Evidence-Based Residency

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By Sara Pschigoda

I am almost halfway through my residency, and I recently had the opportunity to experience something most residents don't-vacation! I was lucky enough to take a few days off to celebrate my Grandma Dottie's 90th birthday with my family on the sandy beaches of the Bahamas. As I relaxed in a hammock (unconsciously evaluating other vacationers gaits as they strolled by), I was contemplating the first half of my residency experience.

I'm starting to feel as if I'm getting into my groove in terms of putting it all together-the essential foundations I learned in school, the ever-improving hand skills, the decoding of L-Codes, and the tact with which to communicate with patients and their families is all starting to become second nature to me. When walking into an exam room, the part of my inner dialogue that kept chanting, "Don't forget the cutout tube," is slowly being replaced by inner-speak about pathological presentations, correcting postures, and three-point pressure systems. In my quest to learn how to provide quality care to my future patients, I have become familiar with the "how" of what we practitioners do, and now I'm becoming increasingly interested in finding better reasoning for why we do what we do.

Sure, I know the basics of orthotic practice, but hardly any patients are open-and-shut textbook cases. I end up wracking my brain searching for the right pieces of the puzzle to determine the best course of treatment for my patients. I continue to explore the current literature on practicing orthotics and prosthetics, and at times I become disappointed. Some may think that evidence-based practice is superfluous, but I think it is vital for the solidarity and continued growth of our field. Evidence-based practice is the method of using reported and published information as an evidential basis for the treatment we provide, but it requires practitioners to continually contribute to this intellectual library.

In order to provide effective data to future clinicians, we must effectively communicate with each other. We all have our own method of using O&P-speak, but we need to learn to use the same conventions when sharing intellectual information. I find it insightful to read research articles about orthoses that are written by professionals in podiatry and other rehabilitation therapies because they have a different way of describing the methods and materials of the various orthoses used in their studies. However, I also find that there are a lot of differences among O&P professionals and how they describe their methods and materials to each other. While giving a speech on a literature search in school, an instructor once asked me if I could duplicate the experiment by following the reported design and fabrication methods in the article. I find myself using this as a litmus test when reading peer-reviewed articles. If I am able to duplicate the work of a colleague by following the written description, that is a sure sign that the reported information is communicated well enough that others can learn from the published evidence.

One of the things that I find so intriguing about O&P is the tremendous amount of educational legacy that exists. There is a wealth of information passed from one practitioner to the next that youll never find in a textbook. You learn this stuff by getting out there and getting your hands dirty. Spending time with clinicians and technicians these last few months has given me a great opportunity to pick their brains. These professionals have learned through their own experiences what works and what doesnt. Of course, all practitioners have methods that have worked best for them over the years, and I get to file these methods away as tried-and-true applications of various ways to practice orthotics. What is even better is that through peer-reviewed journals, evidence from clinicians with various specialties from all around can be shared among residents and clinicians alike. As a resident, this kind of information is vital for me to complete my residency education. I am hungry for this kind of information, and I would venture a guess that other residents and practitioners would respect and devour this kind of information as well.

Sara Pschigoda is a graduate of the master of science in orthotics and prosthetics program at Eastern Michigan University (EMU), Ypsilanti. She is a resident at the University of Michigan Orthotics & Prosthetics Center (UMOPC), Ann Arbor, and will be sharing her experiences as she completes her residency.