Program Review
Staff / Faculty / Chairman
I wrote my last review late in my intern year - I want to update it now as a PGY-4 since I have more experience and have seen both the good and bad my program has to offer. As social media platforms become an increasingly acceptable way for people to gather information about programs, I think it only fitting that information about Summa stay up to date.
We have experience no significant staff/faculty turnover or major changes since my last review. Dr. Weiner, a graduate of the program and our orthopaedic oncologist, continues to chair the program. Under his leadership, my chief class next year will see our program fully expanded to 20 residents (prior to my class we took 3 a year, we now take 4). At a time when many programs are shrinking or staying the same size, our program continues (even with 4 a year) to be unable to cover all cases.
Since my last post, we have added three new sports medicine attendings. All three are graduates of our program and all are young, energetic, already busy, and eager to teach. Their practices are all slightly different. One, has specialized almost exclusively in hip arthroscopy and is performing some of the most innovative procedures I've seen (scopic femoroplasties, acetabuloplasties, labral repairs, iliopsoas lengthenings, and glut med repairs). He's so busy that a typical week comprises 8-10 hip scope cases.
We've also added a new pediatric orthopaedic surgeon, again a former graduate of our program. We've also added a new hand attending, bringing the total of hand attendings we cover up to 7. One will likely retire this year.
Unfortunately, we will likely be loosing one of our most respected shoulder/elbow attendings, Rob Bell soon. After serving as president of the shoudler/elbow society last year, he is retiring. I expect that in the next 5-10 years we will loose around 5-10 of our 30+ faculty members to retirement. Most, however, have already slowed down enough that we as residents do not routinely cover them, and there are always residents eager to come back to Akron to practice. In fact, all three residents in this year's chief class are at least considering coming back.
Dr. Junko continues as program director and does an excellent job keeping the program running smoothly. He is always receptive to input from residents. Case in point, we decided at the end of last year that we needed to overhaul our interview process. He agreed and allowed us to radically change the way we interview. I think it has been a huge improvement. He walks us through a close review of each rotation at the end of each year to discuss needed improvements/changes. In the past this has included changes as major as cutting time from one rotation or adding to another. He's an excellent advocate for our program.
Didactics / Teaching
Little has changed since my last review with the exception of the new attendings being added to the lecture schedule.
We continue to have a 7am-8am morning conference daily with an 1.5hr grand rounds led by the chief resident each Friday. The morning conference is based on a 2 year rotation lecture schedule which is mostly attending-led. In the summer months, we dissect fresh frozen cadaver specimens. As fall approaches, we shift to focusing the conferences more on OITE preparation - even these conferences are well-attended by our attendings who lend their knowledge to the discussion.
The Austen Bioinovations lab (ABIA) is one HUGE addition that deserves special mention. It is a cooperative between University of Akron, Akron General, and Summa that promotes healthcare related research and education. They own a building downtown (about 3 minutes from our campus). They have a lecture hall with state-of-the-art AV equipment on the first floor. In the basement, they have set up stations that are basically miniature OR suites complete with overhead surgical lights, an OR table, and a complete set of instruments. Each station has an overhead camera for demonstrations. This is where we perform our anatomy dissections in the summer. I can't emphasize enough how this has revolutionized the learning experience. We are able to use fresh frozen cadavers allowing a much more realistic feel for dissection as the tissue planes are preserved. Typically, three residents are assigned a part of the body for dissection each week. The intern will review osteology, muscle origin/insertion/invervation patterns. The junior resident performs the dissection. The senior resident performs and discusses surgical approaches. It's been an excellent experience for everyone. These sessions are also well-attended by attendings.
The ABIA has also allowed us to host workshops and seminars that typically would only be seen at industry-sponsored courses. We've held direct anterior hip workshops, trauma workshops, upper extremity workshops, etc. Usually, Akron General and Summa residents attend. These typically last all day and attendings present didactic portions in the lecture hall with cadaver-based dissections in between. This has revolutionized our education process as it has allowed our junior residents to perform senior-level surgical techniques under the watchful eye of attendings (ilioinguinal approaches to the acetabulum, arthroscopic surgical skills, etc).
Summa is very generous regarding conferences. Interns go to AO basic, PGY-2s go to the OTA course, PGY-3s go to the AAOS arthroscopy course in Chicago, PGY-4s get to pick the conference they want to attend, and PGY-5s go to both the annual AAOS academy meeting and Miller's review course in Denver. You can also attend any conference where you're presenting research. All expenses are paid. You are allowed $50/day for food.
Operating Experience
Operative experience continues to be excellent. As in most programs, however, it is what you make of it. We cover so many attendings that if you choose to do a minimal amount of work, no one will notice. On the other hand, there are never a lack of cases.
Our priority is to make sure all cases at St. Thomas hospital and Akron City hospital have resident coverage. After that, residents are free to cover cases at the outpatient surgery center. The surgery center is an excellent experience - it is extremely efficient and as many cases are done there as at St. Thomas. It's a completely different experience that is great to be a part of.
Spine and total joint cases are so plentiful that we cannot cover them all. We don't even come close to covering all of the cases at the surgery center. As a rule, double scrubbing in our program is rare and usually by choice (a rare case or cool pathology). Even with a junior and senior resident on the same service there is plenty to do. Hand, foot and ankle, sports, shoulder/elbow, oncology, joints, and spine cases are always plentiful and if there are two residents on a service, one may go to office while the other operates and vice versa.
Trauma is the only service where double scrubbing is common. By trauma, I don't mean bread and butter fractures which you will do on every service. I mean complex peri-articular fractures, pelvic/acetabular fractures, complex non-unions with bone grafting, difficult infections, etc. The senior resident typically runs this service and has dibs on cases. The junior resident on service often double scrubs with the expectation that if it is a "bread and butter" type case, the senior walks the junior through the case.
One other thing to note is our experience at Akron Children's. Currently, we spend a month there as interns and then two consecutive months each as a PGY-2, 3, and 5. As chiefs, we run the service. I cannot express how nice it is to not have to leave town for our pediatric experience. Akron Children's is a free-standing children's hospital with 7 full time pediatric ortho attendings and NO fellows. When we rotate there, we are only responsible for covering call at Akron Children's and it is an excellent experience. Even junior residents are given significant autonomy in the OR. Call is busy and it is not unusual in the summer to cast 20-30 kids per call. Some require reductions in the ER and some in the OR. It's an excellent experience. The Cleveland Clinic, Allegheny, Akron General, and Summa all rotate at Akron Children's, but the Summa and Akron General residents take turns as chief.
Clinic Experience
Clinic is clinic - none of us love it, but we all recognize the importance of it. Our clinic experience is probably a little backwards from most programs. We tend to do less clinic as junior residents as the priority is 1. cover call and 2. cover cases. As seniors, we are expected to do one full day of clinic per week on whatever service we're on. This can be two half days and we can mix and match attendings.
Further, starting as a PGY-2, we have our own "house clinic" where we see uninsured or underinsured patients. The unique thing about this clinic is that it is set up like a private office and these patients are "ours". Regardless of what service you're on, you never can tell what might show up - a patient needing a total hip, a fracture that needs surgery, etc. This gives the resident the unique opportunity to work up patients pre-operatively and follow them through surgery. As painful as clinic can be, we would all agree that this is a great experience.
Research Opportunities
There are research opportunities, but research is not a huge focus of our program. Most of us come here because we want to be excellent surgeons, not have high-power research careers.
With that said, the ABIA has opened a lot more doors to research. Furthermore, the university of Akron and the med school, NEOMED have labs and ample graduate students eager to participate in projects with residents. The university of Akron has a world-renown polymer science engineering department and a significant portion of basic science research is based in that discipline.
There is grant money available for research. One grant, the Kepley grant, is competitive and provides $50k for research. So there is money available and opportunities if you want.
Residents
Still one of the best parts of our program. We are careful about who we recruit. The way we look at it is we can teach orthopaedics to most anybody who's willing to learn, but we can't do much to improve your work ethic or help you get along with others. This is a tight-knit group and we are proud of our status in the hospital as hard workers. We never say no to a consult and we work hard to keep up good relations with other programs (gen surg, ER, etc). So someone who is rude and doesn't treat people well is going to stand out in a bad way.
We are a very family friendly program. When I started, our welcome banquet at Dr. Weiner's house looked more like a day care than a group of residents! Each class seems to have one or two who is not married or does not have kids but we are definitely a program that recognizes the unique challenges of being a parents/spouse/resident all at the same time. That doesn't mean we excuse people who don't pull their own weight, but we do help each other.
Lifestyle
I'm from Georgia so moving to Akron was a bit of a shock. However, I have found the people to be welcoming as I would expect of a moderate-sized midwestern city. My nextdoor neighbor began having my wife and I (along with our two kids) over for Thanksgiving the first year we were here and it's become a tradition we look forward to.
I think the way you view Akron will depend on what you're used to. For me, I grew up in rural Georgia and went to college/med school in a city not much larger than Akron, so it hasn't been much of an adustment. Akron has everything I need and as a husband/father I don't have too much time to miss other stuff. However, if you're used to New York, Chicago, etc you may want to spend some time here before deciding to pull the trigger on 5 years!
Finally, the weather in the winter is miserable - it's gray, cold, and wet (snow or rain) from November through April. Summer and Fall are great.
As far as the program, we still have a very traditional call model which might bother some people. We've kicked around the idea of nightfloat since I was an intern and ironically, it ends up being the residents who are most resistent to the change.
Interns take 8-10 calls per month, but these are really 16 hour shifts (in keeping with work hour restrictions). Now that interns spend 6 months on ortho, I think this time is better spent. Interns often operate more than the second years for two reasons. One, we want them exposed to the OR, the attendings, and learning basic surgical technique. Second, they require supervision by at least a PGY-2 so it doesn't make sense to have the PGY-2 and the intern leave a line up to see a consult. It's a pretty nice year. The other services (1mo vascular, 1mo plastics, 1 mo trauma, 1mo ER, 1mo medical ICU) all treat our residents really well.
PGY-2s are primarily responsible for the ER. It's by far the toughest year in terms of call. You do start service-based rotations but it is the understand of both the resident and attending that call comes first and you may have to leave a line-up. As a 2, you'll typically take 8 or 9 in-house calls per month. Call is 24 hours, and you are expected to go home post-call with rare exceptions as noted by ACGME guidlines. Dr. Junko/Weiner are sticklers for the work hour restrictions. There is no under the table activity going on. As chiefs, the expectation is that all residents follow restrictions.We cover two hospitals which are 1.8 miles apart. However, after hours, 99% of the work is at Akron City so there is not a lot of going back and forth. You're always one with a senior resident to run things by. Even as a PGY-2 you get 2 free weekends a month.
As a PGY 3, call frequency drops to about 5 or 6/mo. However, this can be one of the most stressful years as you are now a "senior" resident who must supervise the junior residents. It's a good learning experience as doing a consult and supervising while a junior does one are two different skills. Starting in November, the senior resident is now allowed to go home at 8pm if the work is caught up. This frees you up to operate the next day, but you have to be ready to come back in at a moment's notice to help the junior. You spend more time in the OR this year.
PGY-4 is our most lifestyle friendly year. You take 4 calls per month and only one weekend (usually a Saturday). Pretty much your sole responsibility is to operate. In the fall, you are given a month free of any call or clinical responsibility to do an "away rotation" at the potential fellowship programs of your choice. This is an awesome opportunity not given by many residencies and has helped us land some big fellowships. Also, while rotating on the hand service, the PGY-4 is free of regular in-house call and only takes back-up hand call. It's a great year.
PGY-5 is busier but in a different way. Now, you run the program. You take 1 call per month and are allowed to take built-in moonlighting type call from home. Chiefs have traditionally tacked on a significant amount of money to their base salary which helps for fellowship.
Location / Housing
Very affordable place to live. My wife and I own our home - a 3 bed, 1.5 bath in a very nice West Akron neighborhood. I think most residents own. Most live within a 10-15 min drive. There are apartment complexes and a good mix of new and old homes.
Limitations
I want to try and be honest. I feel like all I've done is talk about how great our program is, and I stand by that. However, there are some things I perceive to be limitations. Just take these with a grain of salt. Recognize that what I view as a limitation or strength you may see differently.
1. We cover two hospitals. When I was a junior resident, both hospitals had ERs that we covered so we were driving back and forth all night. The ER at St. Thomas has closed so that is no longer the case. Junior residents now spend the night at Akron City and pretty much all of their calls after hours are there.
2. We cover a lot of attendings. This is a two edged sword. Its great in the sense that you see many different ways to approach a problem. However, it also makes trying to get ahold of guys to staff consults difficult. It also means it takes longer to learn each attending's preferences which in some cases means they won't let you do as much.
3. Despite the amount of cases there are to cover, this does not always translate to an excellent experience. A lot of it is dependent on the service, the attending (you learn early on who to avoid), your interests, and your skill. I imagine this is somewhat true anywhere.
Overall Rotation Experience / Conclusion
Overall, I continue to be VERY happy that I ended up at Summa. We have excellent attendings who all want to see us reach our full potential as surgeons. I come to work every day with a great group of fellow residents. We work hard, but we take care of each other.
Bottom line: if you come here, you'll have the opportunity to become a top notch surgeon. We have every subspecialty in orthopaedics covered right here in Akron by multiple attendings. You'll see various approaches, implants, and techniques. There's research if you want it, but nobody will push it. A lot is expected of us, but in return, we're treated like professionals. No one will hold your hand here - you show up on day one as a doctor, and that's how you're treated. Every few years, we have someone who decides to go into practice without a fellowships and they all seem well prepared. I think that says it all.
