Intraoperative Radiation Exposure to U.S. Podiatric and Medicine Surgery Residents Annually: How Much Are We Really Getting?

As the number and complexity of operative techniques taught at U.S. podiatric medicine and surgical residencies (PMSR) with the added credential in reconstructive rearfoot and ankle (RRA) surgery has continued to increase, so to has the use of intraoperative fluoroscopy. The purpose of the present prospective observational pilot study was to quantify and compare the shallow dose equivalent (SDE), deep dose equivalent (DDE), and lens of the eye dose equivalent (LDE) exposures for podiatric medicine and surgery residents at a single PMSR-RRA over 12 consecutive months. Shallow-dose equivalent, DDE, and LDE exposures (in millirems) were measured using Landauer Luxel dosimeters from July of 2018 to July of 2019. Dosimeters were exchanged monthly, and mean monthly/annual SDE, DDE, and LDE exposures were calculated and compared. Overall, residents averaged 19 operative cases per month and 222 per year. More than half (53%) required intraoperative fluoroscopy, for which a mini C-arm was used in most cases. Monthly SDE, DDE, and LDE exposures averaged 7.3, 9.3, and 7.0 mrem, respectively; whereas annual SDE, DDE, and LDE exposures averaged 87.3, 112, and 84 mrem, respectively. No significant monthly (P = 1.0, P = .70, and P = .74) or annual (P = .67, P = .67, and P = .33) differences were identified between residents. The annual SDE, DDE, and LDE for residents at a single PMSR-RRA were well below the recommended dose limits of 50,000 mrem/year (SDE), 5,000 mrem/year (DDE), and 15,000 mrem/year (LDE) set by the National Council on Radiation Protection. However, given that the stochastic effects from low levels of ionizing radiation are cumulative, not well studied long-term, and relate both to the degree and duration of exposure, mini-C arm fluoroscopy, radiation tracking, and use of personal protective equipment provide simple means for residents to reduce any long-term potential for risk.

A Formal Work Hour Analysis of the Resident Foot and Ankle Surgeon.

As new documentation requirements by governments and third-party payees increasingly occupy physicians' time, duty hour restrictions have continued to restrict the work hours of residents, leaving programs tasked to produce proficient foot and ankle surgeons (FASs) in less time. The purpose of the present study was to quantify the workday of resident FASs at our institution to identify areas suited for revision to improve efficiency and training. A resident from each postgraduate year (PGY) was recruited and consented for minute-to-minute observation by 4 independent observers over 5 consecutive workdays. The time recorded was placed into a predefined work model consisting of 9 categories (education, research, operating room, patient care, documentation/administration, communications, transit, basic needs, and standby) within 1 of 3 value groups (positive, neutral, or negative). A fifth independent observer reviewed and recorded all collected data. Over 5 consecutive days, ancillary staff frequently disrupted the PGY-1 resident's workflow. The interruptions fragmented the resident's thoughts, increased inefficiency, and resulted in the largest proportion of the resident's time (16.7%) being occupied by documentation/administration duties. For the PGY-2 and PGY-3 residents, unexpected trends in standby were identified during the preoperative period. Secondary analysis revealed that during unexpected preoperative delays, resident efficiency was poor. To maximize efficiency and improve training, residents must increase their awareness of self-inefficiency while minimizing unnecessary interruptions and the time occupied by duties of lesser value. It is our hope that the present study will aid other institutions in facilitating similar improvements to the education and training of our fellow resident FASs.