Resident: Dr. Matt Knabel
Year: PGY 3
1) What residency program are you at, and what year are you?
I am a 3rd year resident at Mount Auburn Hospital in Cambridge, MA.
2) What are your thoughts on completing a fellowship versus going straight into practice after residency graduation?
You have to think about what you want professionally, personally, and financially.
Deciding on doing a fellowship versus going straight into practice is usually a personal decision that can differ a lot from person to person. You have to think about what you want professionally, personally, and financially. I decided to go straight into practice. When I was selecting residency programs to rotate with, I wanted programs where the training was so well-rounded that I would have the abilities and knowledge to enter practice at the end of the program. A good measuring stick is the 3rd year residents. Are they confident, skilled, comfortable and such? I was lucky enough to get a program that fits that bill. If you’re thinking fellowship or don’t want to limit yourself while you decide, you should try to rotate at programs that regularly have residents going into fellowships. It is not a coincidence that some programs consistently have residents going into fellowships.
3) What is the best part of residency, in your opinion?
I am toward the end of my residency, so I am feeling nostalgic. As I look back it’s pretty amazing how much you pack into those three years. It’s a short time, but with the right people and the right mindset, you really get a lot out of those 3 years. I have loved the daily opportunity to pick so many amazing brains for techniques, knowledge, and advice. It has inspired me to be an attending with a residency program next year.
4) What is your surgical case volume and type in a typical week at your program?
The 3rd year residents at my program take on more of the rearfoot and ankle surgery, and our 2nd years cover more of the forefoot and midfoot pathology. The 1st years get infection and amputation cases in-between completing a lot of their off-service rotations. Most weeks chief residents log anywhere from 15-35 procedures. As with any surgical program, there are ebbs and flows with types of surgeries and the numbers throughout the year. For example, trauma can be a bit dependent on the season. In New England, we get a spike in our trauma during icy, winter months.
5) If you had to pick again, would you pick podiatry and your program?
Overall I have been pleased with my decision to go into podiatry. Most of my family is in medicine in some form, so I knew a medical career was what I wanted. I have always enjoyed the surgical side of medicine. I think I would have enjoyed general orthopedics as well.
I would absolutely pick my program again. I feel like I have gotten great exposure to surgery, billing, business, research, medicine, and clinic. It hasn’t always been easy, but residency is supposed to be uncomfortable at times. I would hope that everyone gets a program that challenges them in many ways.
6) What advice do you have for a (4th year) podiatry student?
Work hard, be punctual, and be enthusiastic. It sounds easy, but I have been surprised by how many externs with us have struggled with one of those three things. It’s a long year to be on the top of your game, but residency is a grind too. A residency program is looking for the next person that can join the group, and someone the group can depend on. With that being said, a residency program is not only looking for a smart and hardworking applicant, but also someone that they want to work with for the next 3 years. So, treat everyone well and be someone that you would want to work with too.
7) What is your favorite surgery?
My favorite surgery is an arthroscopic debridement of the ankle joint followed by a Brostrom-Gould repair of the anterior-talofibular ligament. That is my favorite because it combines so many different skills and techniques. The correction on the table is very satisfying and tangible. Also, from my experience these patients do very well post-operatively.
8) What has been your favorite outside rotation?
General orthopedics has been my favorite rotation. We do several rotations with our orthopedic attendings. There are no orthopedic residents at our hospital, so they really value having us in the operating room to help. I think a lot of doctors are natural-born educators, and our orthopedic attendings are no different. We may be doing a hip, a shoulder, or a wrist, and they will explain the pathology and the techniques involved for the procedure. You find that there are a lot of parallels between foot and ankle surgery and orthopedic surgery elsewhere throughout the body.
9) What do you see for your future practice setting/case type? Has this changed since you were a student?
My plans for my future type of practice have not changed much. I have always wanted to be able to treat nearly any issue of the foot and ankle that comes through the door. With that being said, one does not always get to choose who or what comes through the door. I think it is important to have a residency that gives you exposure to as much as possible so that you can make your decision about what you are comfortable with on your own. Also, in residency, you learn that there are certain surgeries that are best done by those that do them more frequently. If a patient needs a surgery that you are not comfortable with or that is not within your skill-set, then you need to refer them to the right person. I think the maturity of making those decisions has changed and improved since being a student.
10) Finally, everyone is constantly learning, and new information is more available now than ever before. When you’re finding that things you’ve done or learned in the past are not correct, how do you respond to this?
I would say that it’s important to always approach something with an open mind. As a student, you are always learning new ways to do things. Try to understand the “why”. Be curious and critical of what you are learning. Residency is a good example of that. You will see your attendings do a surgical procedure many different ways, and they will all think they are right. Understanding the “why” is a way to determine if it’s a technique that is best for the patient. As you understand subjects more and learn more you realize that some techniques or fixation may be outdated.
As a young physician and lifelong learner, it is your responsibility to perform the standard of care for your patients. If you are aware that you are performing surgery or doing some other form of treatment that isn’t correct, it is your responsibility to seek out adequate information and training. If you are not willing to do that, then you need to send the patient to someone that will treat the patient appropriately. Doing something because “we have always done it that way” is no way to treat your patients if it isn’t correct. This requires that you continue reading the literature as it comes out to stay current with the latest techniques. Going to conferences and speaking with colleagues about cases can be another way to keep your brain working and your antennae up for new techniques and ideas.
Interview by Elizabeth Ansert
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