Externship & Residency Prep: What should I be doing?

Anthony Schwab, MBS, Dr. Andrew Meyr, DPM, FACFAS, and Dr. Jennifer Van, DPM, FACFAS, FACPM

Dr. Meyr

Dr. Andrew J. Meyr, DPM, FACFAS is the Clinical Professor at Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania. In addition, he is the Director of the Temple University Hospital Podiatric Surgical Residency Program, and Podiatric Director of the Limb Salvage Center. Dr. Meyr is also involved with other podiatry student associations such as Executive Producer of TUSPM Podcast Network, and Curator of The Shoe Museum at TUSPM. He is also recognized as apart of the Board of Directors for the American College of Foot and Ankle Surgeons. Moreover, he is the author of Anatomic Meditation, editor of AJM PRISM App, and founder of Pod Art.

Dr. Van

Jennifer C. Van DPM, FACFAS, FACPM is a current Chair and Clinical Associate Professor for the Department of Surgery. She is also the Division Chief of the Podiatric Surgery, Temple University Hospital – Jeanes Campus. Furthermore, she is involved as Externship Director for TUH Podiatric Surgery Residency, and is involved at a state level as Secretary and Treasurer for the ACFAS Tri-State Region.


Q1.What is the most important thing(s) that first, second, and third year students can be doing to prepare for externship/residency?

Dr. Meyr: The most important thing first and second years can be doing is getting as much information as possible out of their didactic classes. Not just memorizing the material for getting good grades, but making sure they’re starting to apply that information in a clinical setting. They should start reading into different externship programs and start visiting some programs, as well. You could visit as a first-year podiatry student on day one, and show up to start to get an idea of what you like and what you’re interested in. I know sometimes when you’re in the middle of first and second year, it’s no different than undergrad – you’re listening to someone present powerpoint slides, and you’re regurgitating that information on a multiple-choice examination. However, it’s different here – you have to be able to pull that information out in the future when you’re evaluating a patient. So you have to continuously think about the material in terms of clinical application.

Third year students should see absolutely as many patients as they can. If all you did was show up and see the patients that you have to, you’re never going to get anywhere. If you’re not seeing a patient, you should be up and down the hallways seeing if your fellow classmates need any help. You’re getting together with your group afterwards and talking about the patients (saying “oh we ordered this test or saw this radiographic finding” or “this is what we saw on the pre-op or post-op imaging”). You can multiply what you see by your discussions and interactions with other students.

In regards to visiting, I appreciate that there are restrictions due to COVID-19, but being in the classroom and the clinic is different from being in a hospital, and 80% of your time in residency is spent in a hospital. Visiting is a way for you to get an idea about what you like and what you don’t like, and what you think you may be interested in.

Dr. Van: For first and second years, I would say just really focus on didactic training, because if you go to visit a program during your first year, you are going to be completely clueless (as you should be), because you’re just learning your basic sciences. My honest opinion and advice for first and second years is to really focus on the basic science courses. Those are the courses that have the most number of credit hours, so those are the ones that are going to hit your GPA and class rank really hard. Say you don’t do well in Path and Pharm, and you can earn A’s in all of your surgical classes- it’s not going to reflect in your GPA because there’s so many more credit hours for those basic core classes. I would really just tell first and second years to hit the books and go through the grind – it will be worth it.

For third years, it is an exciting year because you get a taste of the clinic and an idea of what it’s like to start interacting with patients. I would say 3rd years should start looking at 4th years and seeing how they perform in clinic, and asking them questions. Definitely start asking these students questions, like, “What programs are you externing at?” or “Hey, can you tell me about this externship?” Ultimately, your colleagues will be much more brutally honest with you, as opposed to me, if I say, “Hey, what did you think of this program last month?” You’ll definitely be a little more politically correct for me, as opposed to asking a 4th year student, so something to keep in mind. I would say the bottom line is to start asking questions as a third year. Part of that is taking the initiative – no one’s going to ask these questions for you, so really take advantage of the students who went through the process before you.

Q2.How about being involved in research? To do or not to do?

Dr. Meyr: The question is “why” you’re doing research. If you want to do research to have something on your CV so that it looks good, I would say no, don’t do it. If you have scientific questions, and you think that you might have an interesting idea and can produce something that might answer those questions that can push the knowledge boundaries of our profession, then I would do it. A lot of people think that they want to do research, but not a lot of people actually want to do research and simply want an addition for their CV. That doesn’t have a lot of value.

Dr. Van: I think if you’re interested in research, you should definitely do it. You want to get started sooner than later, just because research takes time. I think about my own ongoing research and gathering data, which takes a lot of time. It’s tough to do it as a first and second year, because you’re not in clinic and seeing the pathology. However, if it’s something you’re interested in, I always encourage students to go to an attending that you work well with or are comfortable with. It could be your advisor or even someone else, and ask, “I’m interested in getting involved in some research, do you have any projects you need help with?” Again, part of that is to be proactive; no one’s going to come to you and say, “I have this fantastic idea, come help me do this.” The likelihood that something like that is going to happen is probably lower than you saying, “I want to do some research, what can I do?” Also, know that research doesn’t happen overnight. It can take a few years to be completed, which is super important. If you want to get started on something, I’d definitely recommend to get going during the third year.

Q3.What is the most important quality you look for in an extern and resident?

Dr. Meyr: You want someone that is smart, but grades only get you in the door. After you apply for externships, very rarely do I look too much at GPAs, class ranks, etc. Much more important in the decision making is how hard you work, how enthused you are as a learner, and how well you’re getting along with everyone else – those types of things. I would say that our “best residents” haven’t been at the top of the class. We’ve had good residents that have been at the top of the class, but your class rank and GPA only matters so much, in terms of how much you’re getting out of it and how much you’re putting into it.

Dr. Van: For an extern, everyone is going to tell you the same things: someone well-rounded, smart, bright, has good grades, but I think what it really comes down to is you want a student who takes the initiative and “gets it.” What I mean by that is, you can have the number one student in the class and can just be great academically or didactically, but completely clueless in the hospital and OR. You can also have students that may not be as strong academically, but are fantastic externs, and I think the deciding factor is students that have anticipating instincts. When you’re an extern, the things that make you stand out are: one, if you’re paying attention. What I mean by that is that if you know you’re going to scrub an ankle fracture with me, the likelihood I’m going to ask you to classify the ankle fracture is 100%. Things like that are what you have to proactively think to yourself, “I realized I might be scrubbing a bunion tomorrow, so I’m going to review all of my HAV pre-op angles.” So those are the students that really stand out; the ones that are prepared and take the initiative to prepare themselves. Some social cues, as well, which are some of the things that you pick up on when you’re in the hospital. Also, what you want to do is try to make the resident’s life easier. For example, something as small as putting on a dressing: if you see the resident struggling to put on a post-op dressing, just walk over and hold up the leg. That shows me that you’re actually paying attention and trying to help, so again, those little subtle things that seem like not a big deal are what people will catch on to. Keep in mind, you’re not expected to know everything, and the whole point of externships is that you’re constantly learning and trying to come out of an externship with a wider knowledge base.

Q4.Advice for residency interviews or externships?

Dr. Meyr: Generally speaking, people are well prepared for externships and residency interviews. I host residency interviews, so it’s a little different. I think about the Temple students as potential applicants, but I also think about them as my students. So before our residency interview, I want students to do well, but I do think about them as a student, and about representing the school and profession well. I think for the most part, everyone is well prepared and rehearsed, which I think comes from stress. You study and prepare when you need to, because you know the interview is coming up and you’re getting ready for that, as opposed to having it in yourself where you want to be prepared and learn everyday just for your own self-education. I guess if I would change anything, it would be so that students have a different attitude about it, and that they were doing it more for themselves for the specific job application.

Dr. Van: I think that the externship application process is completely different from the residency application process. The externship application process is kind of like training wheels, and the residency application process is where you’re really interviewing for a job that you commit to for 3-4 years. The program is doing the same thing – committing to you for 3-4 years.

Q5.What are some things you look for on a prospective student’s resume/CV, if any?

Dr. Meyr: I would say that people that put corny stuff on their resume are obviously trying to make it look good. It is what it is. If you’re trying to make something out to be more than it is, it becomes pretty obvious. It’s like your GPA and class rank. Everyone has a CV and they all look about the same. Everyone has done about the same amount of “things”, some having a little more or less. However, the decision is not going to be made based on your CV, but more so on how you present yourself.

Dr. Van: When you’re preparing for residency interviews, you want to make sure that your CV is perfect. What I mean by perfect is no misspellings, which I see often. When I see a misspelling on a CV, I think to myself, “That’s sloppy.” Same thing applies with your personal statement. This is the time when all of those things get read and you’re going to get questions about it, whereas when you apply for externships, most likely someone’s not going to call you and say, “Tell me a little bit more about your ongoing research.” That question is going to come during residency interviews, so you need to know your CV well and you need to be polished. Polished, as in the paperwork and application is a reflection of you, so if there’s any misspelling or incorrect use of pronouns, grammatical errors, etc., that becomes a reflection of you. Preparing for residency interviews is a little bit more academic, as well. A lot of residency interviews will have an academic portion and a social portion. So, you don’t want to knock the academic portion out of the park and completely bomb the social questions. If someone asks you, “What do you like to do for fun?”, you should most definitely have a detailed answer to that. The residency program wants to know you’re human, and I know it sounds intuitive, but you should practice answering social questions out loud. Just have a friend or family ask you, “What was your favorite book you read?” or “Tell me something about yourself.” Just practice speaking out loud and telling people about yourself, because there’s the humanistic side that residents and program directors want to see.

Q6.What should the responsibility of the student be in the OR as an extern, and eventually, first year resident?

Dr. Meyr: Really just preparation. All programs are different certainly, but there is definitely a lot of similarity. You don’t get to do something unless you can prove that you can do it. For both externs and first year residents, if you know what equipment needs to be used and set up in the room, if you have the x-rays in a place where they can be easily viewed, and as you are going through the case, not so much that you’re answering pimping questions, but that you’re anticipating what’s happening next in the case. Something as simple as retracting: instead of just retracting and not paying attention, simply moving your retraction in the direction that the surgery is going. You can call out for instruments, since you know what’s coming next. If you can show that you know what’s going on in the case, the attending is going to trust you next time with actually performing the case. Externs can do that. Also, ask questions – too often, students wait to be asked questions; just ask questions as the case is going on.

Dr. Van: One is to be helpful, but in a way that you’re kind of staying out of the way. What I mean by that is you want to be helpful. If you’re doing an elective case, you’re probably going to need a tourniquet, local anesthesia, etc. So those are all things that you can be proactive about. Introduce yourself to the scrub tech and circulator: “I’m Student Doctor so-and-so. I’m happy to help out, and these are the things we’re going to need. I’m happy to help in any way.” Some may be really receptive and ask you to grab all those things, whereas some may simply do it themselves. Something as simple as pulling your gloves and the resident’s gloves – I know it sounds small, but it actually shows that this person is paying attention and helping me get the room ready. Another example: if I ask for suture, you should ask for suture scissors because you’re going to be cutting my sutures. If I ask for a rongeur, you ask for a wet sponge, because you’re going to be grabbing soft tissue out of my rongeur. All that is doing is simply anticipating my next move in the OR, and it goes a long way. A big way for students to sort of crumble in the OR is if the case doesn’t go any better or worse if you’re in the room. If you’re not an active participant, I think that does a student a disservice as well, because you want to do things like suture and make an incision, and no one is going to give you that opportunity if you don’t show interest. As far as externships, you’re going to be spending a lot of time with the residents. The first week I call your “trial period” where you get the lay of the land, but after the first week, you should be able to anticipate things and be helpful. You want the residents to think, “Wow, I really hope this student is scrubbing, because they’re so helpful”.

Q7.What is the most important question you ask on a residency interview?

Dr. Meyr: Mine is kind of philosophical. I always ask this question. Everyone goes to a residency program to get trained surgically. Any program in the country does that and takes pride in that. We’re going to teach you how to do surgery and how to best treat your patients. So, if everyone is doing that, that’s not the reason you go to a residency. And that’s a very common answer you get when you ask: “Well, why do you want to work your butt off for the next couple years in residency?” And you get “Well, I want to become an excellent surgeon,” as an answer. More importantly, I want to know what goals do you have in your residency that go beyond your medical and surgical training. What do you want to get out of residency besides that specific experience? Everyone is different, and there’s not good or bad. You may just want to go into private practice and just throw yourself completely into that. That’s perfectly fine, but I want to learn how to see patients as effectively as possible, learn more about billing, etc. Maybe you are interested in research. Maybe you want to make sure you have a publication by the time you’re done residency, or learn how to break down an article. I want to get involved in the peer review process for JFAS or JAPMA, so I want to learn how to do that. Then other people are different, and want to get involved in residency education or national organizations someday. There is learning in how to do that, and different programs present different opportunities with respect to that. It’s not just learning the craft; it’s what else you want to do. It’s the “why.” What’s the reason you’re busting your butt every day, and why do you want to do so?

Dr. Van: That’s a tough one, because I feel like by the time you interview for a residency program, you’ve probably spent a month there and they actually have a good idea of who you are and how you perform. If I had to pick the one most important question, I guess asking the applicant, “What is it you’re looking for in a program?” We’ll get applicants that say, for example, “I’m really looking for a wound care program. I love wound care. I want to do a ton of limb salvage, and that’s what I’m passionate about.” I guess really asking the student what they want to get out of the program to see if your program aligns with their personal interests and aspirations. Because as much as good students want good programs, good programs want good students, so it goes both ways.

Anthony Schwab, Temple University School of Podiatric Medicine.

Chief Editor, Hallux Magazine