Apmle 2013

[POD2013]

I don't understand why this profession is trying so hard to prove that we are similar to allopath and osteopath ( which will never in a million years happen). BTW, I am a future podiatrist and I am proud to be one.
Our board exam part 2 in changing soon!!!. Could someone explain why? Is it because allopath and osteopath have that clinical skills part in their USMLE II? Why don't dentistry or optometry board do the same? Aren't we comparable to these professions except that they are specialized in different parts of the body?
As a third year student, I am strongly against it. We have to go all the way to PA to take this exam plus possibly pay between $1300-$1700 for part 2 which is ridiculous.

Anybody??

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[Traum]

Because you are a physician. Physicians must take very challenging, tertiary level-based questions. Podiatric medicine and surgery is allopathy. If parity/equality is to be ascertained, one must start with comphrehensive training. We are very similar to MDs---you will admit patients, H/Ps, run lines, foleys, etc....as an intern. You are not a "foot doc." You are a physician-who happens to specialize in pathology of the ankle and foot. Act akin to an OMFS resident.

Dentistry and optometry are much different than podiatry medicine. They do not take residencies, or perform full H/Ps, run codes, etc....

Comparing podiatric medicine to OMFS is a more appropriate analogy.

APMLE step 2, would be great someday for it to be USMLE part 2.

The more brutal the better, to attract very high caliber students/practitioners. Or maybe you could do the podiatry tract (dentistry) and others could do the podiatric surgery tract (OMFS). That is something the profession has been toying with.

 

[347932]

Because you are a physician. Physicians must take very challenging, tertiary level-based questions. Podiatric medicine and surgery is allopathy. If parity/equality is to be ascertained, one must start with comphrehensive training. We are very similar to MDs---you will admit patients, H/Ps, run lines, foleys, etc....as an intern. You are not a "foot doc." You are a physician-who happens to specialize in pathology of the ankle and foot. Act akin to an OMFS resident.

Dentistry and optometry are much different than podiatry medicine. They do not take residencies, or perform full H/Ps, run codes, etc....

Comparing podiatric medicine to OMFS is a more appropriate analogy.

APMLE step 2, would be great someday for it to be USMLE part 2.

The more brutal the better, to attract very high caliber students/practitioners. Or maybe you could do the podiatry tract (dentistry) and others could do the podiatric surgery tract (OMFS). That is something the profession has been toying with.

 

[malleolusman]

While I see benefit of parity and can understand the reasons behind adding a clinical skills exam to our training and agree with the addition of this exam (I'll be taking it February), I think our profession (as usual) is putting the cart before the horse. Our exam, APMLE II, as it exists is poorly written as evidenced by the fact there is clearly no standardization to our education across the schools. Some questions made sense and others were -- unreasonable given our education. I am in awe of everyone who wishes to advance our profession champions causes such as this, but miss out on the fact that there is no STANDARDIZATION of our training across our schools. Why not work on that first? How can you justify adding a clinical exam to an exam that already needs work?

I don't believe one pilot exam cuts it when it comes to testing viability and student proficiency. 100 students, of which mostly will be from NY & PA, is not enough to create an exam to implement across the board to 500+ students. I doubt California, Chicago, Arizona, Iowa, and Miami students will make it out to this one. Seems rushed to me.

Traum, you may be very similar to MDs, but the sad reality is there is a shortage of programs out there that actually admit & medically manage their own patients completely. Whether you should in the first place is debatable. 1 or 2 months on internal medicine doesn't cut it when it comes to medical management. Intern role? -- maybe at the 4 year programs. Not anywhere I've been, or most students I've talked to. Podiatrists are specialists, not generalists in any sense.

Even some Orthopedic residencies have transitioned into more of "specialist" training model. 3 + 5 program. 3 years of medical school + 5 years general orthopedics residency. I would like to see how much EKG knowledge is aquired and utilized, or how often they are spending time changing foley's --- or do they leave that to the nurse or internist team?

Sadly, practicing podiatrists as well as the docs involved with the APMLE are grossly out of touch with what is being taught at the schools. Guess it's easy when you are out and making the rules!

 

[347932]

While I see benefit of parity and can understand the reasons behind adding a clinical skills exam to our training and agree with the addition of this exam (I'll be taking it February), I think our profession (as usual) is putting the cart before the horse. Our exam, APMLE II, as it exists is poorly written as evidenced by the fact there is clearly no standardization to our education across the schools. Some questions made sense and others were -- unreasonable given our education. I am in awe of everyone who wishes to advance our profession champions causes such as this, but miss out on the fact that there is no STANDARDIZATION of our training across our schools. Why not work on that first? How can you justify adding a clinical exam to an exam that already needs work?

I don't believe one pilot exam cuts it when it comes to testing viability and student proficiency. 100 students, of which mostly will be from NY & PA, is not enough to create an exam to implement across the board to 500+ students. I doubt California, Chicago, Arizona, Iowa, and Miami students will make it out to this one. Seems rushed to me.

Traum, you may be very similar to MDs, but the sad reality is there is a shortage of programs out there that actually admit & medically manage their own patients completely. Whether you should in the first place is debatable. 1 or 2 months on internal medicine doesn't cut it when it comes to medical management. Intern role? -- maybe at the 4 year programs. Not anywhere I've been, or most students I've talked to. Podiatrists are specialists, not generalists in any sense.

Even some Orthopedic residencies have transitioned into more of "specialist" training model. 3 + 5 program. 3 years of medical school + 5 years general orthopedics residency. I would like to see how much EKG knowledge is aquired and utilized, or how often they are spending time changing foley's --- or do they leave that to the nurse or internist team?

Sadly, practicing podiatrists as well as the docs involved with the APMLE are grossly out of touch with what is being taught at the schools. Guess it's easy when you are out and making the rules!

I'm going to go out on a limb here and make an observation or two.

Having been involved in both Podiatric and Allopathic medical education, I can say that what you are saying is not exclusive to Podiatry. Almost every medical student I've ever met, and worked with or helped to train has the same complaint as you do. There is no blanket standardization. The CPME has the same role as it's counterpart in the Allopathic world (the name is escaping me atm), and that is to assure that all the schools function to provide a BASIC medical education. Minimum competency is the order of the day. There is no magic formula that the allopathic world has that we don't. They rely on each individual student's drive to succeed as the motivating factor. I've been involved with interviews, and helped with curriculum management within a large allopathic medical school and the issues are the SAME, but on a grander scale because of the size of their profession.

I hope you realize that a sample size of 100 represents about 20% of the whole in this case, which when testing an examination is actually quite a good number. In other realms, if the sample size is 1% or 2% that number is decent to good, so what you're saying just doesn't equate.

Maybe I am out of touch with the curriculum at the Podiatry schools at this point in my career, but having trained residents and worked alongside other attendings from all aspects of medicine in a large medical school institution/teaching hospital, it really sounds like you are very out of touch with life outside of school, into residency and through to practice. I'm sorry if you are not meeting with or meeting the students/residents that are really shining, but where I taught for 9 years, it didn't matter what degree you had when you were on the floor. If you were on IM, you were THE IM intern/resident. You better know your stuff, or you fail your rotation. DPM or MD, no one cared.

It's sad for me to think that you feel we are not up to par. Unfortunately, your future patients will hope that you are and take care of them to the fullest extent of your knowledge and training.

Ultimately, your education and training is up to you to make the most out of. Don't shortchange yourself or the profession. When you are out there make sure you are on the ball, or you will be left behind.

 

[malleolusman]

Right - I'm sure most IM teams trust the PGY-1 podiatry resident with their patients complete medical management. Sorry, what you speak of is the exception, not the rule. I may not be out in practice, but I have had a decent sampling of what is going on with our profession at radically different hospital systems.

If we go with what you say, I am sure podiatry residents every year would end up failing their IM rotations every year at the 200+ programs where they are THE functioning intern. Clearly, this isn't the case. The rotation is more for exposure and supplementing your knowledge - you cannot possibly become a 2 month internist. Same goes for orthopods who do 3 months of general surgery. Guess that means they are proficient in performing colon surgery and should add it to their armament of surgical options.

Kidsfeet, while I respect that you have time as an attending on me, students are more in-touch with what is happening on the ground.

Don't be sad, you misunderstand me at the core. It's not that we aren't up to par, it's that there are those out in our profession that don't acknowledge what we know is what we know - and that what we know and are taught is quite profound and valuable. Instead, there is the constant "we aren't doctors, we need to be MDs/DOs because they REALLY get respect" which is non-sense - because our fundamental clinical years are different from them and so is our knowledge. I haven't seen much difference in respect, but I acknowledge haven't been out enough to assess any prejudice.

Also- 100 students from TWO schools isn't a good sampling size. Different story if other schools students were involved.

 

[Ferocity]

What happened to Vision 2015

 

[347932]

Right - I'm sure most IM teams trust the PGY-1 podiatry resident with their patients complete medical management. Sorry, what you speak of is the exception, not the rule. I may not be out in practice, but I have had a decent sampling of what is going on with our profession at very different hospital systems.

Where I did my first year of training and where I taught this was the case. How many hospital systems have you visited where this is not the case? You are also not paying attention. Where there are multidisciplinary programs, there is no distinction between DPM and MD when on these rotations.

Kidsfeet, while I respect that you have time as an attending on me, students are more in-touch with what is happening on the ground.

I disagree with you sorry. Students only have a very narrow perspective with little experience in these areas. I don't mean to belittle students at all. It's just a matter that all they see is what happens around them, and rarely see the big picture. You can't see the big picture. It's not an insult, because I was there as well, and only came to realize this as time went on. The mutlifactorial nature of the reality can only be seen when you're on the outside looking in, not from the inside looking out. You are on the inside, and no matter what I say, you will not see it. Talk to me in 10 years and you'll see how differently your outlook will be.

I realize this is coming across as condescension, but it is by no means intended that way at all. We all have a very important role to play in how all of this plays out. As a student, be the best you can be and don't concern yourself with the who, what, where and how. Get through school, get excellent training, then get into practice and truly get involved. At that point is when you can make the biggest difference. You can certainly start while a student, but things will change for you as you go through the ranks. Trust me. I've been and continue to be there.

 

[347932]

What happened to Vision 2015

It's alive and well, with three years go.

 

[dtrack22]

...

 

[Traum]

If you attend an academic based 3yr residency program, you are a surgical intern, then have two years for ankle and foot surgery. You will admit patients, clear patients, perform rectals, pelvics, foleys, code team, intubations---much, much more that is internship. That was my internship and then residency with 30+in house patients medically and surgically managed by DPMs. Reading EKGs, ordering ABGs, performing ABGs, narcan, propanolol, that is medicine, that is podiatric surgical residency. No one gives a rat's rear if you are MD, DPM, or C3PO. You BETTER know your stuff--- or you are terminated. That is it. That is the way it ought to be. You are a either a physician (who specializes in ankle/foot) or, a "foot doc."

if the schools are not teaching real world medicine (with 12h, 12h off real clerkships, rotations etc... in 3rd and 4th year), then issue a formal compliant, txfr, or speak to the Dean--you are paying their salariesthrough massive student loans. Demand much more. Their job is to prepare you as physicians, who happen to focus on ankle and foot pathology.

It is 2012. If you want to be a "foot doc" that is fine. However, those days are numbered as we're moving forward-we're on the move.

You practice allopathic medicine already--that is podiatric medicine and surgery.

All 3 year residency must be consistent/uniform and have ABSITE or other in-training service exams that are brutal.

You want parity, you must earn through tertiary level questions, 80-110 hr work weeks of grueling training--as a sub-I, then an intern, , and acting as the intern and/or resident in full capacity on each different service--otherwise, be a :foot doc," then wonder why podiatry is lumped in with chiropractic "services" and optometric "services" in Medicaid?!

Never heard of thoracic surgery "services."

 

[darazon]

Just a few comments on this topic....

First off, I think adding a clinical component to the exam is a great step that needs to be done. However, I also agree that the current APMLE format is horrible -at least my experience with part 1 (you can check my previous comments on this on another thread). At Western, we've been training for the clinical portion since 1st year with the expectation that when it is our turn to take part II it will be implemented.

Secondly, any hospital that I have been in, the medicine intern IS the one who is medically managing the patients. Yes, the attending and R3s oversee them, but the Intern is the one who writes the orders and adds medications. I look forward to doing this as well when I am an intern. My last IM rotation (I've done 2 so far in my 3rd year) I was the one who was writing orders, putting together D/C orders, admitting patients, writing prescriptions -with direct supervision of my interns. I felt comfortable doing it and my interns trusted me. Obviously they checked everything and signed off on it, but I was very involved in the patient management and actually caught a few things the Interns had missed.

We need to be, and should be, held to the same standards as DO/MD no matter what rotation and service we may be on. As a previous poster explained, and I completely agree, we are future physicians and surgeons and should be held to that standard.

Thirdly, yes a sample size of 20% is good. But if it is from only 2 schools it makes it not representative of the whole.

 

[347932]

This is like saying that Part I is easy and or podiatry students ought to have a 98% pass rate because you sampled 50 DMU students (around 10% of the whole, which is quite a good number). What he or she is saying makes perfect sense, assuming that the students who show up do end up representing only 2-3 programs.

I'm curious if you've ever done any clinical research?

 

[347932]

Just a few comments on this topic....

First off, I think adding a clinical component to the exam is a great step that needs to be done. However, I also agree that the current APMLE format is horrible -at least my experience with part 1 (you can check my previous comments on this on another thread). At Western, we've been training for the clinical portion since 1st year with the expectation that when it is our turn to take part II it will be implemented.

Secondly, any hospital that I have been in, the medicine intern IS the one who is medically managing the patients. Yes, the attending and R3s oversee them, but the Intern is the one who writes the orders and adds medications. I look forward to doing this as well when I am an intern. My last IM rotation (I've done 2 so far in my 3rd year) I was the one who was writing orders, putting together D/C orders, admitting patients, writing prescriptions -with direct supervision of my interns. I felt comfortable doing it and my interns trusted me. Obviously they checked everything and signed off on it, but I was very involved in the patient management and actually caught a few things the Interns had missed.

We need to be, and should be, held to the same standards as DO/MD no matter what rotation and service we may be on. As a previous poster explained, and I completely agree, we are future physicians and surgeons and should be held to that standard.

Thirdly, yes a sample size of 20% is good. But if it is from only 2 schools it makes it not representative of the whole.

Yep.

 

[malleolusman]

While I wish what you said were true, the reality is it is not. No amount of huffing and puffing can change that. Not many academic programs/teaching hospital set-ups out-there, just a handful.

Surgical intern? There are only a handful of programs that have the training you speak of. The ones off the top of my head are Presby & NYC Queens. The majority of PGY-1s rotate through their off service rotations in medicine, and then yes, the 2nd and 3rd years are as you describe. So no, they are not medically managing their patients.

What other academic programs are you referring to other than the 4 yr programs?

 

[Traum]

Harvard Medical School, Boston.

Either you want training as a foot dentist, or you can opt to be a physician get training as a foot and ankle surgeon. Similar to dentistry and OMFS. If the post-graduate training is still disparate then action must be taken. Why are folks spending hundreds of thousands to get foot dentistry training? Are podiatrists-physicians? Yes, they are.

Each and every program MUST be brought up to the SAME level for every 3yr residency plus ABSITE exams--identical to MDs. Or be a "foot doc."

Surgical Intern, then 2,3 years thereafter. Transfusing pts, narcan, etc...all in the 2nd and 3rd year. Plus code team. That is reality for some. Not others. Still uneven, inconsistent traing after all this time, hundreds of thousands in dollars per student and the public and MDs will still have no clue what training you got, didn;t get, etc....status quo.

For example, in podiatric surgery boards, artificially dividing the foot into two parts--foot and rearfoot b/c of inconsistent training.
Are any OMFS boarded in incisors and others molars? How about dentists-- can they clean the molars in IL, but only the incisors in NY? Therein lies the scope issues too.

Until consistent, brutally rigorous training occurs the parity thing will still be a parody and podiatry will be divided into foot dentists and foot and ankle surgeons.

 

[jonwill]

All very valid points. Yes, podiatry is allopathic medicine. It is a much different world than dentistry or optometry. I just saw a patient with a trimalleolar ankle fracture (fall from a ladder) in the emergency room. I did a full H&P, admitted the patient to MY service, and am operating in about an hour. I will then obviously medically manage the patient after the operation tonight until discharged. For those in pod school or residency, learn all aspects of medicine and learn them well. Take your boards seriously. Sooner than later, there will be nobody looking over your shoulder.

 

[POD2013]

Instead of putting all that time and money in constructing a new exam, why don't we put that energy in constructing new residency programs for the 60+ students (about to become 120+ in few months) who are out there with $250k debt. Don't you think that this is more damaging to our profession than anything.

 

[dtrack22]

Instead of putting all that time and money in constructing a new exam, why don't we put that energy in constructing new residency programs for the 60+ students (about to become 120+ in few months) who are out there with $250k debt. Don't you think that this is more damaging to our profession than anything.

Easy there turbo. Last year there were about 5 programs who would rather take none of the available students, than fill their last seat. Another year, another shortage of quality applicants/"graduates". Maybe instead we should focus on not allowing kids who haven't passed part II to "graduate"...and believe it or not there are "graduates" out there who never passed part I.

 

[347932]

Instead of putting all that time and money in constructing a new exam, why don't we put that energy in constructing new residency programs for the 60+ students (about to become 120+ in few months) who are out there with $250k debt. Don't you think that this is more damaging to our profession than anything.

Please learn the process before bashing it. How this works has been addressed many times in many other threads.

 

[dtrack22]

Isn't this not the case anymore? I know at SCPM they have told the students they will not graduate anyone who hasn't passed their boards. Isn't this universal now between all the schools?

I'd have to check to see if it is something the CPME has actually mandated (if they can?), or if it is something that has been agreed up by the colleges. I do know that CPME requires residency programs only select from students who have passed both parts of the APMLE. That, in and of itself, sort of forces the schools hand when it comes to graduation requirements. Someone like kidsfeet may know more, as it could have been brought up at an APMA HOD meeting during a committee report. I'm kind of assuming how their meeting is run so forgive me if I'm wrong.

 

[Sig Savant]

Boop.

 

[bobdolerson]

Wait a minute...

Hold on...

Let me get this right...

After putting forth the mediocre effort required to graduate at a university with the stats needed to matriculate and paying somebody vast sums of money for my education, I have to do more?

I was under the impression that learning in medical school was via osmosis, and I could just do something akin to blending up these gratuitously numerous handouts and dunking my hand in it while I slept or watched Jersey Shore.

If I knew that becoming a board-certified practicing podiatrist was exponentially harder than the effort I put forth to get admitted, I never would have applied.

If you haven't already guessed, I'm speaking ironically and having but good things to say about what you do. Life cereal, do not change a thing.

 

[FC Omar]

While I wish what you said were true, the reality is it is not. No amount of huffing and puffing can change that. Not many academic programs/teaching hospital set-ups out-there, just a handful.

Surgical intern? There are only a handful of programs that have the training you speak of. The ones off the top of my head are Presby & NYC Queens. The majority of PGY-1s rotate through their off service rotations in medicine, and then yes, the 2nd and 3rd years are as you describe. So no, they are not medically managing their patients.

What other academic programs are you referring to other than the 4 yr programs?

dont forget maricopa medical center, Phoenix az (3 yr, 1 surgical intern, 2yr podiatry)

 

[scrlet52]

at least 5 of my classmates (including myself) will be attending. We are from Barry. So, Miami will be represented and we will be wearing lebron jerseys

 

[smiledr6]

Just because podiatrist label themselves as physicians, I really doubt if many outside of the profession believe this. Chiropractors are labeled in many states as chiropractic physicians. Does this make them a true physician? To say that dentists don't do residencies, perform H/P's, function with code teams is absurd. any dentist that completes a GPR has completed H/P's, admitted pts, etc Dentists are no less a physician then a podiatrist is. We just don't call ourselves dental physicians. First of all, most if not all dental schools are closely affiliated with major allopathic schools. In fact, in many schools, dental students complete the first 2 preclinical years with med students. When you talk about OMFS there is little comparison. The minimum time spent in surgical training is 4 yrs with many programs a full 6 yrs. These programs are not in community hospitals. More than 50% of OMFS training programs confer a Dual Medical degree after the resident completes the final 2 yrs of med school rotations. These programs require a full yr of general surgery internship for medical licensure. The scope of OMFS training varies and their scope of training and practice far excedes that of a Podiatrist. In fact,some go on to additional med residency, ENT, plastics, etc. I think students in other med professions underestimate the extent of training many dentists receive.

 

[Ferocity]

Just because podiatrist label themselves as physicians, I really doubt if many outside of the profession believe this. Chiropractors are labeled in many states as chiropractic physicians. Does this make them a true physician? To say that dentists don't do residencies, perform H/P's, function with code teams is absurd. any dentist that completes a GPR has completed H/P's, admitted pts, etc Dentists are no less a physician then a podiatrist is. We just don't call ourselves dental physicians. First of all, most if not all dental schools are closely affiliated with major allopathic schools. In fact, in many schools, dental students complete the first 2 preclinical years with med students. When you talk about OMFS there is little comparison. The minimum time spent in surgical training is 4 yrs with many programs a full 6 yrs. These programs are not in community hospitals. More than 50% of OMFS training programs confer a Dual Medical degree after the resident completes the final 2 yrs of med school rotations. These programs require a full yr of general surgery internship for medical licensure. The scope of OMFS training varies and their scope of training and practice far excedes that of a Podiatrist. In fact,some go on to additional med residency, ENT, plastics, etc. I think students in other med professions underestimate the extent of training many dentists receive.

 

[bobdolerson]

I don't think anyone here wants a significantly different scope. I think they just want less of that ignorance you just espoused.

 

[shenanigans327]

I don't think anyone here wants a significantly different scope. I think they just want less of that ignorance you just espoused.

+1

 

[347932]

Just because podiatrist label themselves as physicians...

You have no idea of what you speak. Medicare and other insurances label our profession as physicians. My hospital ID labels me as a "Staff Physician".We don't label ourselves as such.

If I had a foot and ankle issue, I would want a highly trained podiatrist taking care of it. We are the experts. Period.

 

[msion]

Just because podiatrist label themselves as physicians, I really doubt if many outside of the profession believe this. Chiropractors are labeled in many states as chiropractic physicians. Does this make them a true physician? To say that dentists don't do residencies, perform H/P's, function with code teams is absurd. any dentist that completes a GPR has completed H/P's, admitted pts, etc Dentists are no less a physician then a podiatrist is. We just don't call ourselves dental physicians. First of all, most if not all dental schools are closely affiliated with major allopathic schools. In fact, in many schools, dental students complete the first 2 preclinical years with med students. When you talk about OMFS there is little comparison. The minimum time spent in surgical training is 4 yrs with many programs a full 6 yrs. These programs are not in community hospitals. More than 50% of OMFS training programs confer a Dual Medical degree after the resident completes the final 2 yrs of med school rotations. These programs require a full yr of general surgery internship for medical licensure. The scope of OMFS training varies and their scope of training and practice far excedes that of a Podiatrist. In fact,some go on to additional med residency, ENT, plastics, etc. I think students in other med professions underestimate the extent of training many dentists receive.

I smell a troll seems like an unsuccessful dentist/resident who is unable to payback his/her dental loans (last time i checked, dental schools are twice as expensive as podiatry schools), yet his podiatry counterparts are way better off.

Anyway, I checked your other posts and your attitude explains everything. Podiatry is a field that is constantly evolving. The ignorance of disrespecting another health profession won't make you a better doctor, and to a certain extent, pitiful.