Starting Your Residency and Finding Your Feet

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By John Pope, MS, MPO, CSCS

Congratulations. You have found the right residency. It's smooth sailing from here, right? Perhaps, but now it's time to take on another set of challenges.

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Office Dynamics

If you were not already aware, the office dynamics at most businesses are quite complex. I had never worked in an office environment before, so the day-to-day ebb and flow of the front office is something that I had not taken into account before starting my residency.

The best advice that I can offer for making a smooth transition is to pay attention to the checks and balances, the flow of paper, and who has influence over which decisions. Realize that the front office staff is your safety net; when you make a paperwork or clerical mistake they are the ones who catch it. Creating an open line of communication can go a long way in preventing future miscommunications and disagreements.

Next, make a point to get to know the practice's lab technicians. As a resident, you will be responsible for improving your fabrication skills, but depending on the facility, you may not be doing all of your own work. Discuss the materials and trimlines you like with the technicians, talk about order forms, and ask how the technicians refer to different modifications. Communication is key. Remember that most of the technicians you will be working with have been doing their job a lot longer than you have been; they will often have helpful advice and suggestions about materials and techniques. Listen, learn, and have an open mind.

Trial by Fire

Always be ready to learn.

It is inevitable that at some point during your residency you will wind up in a situation for which you are not prepared. If you are asked to do things that you don't have a lot of experience with, jump at the opportunities. These are chances for you to shine-or to fall flat on your face. Don't be afraid of making mistakes, as these are the educational experiences from which you often learn the most, and it's what you learn that matters. Your residency director and your colleagues are there to provide guidance. They want to see you succeed. If you're smart you will take advantage of all chances to learn, and if you're really smart you'll know when it is time to ask for help.

Try your best, take the successes as they come, and embrace the failures. You learn more by making mistakes and fixing them than you will by getting it right the first time.

The first patient I saw on my own came in for an AFO. I had assisted on quite a few AFO fittings, and I was ready. I was also the only practitioner available at the time. I read the diagnosis and the prescription, did a thorough assessment, and talked to the patient about his previous orthosis. We discussed what he wanted and what he expected. I told the patient what I was thinking, how it would be different from his previous AFO, and the added benefits it offered. He was pleased, agreed to the modifications, and thanked me for my help. I gave myself a pat on the back. I thought I had done a great job. But as we all know, even the best laid plans can go awry.

Upon delivery, the patient realized that he didn't want a different type of AFO, even if it was easier to don and doff and provided more support than his prior one. He had changed his mind and just wanted me to duplicate his previous orthosis. The problem he had was that his hands were too arthritic to put his previous orthosis on properly. I asked for advice from my colleagues and then stepped back to look at the problem from a different perspective. What was more important-the increased support, which effectively made movement harder and decreased the likelihood the patient would use the orthosis, or the ease of donning and doffing that he needed? With help, I developed a new direction for the patient's AFO treatment plan: I added Velcro to the new AFO, which was otherwise similar to his old one. The patient loved it.

So what did I learn? First, most of the time the less complicated answer is best. Second, the most effective orthosis is the one the patient will wear, not the well-thought-out one in the closet. Third, look at the context behind the patient you are working with. Finally, if it's not broken don't fix it-too much.

John Pope, MS, MPO, CSCS, is a resident at Orthopedic Appliance Company, headquartered in Asheville, North Carolina.