Firsthand Tips to Improve the Residency Experience

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By Nina Bondre, MPO
resident with mentor

Being a resident at an O&P facility has been exciting. I have had the opportunity to see real-world applications of the clinical and technical knowledge I gained while pursuing my master's degree in O&P and have been further educated by experts in practice. I have had an overwhelmingly positive experience in nearly every facet of my residency, however, some of my peers have found their residencies lacking. Through my experience and my conversations with peers, I am sharing with you firsthand tips for a successful residency experience for both parties.

What Can the Facility Do?

The facility's employees can create an environment where a resident feels comfortable but is also challenged with difficult patient presentations and learning new skills. Ideally, a residency facility has several seasoned clinicians with whom a resident can work. Having different mentors gives residents a chance to observe and learn differing techniques for adjusting devices and diagnosing problems, develop an understanding of each clinician's processes, and experience various ways of interacting with patients. This allows residents to develop their own problem-solving schemes by incorporating elements of each mentor's skills that best match their own personalities and help them be more successful.

When possible, it is helpful for the resident to experience patient care settings beyond the clinic, such as hospitals and skilled nursing facilities. Additionally, gaining exposure to the larger rehabilitation care team of physical therapists, occupational therapists, and physical medicine and rehabilitation physicians helps residents understand the patient care process in more holistic terms and witness the team approach to patient management.

Exposing the resident to various professional development activities also makes him or her more apt to engage in the professional community. Residents should be encouraged to utilize the O&P mentoring program set up through the American Academy of Orthotists and Prosthetists (the Academy), to meet other clinicians in the profession, and to begin to build a professional network. Attending national conferences and courses helps develop a sense of belonging and a desire to contribute to the O&P community. There is no shortage of experienced clinicians who want to see the next generation of O&P professionals succeed-and who attend these conferences-and this professional support network has helped me become more confident.

Mentors should also encourage residents to engage in the local community. Meeting orthotic and prosthetic users at volunteer events, such as walking and running clinics for people with limb loss, can help residents see the results of their work and the impact O&P care has on the lives of their patients.

What Can Residency Mentors Do?

A primary mentor will have many one-on-one interactions with his or her resident. It is important to establish a working relationship from the beginning. Creating a game plan for the resident's tenure at your facility can give you both a sense of direction. Knowing with whom he or she will be working, the main focus of each portion of the residency, and having goals for each quarter will help motivate the resident. For example, I worked with mentor A during my first quarter and mentor B during my second, and I am again working with mentor A in my third quarter. At the beginning of each quarter I discuss my goals with my residency supervisor, and this helps guide activities and enrichment opportunities inside and outside of work. I find it extremely helpful to know what types of skills to focus on each quarter.

Forming a positive mentor/mentee relationship is largely dependent on giving regular, constructive feedback. Residents can only improve if they know what they are doing wrong. Explaining why something is wrong, understanding the resident's thought process, and then introducing a new way of addressing a task help the resident develop problem-solving skills. In addition to this strategy, giving residents some degree of repetition is crucial to reinforcing how to address similar patient cases. For example, having your resident take multiple transtibial castings within a short timeframe will help reinforce the hand skills, modification process, and techniques for various lengths of transtibial amputations. I delivered several DAFOs in one week and gained confidence working with that particular family of orthoses-how to fit them, properly adjust them, and educate patients on their care and use. However, the resident should also see a variety of cases to understand and gain experience with the different types of presentations that he or she may encounter in professional practice.

Encourage your resident to handle cases in which he or she may have less confidence. Early in my residency, my mentor was triple-booked during a particular time slot and asked me to do a full transtibial evaluation on my own. I hesitated, but she told me she trusted me and that I could do it, and that I would report back to her with my findings before proceeding with casting. With her reassurance and supervision, the appointment was a success. I realized that having a gentle push forced me to assume the role of an independent clinician. Slowly increase your trust in your resident as he or she proves to be competent. This will help him or her develop confidence and become more independent.

When I started my residency, I learned many different procedures (i.e., steps for evaluating a patient for an AFO, how to fill out OPIE forms, how to perform transtibial diagnostic fittings, etc.), which were excellent tools to fall back on in case I felt lost. Teaching residents procedures and methodologies to tackle problems gives them a starting point to develop their own procedures. I have since modified the processes I was taught to better suit my needs. Working with a patient becomes less stressful when there is a procedure to follow, at least for segments of the appointment.

Simply being available to your resident can greatly improve your relationship. Having an accessible mentor (or mentors) can help residents when they are with a tough patient and need another set of eyes. Having staff that are willing to explain processes to residents, as well as other clinicians who can offer clinical advice, is invaluable in a busy office. When my mentor is busy, I know there is always someone else I can ask for advice in case I have a question or concern about patient care.

What Can a Resident Do?

Having the right match is essential for a mutually beneficial experience. The resident should be compatible with the practice's technical and clinical needs, as well as the office culture, which requires that both parties interview each other in the selection process A resident should seek a residency site that treats patient populations of interest to him or her, and offers the development of professional skills.

During residency, the resident should be inquisitive and want to understand the thought process behind clinical decisions, as well as how to handle more challenging cases. Above all, residents should respond to feedback in a positive manner. Residents should accept making mistakes, take correction, and be willing to learn from the mistakes. In addition, residents should be comfortable communicating professionally and providing patient care for a diverse patient population-diversity in race, age, education, socioeconomic status, and many other factors. Residents who only understand how to work with people they connect with will quickly be frustrated.

Residents should follow through on their work. Finishing notes, making calls, and modifying casts in a timely manner will not only develop professional and technical skills, but will also build individual value. Taking initiative in finding ways to be of assistance can help establish the resident as part of the team and not simply as "the resident."

A successful residency program hinges on the facility's culture and having an involved primary residency director and an engaged resident. These three components help to produce educated individuals who can make valuable contributions to the O&P profession. While employing a resident may be a financial strain to some companies, there are ways to make it useful and effective for the business. Each resident will have different attributes, and understanding his or her strengths can help each residency site know where to place that person in the practice so all involved can derive maximum benefit. Further, residents who have just finished their educations were taught the latest techniques and educated on the latest technologies may be able to pass that knowledge along. Keeping these suggestions in mind should help your next residency experience run more smoothly and be more beneficial for the patient care practice and the resident.

Nina Bondre, MPO, is an O&P resident at Dankmeyer, headquartered in Linthicum Heights, Maryland.