We are joined by Dr. Patrick Burns, the former residency director at the University of Pittsburgh Medical Center, and current residency director of the new West Virginia University program. We discuss his background, experience building the UPMC program, and his current work at West Virginia University. He emphasizes the importance of teaching and mentoring residents and the value of consistency in surgical techniques. Dr. Burns also shares insights on starting a new residency program and the challenges and opportunities it presents. In the case discussion, he explores the treatment of Lisfranc injuries and the role of classification systems. He advocates for primary fusion as a reliable and effective treatment option. He also explains his approach to treating Charcot foot, emphasizing the importance of controlling the rear foot and gradually correcting the deformity. Additionally, he discusses the use of external fixators and computer-assisted systems for gradual correction of deformities. In this episode, Dr. Burns discusses personal experiences and relationships, matching programs and the couples match, traveling and adventures, designing medical devices, future goals and bucket list, residency programs, supporting residents and starting a family in residency.