremity anatomy and to demonstrate and perform foot and ankle surgical procedures.
Benefits
The present stipend for year one of training is $33,400 per year, second year of training $37,850 per year, third year of training $44,000 per year. These stipends have typically been increased at the rate of five percent per year effective July 1 of the resident training year. In addition to these stipends the sponsoring institution will provide health insurance for the resident and his/her family, professional liability insurance, life insurance, dental insurance. The resident also receive $500 per year towards continuing medical education programs (unused amounts may be carried forth to the following residency training year). All third year residents will be provided fully paid transportation, lodging and registration for the annual meeting of the American College of Foot and Ankle Surgeons.
Outcomes
All first and second year residents annually take the in training residency self-assessment examination offered by the American Board of Podiatric Surgery. Historically all residents have performed very well on this examination performing in the upper 25% nationally. Upon completion of their residency training all residents who have taken the American Board of Podiatric Surgery Board Qualified Examination for Foot Surgery and Reconstructive Rearfoot Ankle Surgery have passed this examination on the initial attempt. All residents who have taken the Board Certification Examination after practice experiences have become Board Certified in Foot and Reconstructive Rearfoot Ankle Surgery.
Residents completing the residency program have found professional opportunities in solo practice, group practices as well as orthopedic practices. Several residents have gone on to faculty appointments at colleges of podiatric medicine and surgery.
Application and Contact Information
For applications to this postgraduate residency-training program please contact the American Association of Colleges of Podiatric Medicine at www.aacpm.org. For further information in reference to this postgraduate training program please direct your e-mails tojean.kinney@stjohn.org or stuart.wertheimer@stjohn.org or call (586) 466-5251 and ask to speak to Jean Kinney, Medical Education Coordinator. We look forward to hearing from you and offering you access to a premiere Podiatric Surgical Education.
