Using resident input to identify and integrate essential components of a foot and ankle rotation

Foot and ankle surgery is one of the orthopaedic subspecialties to which residents not uncommonly receive limited exposure. Therefore, it is important to identify what both faculty and residents regard as fundamental to a foot and ankle rotation. The purposes of this study were to identify the essential components of a foot and ankle rotation and to correlate these with the American Orthopaedic Foot and Society (AOFAS) core curriculum, and to discuss how to integrate resident input and AOFAS guidelines into a valued foot and ankle rotation.

Over a 5-year period, each orthopaedic resident beginning a 10-week postgraduate year (PGY) 3 foot and ankle rotation was asked to choose topics to be covered during weekly 45-minute discussion conferences. Each resident also identified personal goals for the rotation. Data were collected in this prospective nature, and the responses of the 24 PGY 3 residents from our program who completed the rotation between February, 2000, and April, 2005, were analyzed. The discussion conference topics were compared to the AOFAS guidelines, and the top 10 personal goals were determined. Prerotation and postrotation Orthopaedic Inservice Training Examination (OITE) foot and ankle scores for the residents also were analyzed.

Among the nine AOFAS core curriculum categories, residents most frequently chose chronic soft-tissue foot and ankle problems, followed in frequency by foot and ankle arthritis, foot and ankle trauma, and diabetic foot. Individually, posterior tibial tendon insufficiency, hallux valgus, diabetic foot, and calcaneal fracture were the most frequently chosen discussion conference topics. In regards to personal goals for the rotation, residents most commonly wanted to improve their physical examination skills (88%) and increase their orthotic knowledge (71%). The OITE scores improved by a mean of 12% after the rotation.

This study provides new and detailed information about resident expectations for a valued foot and ankle rotation. These results should be integrated with existing AOFAS guidelines to further refine the essential components of a core foot and ankle curriculum.