How to Impress During Externships

The fourth year of podiatry is a very exciting but stressful time.  It’s exciting because you are finally getting out of the classroom and start interacting with patients in clinical settings.  But it’s stressful because you constantly feel like you are being judged because let’s face it, you are.  You are going out on these 4 or 5 week “interviews” and you want to make a good impression.  All the while you are most likely moving from place to place, sometimes away from family and friends for months at a time.  Someone on one of my rotations once told me, “The majority of externships are spent either standing around with strangers in awkward silence or trying to find your way around.  And just when you feel comfortable with who you’re with and where you are it’s time to leave and start over.”  You’ll find out that this is basically the fourth year of podiatry school in a nutshell.  They key is getting the most out of the time you have at each rotation. In order to do that, please consider the following:

Be on time

There are definitely things which I will discuss that you can do to impress, but there is a lot more things you can do that can negatively affect your chances of matching.  First and foremost, be punctual.  There is nothing more noticeable that irritates people more than showing up late-- or even asking to leave early.  Always leave yourself plenty of time to account for traffic or getting lost.  It is always a good ideal to plan on being somewhere early and if you get there before everyone else, bring something to read.  Another easy way to look bad is to ask for days off or to leave early. Only ask for time off when absolutely necessary.  

In clinic

There is a big difference between school clinic speed and externship speed.  There is nothing more annoying to a resident or attending than having their clinic fall behind because a student can’t keep up.  The flow of every clinic is different but in general a student will work up the patient and present to a resident or attending.  The workup needs to be conducted in a timely fashion.  You don’t need to talk to them about how their great uncle died of cancer or they had their tonsils out when they were six.  See how they are doing, do a focused physical exam, and present only what is pertinent.  Try not to talk with the patient a regarding their assessment or plan until you have discussed first with a resident or attending.  But be prepared for them to ask you what you think the diagnosis is and what you would do for them. 

Some programs ask a lot of questions to the students (aka pimping).  They are usually doing this to see what you know. There is nothing wrong with not knowing the answer to a question.  If you don’t know, look up the answer and either email the resident what you found out or let them know the next time you see them.  This shows willingness to learn. Never miss the same question twice.  If an attending asks a resident a question that he/she doesn’t know the answer to, don’t blurt out the answer.  Never try not to make a resident look bad in front of an attending, the residents may remember this and they usually have a say in how the program ranks their students so you don’t want to get on their bad side.

In the OR

It’s not a bad idea to ask a resident on the first day of your rotation what is expected of you in the OR.  Each program is different.  Some programs will expect you to have the room set up before the resident gets there i.e. pull gloves, draw local, make sure tourniquet is in the room and lights are at the foot of the bed, etc.  In some programs, the resident will do it. Some let students get very hands on in the OR.  Some expect the students to stay out of their way.  At my program, usually the first thing I will let a student do is throw a stitch.  This is their time to impress me. Then, if they do a good job, I may let them get more involved.  Therefore, it is vital to come prepared. There is no excuse to not know how to suture. My advice is to practice practice practice. Try to get your hands on some old expired suture and you can practice on a felt pad, a banana, a raw chicken breast or a pig’s foot.  You can buy a cheap needle driver and pickup online.  There are plenty of tutorials on youtube although these skills you should have been taught in school.

It’s good to ask questions, but there is always a time and a place for them.  Make sure you get a feel for the room.  If they are just about to do a delicate part of the case or just had a complication, I would keep my mouth shut.  Do not ask questions that you should know the answer to or can be easily found by looking it up.  But there are also good questions for example why they used a specific technique or what their post op protocol is for that procedure.

An easy way to stand out in a negative way is to break sterile. We know it happens to everyone but if you are constantly touching things you shouldn’t be touching or not gowning and gloving in the proper manner, it looks bad.  Be careful, and when in doubt-- ask.  

In the hospital

When you are rounding with a resident, your biggest job is to make their life easier.  The first thing you should do when you walk in a patient’s room is to put on gloves.  This shows the resident you are willing to get your hands dirty.  There are certain supplies/tools that you should have on you at all times like scissors, tape, gauze, etc. It can be a huge help to take down the patient’s dressings (ask first) or hold up their leg while they redress.  Rounding is not always required of the students, at least at my program, but I always appreciate the help and think highly of the students who volunteer to round with me before or after clinic. This shows me that a student is willing to go above and beyond what is expected of them.

Presentation

Most programs will have the student present on a topic of their choice or given to you by a resident or attending.  This is really your time to shine.  It is a way to show off your creativity, confidence, social skills, and knowledge.  You should spend a lot of time on it and become an expert on your topic.  Practice giving your presentation over and over until its second nature.  At my program, as residents, we present research at a podiatry conference every year. So we use this as a way to see if a student is capable of reviewing and evaluating literature as well as think critically.  The presentation is very important.  If you have an opportunity to give one-- do not blow it off. 

Social

This topic should be common sense but I have heard students say some ridiculous things.  I would suggest staying neutral on most controversial or political topics and try not to use lingo that may be considered offensive.  Be professional at all times.  If you are asked to “go out” with the residents, there is no problem with accepting the invitation.  It’s okay to let loose a little but you must act appropriately.  Also, don’t talk negatively about other programs. You never know what relationships they have with those programs. Remember podiatry is a small close knit community.  Try to keep gossip to a minimum.  If you are starting a sentence with “I heard that”, you probably shouldn’t be saying it.

 Overall

An attending once told me he could teach anyone to do surgery. He claimed he could probably even teach a monkey to fix a bunion. The things that you can’t teach are work ethic and willingness to learn.  An impressive student is a hard worker and is enthusiastic.  An impressive student is present at all times and does not spend time messing around -- especially on their phone (this is a big pet peeve of residents and attendings).  You may not think so, but we are always watching.

The biggest piece of advice I can give you is to just relax and be yourself.  You are interviewing them as much as they are interviewing you. If you put on an act and try to be who you think they want instead of who you really are then if you match there you’re not going to be able to keep the act up for 3 years and that is a recipe for disaster. You want a good fit.  It’s also okay to be transparent with a program. If you really like them, go ahead and tell them.  They want a resident who wants to be there and letting them know your level of interested should only help you.

Lastly, it is a good idea to send some sort of thank you note.  It can be hand written, typed, or emailed but this is a simple thing that goes a long way.  I can’t believe the amount of students that neglect this.  It doesn’t take very long and anything you can do to increase your changes of matching you should do.

  Best of luck to you all!!!    David Kretch, DPM, IPED Member Rush University Medical Center – PGY-2 KSUCPM Class of 2015

Best of luck to you all!!!

David Kretch, DPM, IPED Member
Rush University Medical Center – PGY-2
KSUCPM Class of 2015