Part 2 Boards Fail Rate

[MGHFOOTDOC]

Hello

I am currently on staff at a hospital where there is a residency program. Yearly I take part in the residency interviews and I am present for most of the individual interviews that take place and have taken place for the past 2-3 years.

I can honestly say I have been very surprised and disheartened to hear student after student tell me that they haven't taken part in internal medicine and general surgery externships when it is listed as part of their curriculum. I am also suprised to hear how little general medicine is actually taught in school.

To now find out just under 10 percent of current students failed part 2 of the boards is a shame for our profession and our schools. These tests are designed to be based as minimal compentency tests. I am appalled that if after 3-4 years of podiatry school eductation that many people can not pass a minimal competency test, yet somehow can pass their classes and be moved through the schools.

Schools are not held to as high a standard as they should and parity will only be achieved after all students are given a good solid education in podiatry and medicine. Forty students failing is not acceptable for a profession.

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[air bud]

The points you make are all correct. Unfortunately, I think residency directors are now being asked to be gate keepers to the profession. Since they can't rely on the schools, they must do this job. I would hope that a director would take no students instead of an incompetent one.

 

[347932]

Sorry to say, but these failure rates are not exclusive to Podiatry.

The percentages are similar in Allopathic medicine for board failure rates.

Forget about how many lawyers fail the Bar exam.

 

[dtrack22]

Sorry to say, but these failure rates are not exclusive to Podiatry.

The percentages are similar in Allopathic medicine for board failure rates.

This isn't exactly true for part II. Allo's USMLE pass rates are a bit higher. 6-7%.

In terms of schools not being held to a high standard, I would agree that they aren't. But most schools police themselves just fine. However, the one(s) that "graduate" students who haven't passed boards clearly need to change something. I don't see that happening with our current applicant pool. There are too many desperate applicants that don't care about the school they will be attending. If you want a program to change, hurt their bottom line ($$$). Only incoming students have that power since CPME really has nothing in their bylaws that would allow them to punish the schools. My 2 cents

 

[amaprez]

How dare these people fail?
I fart in their general direction.
Their mother was a hamster and their father smelt of elderberries!

 

[hematosis]

This isn't exactly true for part II. Allo's USMLE pass rates are a bit higher. 6-7%.

In terms of schools not being held to a high standard, I would agree that they aren't. But most schools police themselves just fine. However, the one(s) that "graduate" students who haven't passed boards clearly need to change something. I don't see that happening with our current applicant pool. There are too many desperate applicants that don't care about the school they will be attending. If you want a program to change, hurt their bottom line ($$$). Only incoming students have that power since CPME really has nothing in their bylaws that would allow them to punish the schools. My 2 cents

Its similar to the COMLEX step 2 for DO's which is in the 80's.

 

[SuperFeisty]

The only podiatry school that gets the total medical education is Western since they take the exact same courses as the DO students in their first two years. DMU and AZPOD replicate the medical education of their respective DO programs the first two years as well but they deviate more in the 2nd year than in the 1st. Scholl takes only a handful of classes with the MD medical students. All the other schools currently do not take classes where they are sitting in the same classroom with medical students. Maybe Temple does but I'm pretty sure they don't.

The point?

Very few podiatry schools offer their students a general medical education that mimics what is taught in MD/DO medical schools.

Podiatry is in a tight spot right now with our education in my point of view. Vision 2015 makes everything more complicated rather than better in my opinion. Yes I understand why Vision 2015 was created. If we have an education that's similar to MD/DOs then maybe our profession will be taken more seriously, our state scopes won't be so varied, and we will be able to sit for board exams that our fellow medical students are taking(i.e. USMLE).

That fact is there is a lot of information specific to the lower extremity and trying to offer a general medical education that rivals MD/DO medical school while still teaching all the relevant information specific to podiatry is a tough task. Our visiting derm professor, Dr. Bakotic had similar sentiments as well. In his opinion, with the incorporation of a medical education similar to MD/DO medical school we are sacrificing the education that defines podiatry. As a current P2 student who is almost done with the second year I have to agree with this. We are currently taking A LOT of podiatry specific clinical courses right now and I am unsure where a very thorough and in depth internal medicine course would fit in our curriculum. Yes we are taking a course called "medicine" right now but it's not what I had anticipated.

If you do a search there has been at least one resident who came on here stating how they didn't know a lot of stuff on their non-podiatry rotations. The residents and current M4s basically "helped" this person along. How embarrassing and to be honest I feel I will be put in the same situation.

I personally think sitting for the USMLE in the future is a pipe dream. Western students are getting the best education for the exam but how did they fair on the APMLE? If I recall correctly their first time pass rate was an 82% or something like that. Yes they did get to 100% after the re-take but it appears they were juggling so much information that some of their students couldn't pass a minimal competency podiatry board exam. So you can see pursuing this general medical education via Vision 2015 is not as straightforward of a goal as the politicians of podiatry make it seem.

And this is why I always listen to Anklebreaker

 

[hematosis]

The only podiatry school that gets the total medical education is Western since they take the exact same courses as the DO students in their first two years. DMU and AZPOD replicate the medical education of their respective DO programs the first two years as well but they deviate more in the 2nd year than in the 1st. Scholl takes only a handful of classes with the MD medical students. All the other schools currently do not take classes where they are sitting in the same classroom with medical students. Maybe Temple does but I'm pretty sure they don't.

The point?

Very few podiatry schools offer their students a general medical education that mimics what is taught in MD/DO medical schools.

Podiatry is in a tight spot right now with our education in my point of view. Vision 2015 makes everything more complicated rather than better in my opinion. Yes I understand why Vision 2015 was created. If we have an education that's similar to MD/DOs then maybe our profession will be taken more seriously, our state scopes won't be so varied, and we will be able to sit for board exams that our fellow medical students are taking(i.e. USMLE).

That fact is there is a lot of information specific to the lower extremity and trying to offer a general medical education that rivals MD/DO medical school while still teaching all the relevant information specific to podiatry is a tough task. Our visiting derm professor, Dr. Bakotic had similar sentiments as well. In his opinion, with the incorporation of a medical education similar to MD/DO medical school we are sacrificing the education that defines podiatry. As a current P2 student who is almost done with the second year I have to agree with this. We are currently taking A LOT of podiatry specific clinical courses right now and I am unsure where a very thorough and in depth internal medicine course would fit in our curriculum. Yes we are taking a course called "medicine" right now but it's not what I had anticipated.

If you do a search there has been at least one resident who came on here stating how they didn't know a lot of stuff on their non-podiatry rotations. The residents and current M4s basically "helped" this person along. How embarrassing and to be honest I feel I will be put in the same situation.

I personally think sitting for the USMLE in the future is a pipe dream. Western students are getting the best education for the exam but how did they fair on the APMLE? If I recall correctly their first time pass rate was an 82% or something like that. Yes they did get to 100% after the re-take but it appears they were juggling so much information that some of their students couldn't pass a minimal competency podiatry board exam. So you can see pursuing this general medical education via Vision 2015 is not as straightforward of a goal as the politicians of podiatry make it seem.

I'm going to have to agree here. As a student who sits next to DO students for every class, unlike DMU, I have confidence to take on any student at our school when it comes to general medicine knowledge. However, I do feel like we dont have the ability to master some of our biomechanics courses, detail lower anatomy, Lower radiology classes, etc, because most of the students are trying to learn how to understand how to diagnose a lesion in the MLF vs central tegmental tract or memorizing pallidal efferent and nigral connection pathways which maybe of more importance to MD's and DO's.

 

[dtrack22]

Its similar to the COMLEX step 2 for DO's which is in the 80's.

How dare DO schools not prepare their students to take a minimal competency exam!

 

[MGHFOOTDOC]

I am not expecting a comparable education in medicine from our schools, that would not be possible with the current system. I do however expect a medicine course to include more than a so called teacher spending a week reviewing a test and giving students the answers and then giving them the same test.

I once was a student, resident (pms36), and now I am helping train residents and there is a reason I chose to put this topic in the students section, because I honestly feel some of you are being short changed. You are all young professionals paying a large sum to be taught something, it is the schools responsibility to make sure everyone is taught to the highest standard and if necessary let go early on if that standard is not met. You all need to hold your teachers and schools to a high standard and not simply take not being offered a rotation or not being taught something correctly.

Residency comes hard and fast and if you don't have the basics of surgery and medicine down before you start it will be a tough road.

 

[dtrack22]

some of you are being short changed

Some...?

 

[MGHFOOTDOC]

Yes I would say some are being more short changed vs. others. I typically hear students say that for some clinical rotations there appears to be a lottery where some people get to spend a month in a hospital setting getting a decent rotation and others get a month in a private setting. Yet both students pay the same amount for the same experience.

In my mind everyone is getting short changed in there education, but some more than others as noted above.

 

[Porkchop22]

The only podiatry school that gets the total medical education is Western since they take the exact same courses as the DO students in their first two years. DMU and AZPOD replicate the medical education of their respective DO programs the first two years as well but they deviate more in the 2nd year than in the 1st. Scholl takes only a handful of classes with the MD medical students. All the other schools currently do not take classes where they are sitting in the same classroom with medical students. Maybe Temple does but I'm pretty sure they don't.

The point?

Very few podiatry schools offer their students a general medical education that mimics what is taught in MD/DO medical schools.

Podiatry is in a tight spot right now with our education in my point of view. Vision 2015 makes everything more complicated rather than better in my opinion. Yes I understand why Vision 2015 was created. If we have an education that's similar to MD/DOs then maybe our profession will be taken more seriously, our state scopes won't be so varied, and we will be able to sit for board exams that our fellow medical students are taking(i.e. USMLE).

That fact is there is a lot of information specific to the lower extremity and trying to offer a general medical education that rivals MD/DO medical school while still teaching all the relevant information specific to podiatry is a tough task. Our visiting derm professor, Dr. Bakotic had similar sentiments as well. In his opinion, with the incorporation of a medical education similar to MD/DO medical school we are sacrificing the education that defines podiatry. As a current P2 student who is almost done with the second year I have to agree with this. We are currently taking A LOT of podiatry specific clinical courses right now and I am unsure where a very thorough and in depth internal medicine course would fit in our curriculum. Yes we are taking a course called "medicine" right now but it's not what I had anticipated.

If you do a search there has been at least one resident who came on here stating how they didn't know a lot of stuff on their non-podiatry rotations. The residents and current M4s basically "helped" this person along. How embarrassing and to be honest I feel I will be put in the same situation.

I personally think sitting for the USMLE in the future is a pipe dream. Western students are getting the best education for the exam but how did they fair on the APMLE? If I recall correctly their first time pass rate was an 82% or something like that. Yes they did get to 100% after the re-take but it appears they were juggling so much information that some of their students couldn't pass a minimal competency podiatry board exam. So you can see pursuing this general medical education via Vision 2015 is not as straightforward of a goal as the politicians of podiatry make it seem.

....at AZPOD we sit next to the DOs for the first 2 years as well. We have a podiatry class every quarter but otherwise we are with them the whole time. The change comes at the end of 2nd year when the DOs start focusing more on OMM and we start focusing more on Podiatry. So, Western and AZPOD both get the full medical education. Just thought I would point that out.

 

[347932]

I gotta respond here because this thread is killing me.

If we are getting short changed, why are there so many bright, successful people out there? This is professional school we're talking about here. It is up to the individual to motivate themselves and achieve. You're damn right no one is going to spoon feed you and you better be ready to work your tail off.

I would love to talk to all these people who feel they are short changed and ask them what they are doing to improve THEIR education. Every school gives you the tools, but not everyone uses them.

 

[SuperFeisty]

Uhhh Anklebreaker, I think you misunderstood what Kidsfeet meant. He's saying that the OP believes that pod students are being cheated out of an education. Kidsfeet disagrees with THAT. Like he said w/ motivation (which you certainly have) you are taking advantage of every opportunity given. I'm pretty sure he wasn't dissing you and saying that if you don't study internal medicine, that you have no motivation.

 

[347932]

LOL wow...Thanks Superfeisty for that very concise estimation of my post.

AB,
Now that you bring it up, as someone who worked and works with residents, and as someone who may potentially be looking to employ one eventually, I don't look for those that expect to be taught. I look for those that go out of their way to teach themselves, whether they think they have the time or not.

Pipe down, wouldja please? Jeez...

 

[MGHFOOTDOC]

"Every school gives you the tools, but not everyone uses them"

I would disagree with that statement because schools are not providing adequate rotations for all students, a lottery system for a rotation is a joke. If you don't have enough rotations for your students to all get an equal chance at learning something, get more rotations.



Either way the point of this post was to remind everyone that as students they should demand more from their schools and should strive to learn as much as they can during the 4 years of school.

 

[RockyIV]

Yearly I take part in the residency interviews and I am present for most of the individual interviews that take place and have taken place for the past 2-3 years.

I can honestly say I have been very surprised and disheartened to hear student after student tell me that they haven't taken part in internal medicine and general surgery externships when it is listed as part of their curriculum.

Some schools do a better job, in general, of preparing students for 4th year. So if you were only talking about the first encounter with a student being less than satisfactory, I would agree with you for the most part. But you aren't. You are talking about interviewing students in January too. Even the good schools rely on those externship months to teach their students "general medicine". If you are seeing students in January (of their 4th year) who rotated through your program and still don't have the foundation you personally expect, you might want to look at your own residents and fellow attendings. As well as the individuals at the other programs that student visited. You agreed to be an educator, so teach. If that isn't working, consider the students who are visiting your program and which school they are coming from. I bet you'll see a trend.

As for externships in IM and general surgery, there are plenty of smart kids who haven't had those rotations before they get to us. I always felt like I've been understanding of that situation and only expect them to know the info after I've made them feel stupid (in a good way). I used to pride myself on preparing students for their next month. I always felt like that was part of my job as a resident, and as a member of the profession. I knew we would get good students regardless, so why not help them land that dream program of theirs?

 

[RockyIV]

...a lottery system for a rotation is a joke. If you don't have enough rotations for your students to all get an equal chance at learning something, get more rotations..

I'm pretty sure some of us have a good idea of which school(s) you are referring to. Why don't you go post it in the pre-pod forum? I think it's been said on here, but schools aren't going to do anything about it until interviewees, students, etc. start asking about it and maybe stop matriculating to that/those program(s).

Quit complaining and actually do something about it if you are so passionate about this travesty.

 

[bobdolerson]

It seems what some of you are alluding to is the desire to become DO/MD specializing in feet.

There's a reason i didn't want to be an MD, and it wasn't so I could get the same education and exam same knowledge without comparable pay.

I wanted a streamlined process that eliminated some of the erroneous information I would need.

I'm not disagreeing with much of what you're saying, I go to DMU and perform better than most of the DO's I sit next to (well, I don't really ever go to class, but that's not the point), but I don't really see an issue with how my school strays from the DO curriculum during the second year.

I specifically chose the profession because of the streamlined DPM-related teaching that starts second year. I don't want to be an MD, or a DO, or a PT, or a mechanic. It's true that the fields overlap in much of what you need to be successful, but they aren't the same profession and don't require exactly the same information for success.

 

[amaprez]

"Every school gives you the tools, but not everyone uses them"

I would disagree with that statement because schools are not providing adequate rotations for all students, a lottery system for a rotation is a joke. If you don't have enough rotations for your students to all get an equal chance at learning something, get more rotations.



Either way the point of this post was to remind everyone that as students they should demand more from their schools and should strive to learn as much as they can during the 4 years of school.

Not sure if you realize this, but MD/DO schools commonly use lottery systems for rotations as well.

 

[347932]

Either way the point of this post was to remind everyone that as students they should demand more from themselves and should strive to learn as much as they can during the 4 years of school.

Fixed.

 

[TimmyT]

....at AZPOD we sit next to the DOs for the first 2 years as well. We have a podiatry class every quarter but otherwise we are with them the whole time. The change comes at the end of 2nd year when the DOs start focusing more on OMM and we start focusing more on Podiatry. So, Western and AZPOD both get the full medical education. Just thought I would point that out.

Hey porkchop, do you guys take the same exams as the DOs in the core classes as well?

 

[flyhi]

It seems what some of you are alluding to is the desire to become DO/MD specializing in feet.There's a reason i didn't want to be an MD, and it wasn't so I could get the same education and exam same knowledge without comparable pay.

I wanted a streamlined process that eliminated some of the erroneous information I would need. It's true that the fields overlap in much of what you need to be successful, but they aren't the same profession and don't require exactly the same information for success.

+1

 

[Porkchop22]

Hey porkchop, do you guys take the same exams as the DOs in the core classes as well?

Yes we do. We sit in the auditorium with all the Dos

 

[TimmyT]

Yes we do. We sit in the auditorium with all the Dos

That's good to hear. You guys are getting a good education as well.

 

[bobdolerson]

DMU operates the same way, going along with what they push all the time (interprofessional education). I think that goes a long way to increase competition within the individual schools, especially considering we get a whole-class average and a DPM average after each exam to compare (I'm sure the other programs get the same).

I think it's also beneficial for our perception to other disciplines...sure, you can think that a DPM doesn't know anything, but it's hard to maintain that attitude when you have one in your anatomy group that scores comparable or better than you on all the exams.

 

[347932]

That's good to hear. You guys are getting a good education as well.

Forgive me if I seem sensitive about this, but I didn't sit next to DOs or MDs during my time in school and felt I got an excellent education that has served me very well.

How does one have anything to do with the other?

 

[FiveOVicryl]

Forgive me if I seem sensitive about this, but I didn't sit next to DOs or MDs during my time in school and felt I got an excellent education that has served me very well.

How does one have anything to do with the other?

It has been established that Timmy is an idiot. Remember the whole "Western podiatry students gets the EXACT same education as the DO's" discussion?

http://forums.studentdoctor.net/showthread.php?t=858822

 

[bobdolerson]

I don't think that the education I'm getting by sitting next to other professions is any better. My education is my own, and basically entirely a result of studying that I do outside of the classroom.

That being said, comparing my scores to those of the other folks does give me more motivation to succeed than I think I would have had elsewhere, because so far the cumulative averages of everyone taking the exams has been higher than the DPM class average, and the cumulative is what I use to compare.

Personal issue, really.

 

[SuperFeisty]

Derp... I don't wanna get into this. I regret posting.

 

[air bud]

DMU operates the same way, going along with what they push all the time (interprofessional education). I think that goes a long way to increase competition within the individual schools, especially considering we get a whole-class average and a DPM average after each exam to compare (I'm sure the other programs get the same).

I think it's also beneficial for our perception to other disciplines...sure, you can think that a DPM doesn't know anything, but it's hard to maintain that attitude when you have one in your anatomy group that scores comparable or better than you on all the exams.

Sorry Bob, you are wrong on this one. You are correct for year 1, but not year 2 when you do systems. One quick example: We have to memorize 4-6 easy heart sounds a few minutes before a test. The DO's have to learn and understand all of them.

 

[MGHFOOTDOC]

The whole point of this topic has been taken over and changed. I don't feel as a Podiatry student you have to sit next to a MD/DO student to get a great education and if you don't sit next to them you some how have lost out. Nor am I a pro MD/DPM person.

I am very happy being a podiatrist, I have become very successful and very fullfilled, I take care of my family w/o concern and live a great life and I didn't sit next to any MD/DO student to get what I consider was a great education. But I also recieved a great education. My internal medicine rotation was a hospital based internal medicine rotation, that oportunity was afforded to everyone in my class. Some students took that oportunity and ran with it others sat and did nothing, however they all got the oportunity, same with my general surgery rotation and every rotation I had.

As a student if I felt I was being short changed in something I spoke up to my administrators and teachers. My hope is that the students curently in school have the courage to speak up when they are being short changed and some schools are doing that and we all know that. If you happen to not be a student that is being short changed or if you were a student that recieved a great education this post has nothing do with you and congrats.

 

[MGHFOOTDOC]

Sorry Bob, you are wrong on this one. You are correct for year 1, but not year 2 when you do systems. One quick example: We have to memorize 4-6 easy heart sounds a few minutes before a test. The DO's have to learn and understand all of them.

That is exactly my point, everyone that holds a scapel to someone and refers to themselves as surgeons should understand and be able to read an EKG, that is a core teaching point in any medical school. There are "rear-foot experts" out there that I know personally and are held up as experts in our field that do not know which side is up on an EKG read-out.

 

[bobdolerson]

Sorry Bob, you are wrong on this one. You are correct for year 1, but not year 2 when you do systems. One quick example: We have to memorize 4-6 easy heart sounds a few minutes before a test. The DO's have to learn and understand all of them.

I simply meant in regards to sitting with DO's during the exams in the same classes. Are you talking about a class you take together with different requirements for the DO/DPM students?

It would make sense, considering I always see a DPM and a DO syllabus in each class, and have yet to see any difference between them..

Anyway, thanks for the clarification.

 

[bobdolerson]

But see....I do know how to read an EKG, and studied it as much as the DOs in physio.

As far as heart sounds are concerned...why should I need to know them?

I understand being able to recognize a disturbance in an EKG during a surgery, but knowing each and every heart sound isn't something I care to do unless it's necessary for my success as a podiatrist.

I'm not saying it's not, I just don't see how it is and would appreciate some clarity if that's what you mean.

 

[347932]

That is exactly my point, everyone that holds a scapel to someone and refers to themselves as surgeons should understand and be able to read an EKG, that is a core teaching point in any medical school. There are "rear-foot experts" out there that I know personally and are held up as experts in our field that do not know which side is up on an EKG read-out.

You know which specialty does the most surgery of any?? Dermatologists. Ask one to read an EKG one day. They'll look at you mystified. As will an Ortho surgeon out more than two years. Many medical specialties that deal with surgery haven't a clue. You think the boob job specialists in Beverly Hills know how to read an EKG? Bet they don't. Does that make them any less of a plastic surgeon?

I knew how to read an EKG when I did my Internal Medicine, ID rotation and Vascular surgery rotations as a PGY-1.

How exactly does knowing how to read an EKG make you more of a foot and ankle expert than a colleague that doesn't know how to read an EKG?

 

[FiveOVicryl]

One quick example: We have to memorize 4-6 easy heart sounds a few minutes before a test. The DO's have to learn and understand all of them.

This is where Kidsfeet was spot on. The school provides you with the material but it is ultimately up to the students to learn it. In this example, there were two options: memorize the answers for the exam or learn/understand the material that was provided.

 

[bobdolerson]

I feel that this is different than the point the OP made, though. He seemed (please correct me if I misunderstand this, I hate people putting words in my mouth) to be saying that the schools were doing in inadequate job of providing enough material, as in, graduating from a school didn't really mean you knew enough to be a "good physician".

It seems to me that since most of the studying that goes on isn't in the classroom, the method of the schools is to give you all of the information that they deem appropriate, and require enough of it for an exam that by being successful on the exam, you will have learned enough for future application.

Considering so much material is covered on each exam (ie, pathology for instance, we just covered a couple thousand slides for about 160 questions), they can't conceivably test you over all of it, so they would test you over a varying amount of information. This way, in order to be confident than you know all of what's on the exam, you will have to study everything. This is what I do, and I've been successful.

I also understand that each class builds on others, and it makes no sense to simply memorize, as it will just come around again and you'll waste more time memorizing it. The way I study, I understand and I'm able to apply. Most every time material comes up that we've studied before, I don't need to study it again, but simply understand a new way that it applies to this new concept.

So my question is, are you saying that students are inadequately understanding the material as they enter residency? Or that the boards are testing inadequately? Or do you think that the material required to even be successful in pod school exams and on the boards isn't enough to be what you consider a properly trained podiatrist?

I really don't understand what all you think a podiatrist needs to know that you're finding so many students lacking...

Like I said before, I don't want to be an MD, and I think that providing identical education is completely pointless, and if anything goes a long way to make our profession useless....it would basically mean that it's an easier way to become an MD with a smaller scope of practice and less pay, and that's not what I signed up for.

I want to learn about the feet, and I will happily trade a deeper understanding of other information that I won't be using or needing on a regular basis to be an expert regarding the lower limb.

Considering I'll be treating my patients food problems, wouldn't it make more sense to spend extra time studying that, and not general medicine that the MDs and DOs will be studying, especially considering that even they won't need much of it depending on the field they go into?

I hope this doesn't come across as combative, I'm simply looking for a better understanding as to the inadequacies that you're describing in our field. I'm only a first year, and don't pretend to know it all, or much of anything to be honest. I'm only speaking regarding my perception of the field thus far, and the reasons I chose it.

 

[TimmyT]

It has been established that Timmy is an idiot. Remember the whole "Western podiatry students gets the EXACT same education as the DO's" discussion?

http://forums.studentdoctor.net/showthread.php?t=858822

I haven't been called an idiot many times in my life but I can't really be surprised its from someone from an ONLINE forum. Thanks. I guess there is a first for everything. But it just shows how mature you are (or lack of). My advice to you is to turn down the name calling because this is a small field. I apologize if I offended anyone, that was not my intention. Have a good day.

 

[MGHFOOTDOC]

"what does reading an EKG have to do with being a good foot and ankle surgeon"



Perhaps I travel with a different group of doctors. I wonder as a surgeon who pre-ops patient are you stating that being able to read an EKG is not important to you. Do you rely on others to pre-op your patients?

 

[MGHFOOTDOC]

Bobdolerson - A school can not make someone a "good physician", but it should give you the basic building blocks to expand and grow in residency. The point of my post is that nearly 10 percent of students this year are out of the match because they couldn't pass a minimal competency board test after 4 years of studying and passing classes. There is a failure somewhere there either at the level of the school teaching or at the level of the schools failing these people who are not thriving early on and weeding them out. If you have made it through 4 years and passed your classes, you are not lazy nor not taking studies seriously.

 

[347932]

Perhaps I travel with a different group of doctors. I wonder as a surgeon who pre-ops patient are you stating that being able to read an EKG is not important to you. Do you rely on others to pre-op your patients?

Yep. As do some of the Orthopods I know. What' your point?

Before you answer that question, I'm pretty sure that if I miss a medical issue if I did try to pre-op my patients, my malpractice insurer may have a problem covering the lawsuit. What does your policy say about that?

I don't pretend to be an expert in all things medical that don't pertain to the foot and ankle. That's why I have a host of good PCPs that refer to the group I work with.

I'm glad to know that you have a good group of doctors to travel with you. I wonder if they'll back you up if your patient with a history of a-fib and forgot to tell you about it and you missed it, strokes out on you during on of your cases.

"What's your specialty doctor?"

"I'm a podiatrist".

"So your specialty doesn't really deal with cardiac issues much do they?"

"No, my specialty doesn't".

"So you're not exactly trained to identify the atrial fibrulation which caused your patient to have a stroke while you were performing that bunion procedure, causing your patient to die during the procedure, are you?"

"Well, I know how to read an EKG..."

"First of all, you're not answering my question, second of all, it is quite clear to this jury that in fact, you don't, do you Dr.?"

Sorry man, I'm not touching that with a ten foot pole.

And before you all go off on me that you want to do H&Ps and all that, I have no problem with that at all. Be prepared for the potential fallout though if you make a mistake.

 

[347932]

Bobdolerson - A school can not make someone a "good physician", but it should give you the basic building blocks to expand and grow in residency. The point of my post is that nearly 10 percent of students this year are out of the match because they couldn't pass a minimal competency board test after 4 years of studying and passing classes. There is a failure somewhere there either at the level of the school teaching or at the level of the schools failing these people who are not thriving early on and weeding them out. If you have made it through 4 years and passed your classes, you are not lazy nor not taking studies seriously.

These numbers are the same in the allopathic world. We are no different.

 

[MGHFOOTDOC]

Would your malpractice insurance be happier with you telling them that you operated on someone and had no idea that he had atrial fib and didn't bother reviewing EKG because the PCP told you everything was fine?

I don't perform H an P's on my patients but I have enough of a base of knowledge that I can review studies and be comfortable with what I am doing as a surgeon and do not solely rely on others to pick up things. All our students and residents should have a fund of knowledge to do that, if they don't they have no business expecting parity, and will never achieve it. Parity begins and ends with our students being taught and prepared to succeed in residency.

As for what the percentage points are for failures in others profession, I don't care about them, we should strive for better.

 

[bobdolerson]

Bobdolerson - A school can not make someone a "good physician", but it should give you the basic building blocks to expand and grow in residency. The point of my post is that nearly 10 percent of students this year are out of the match because they couldn't pass a minimal competency board test after 4 years of studying and passing classes. There is a failure somewhere there either at the level of the school teaching or at the level of the schools failing these people who are not thriving early on and weeding them out. If you have made it through 4 years and passed your classes, you are not lazy nor not taking studies seriously.

If I'm not mistaken, many of the people not getting spots in the whole "match and scramble" ordeal are not students of this year; is that not the case? I don't know if that matters regarding what you're saying, but it would seem if you're not successful the first time around, you've got less chance the next year and, as far as my Dean said yesterday anyway, minimal chances the following years.

I appreciate your ability to discuss this in a reasonable way. It's easy to find people in forums who take questions regarding their posts in a negative way and resort to things other than polite explanation as you have, and It's appreciated by a current student.

I suppose I understand what you're saying, but it's too early in my "career" to have made an opinion regarding it's content. My instinct is to disagree, simply because I /can/ read an EKG and recognize atrial fibrillation when I see it (actually, I'm studying it again right now for a comprehensive physiology test tomorrow morning that I should probably be studying for and not typing this...), but I understand that you're using that as an example and not as the entire base of your opinion.

Do you mind if I ask, are you frustrated about the high number of students failing the boards, or is this a personal experience /with/ residents in whom you've been disappointed with their general medical knowledge?

I'm at a bit of a disadvantage as far as understanding you, mostly because I pride myself in trying to be the best at what I do, and have no doubts about passing the boards as I consider them more of a right of passage and not as much of a thing to be afraid of (ie, other people did it before me, I'm here and doing fine in classes, I should do fine).

I see your frustration regarding the field, and I too would like to see a high level of competency in all practicing podiatrists and residents, I just (in my limited knowledge of the field and the world) don't think it entails being as informed about general medicine as a DO/MD, considering my specialty will be in the lower limb.

As far as reading an EKG, or in effect understanding anything that may come up in a practicing setting that I would need to know for the patient to have competent care, I agree that it should be common knowledge and the bare minimum for someone to enter practice. I just don't know what that means at this point.

Anyway, thank you again for your contribution to this thread and to my own knowledge. I'm always happy to hear the perspective of someone more advanced than I am in my career, which it this point is basically everyone.

...except all of you pre-pod punks

 

[SuperFeisty]

Why you gotta be like that bob! We could have had something special!

 

[MGHFOOTDOC]

Bobdolerson - I am someone that cares about Podiatry and its future, I chose to be a part of a residency program to help train future Podiatrists to be better than I am and that is how our profession grows. It frustrates me that 40 people failed a part 2 board exam that is essentially clinical information. I am not comforted as others seem to be knowing that other professions fair about the same, my care is for Podiatry.

The residency that I teach at is a well rounded residency where our first year is strictly an intership year where 1st years spend about 3 months with medicine interns both inpatient and patient. They are not treated as Podiatry observers but part of the team and expected to perform as a team member. We make these 1st years take hospital based lectures and workshops designed for Med school year 4 students with regards to medicine. They all complain the 1st day that they are treated as students but that ends the moment they realize how much they dont know. We have cultivated respect in our hospital through such things and are the go to people for foot problems, because every service knows us and knows that we are good physcians. Our first year also spends 2 full months in surgery (general and vascular) again as an integrated part of the team, knowing that our scope is the foot, so our residents work on the foot cases, but round on everyone and are expected to be somewhat knowlegable as to what they are saying. Every year 1 we have struggles with this but gets through it and they all say they wished they had more medical knowledge taught to them, so they don't play catch up, when they should be seen as equals, by the end of the 1st year they are. Our third year teaches medicine interns about the foot, other service residents rotate through our services often. Thats how it should be.

Now if your goal is to work hospital based you need to know your medicine, surgery and podiatry to be part of a team. If your goal is to open a private office maybe you can get way with focusing solely on podiatry and referring out to PCP's.

My perscpective is Hospital based medicine.

 

[streetsweeper]

If I'm not mistaken, many of the people not getting spots in the whole "match and scramble" ordeal are not students of this year; is that not the case?...

You may be right but I wouldn't be too sure about that. I know of at least 4 people (good friends) who scrambled last year. This year they all passed their boards and they all got good reputable programs.

 

[streetsweeper]

Bobdolerson - I am someone that cares about Podiatry and its future, I chose to be a part of a residency program to help train future Podiatrists to be better than I am and that is how our profession grows. It frustrates me that 40 people failed a part 2 board exam that is essentially clinical information. I am not comforted as others seem to be knowing that other professions fair about the same, my care is for Podiatry.

The residency that I teach at is a well rounded residency where our first year is strictly an intership year where 1st years spend about 3 months with medicine interns both inpatient and patient. They are not treated as Podiatry observers but part of the team and expected to perform as a team member. We make these 1st years take hospital based lectures and workshops designed for Med school year 4 students with regards to medicine. They all complain the 1st day that they are treated as students but that ends the moment they realize how much they dont know. We have cultivated respect in our hospital through such things and are the go to people for foot problems, because every service knows us and knows that we are good physcians. Our first year also spends 2 full months in surgery (general and vascular) again as an integrated part of the team, knowing that our scope is the foot, so our residents work on the foot cases, but round on everyone and are expected to be somewhat knowlegable as to what they are saying. Every year 1 we have struggles with this but gets through it and they all say they wished they had more medical knowledge taught to them, so they don't play catch up, when they should be seen as equals, by the end of the 1st year they are. Our third year teaches medicine interns about the foot, other service residents rotate through our services often. Thats how it should be.

Now if your goal is to work hospital based you need to know your medicine, surgery and podiatry to be part of a team. If your goal is to open a private office maybe you can get way with focusing solely on podiatry and referring out to PCP's.

My perscpective is Hospital based medicine.

You've expressed my sentiments exactly. I too wished I had more of a medical management background before starting residency. I can think of a few b.s. rotations that can be dropped in place of more quality medical rotations in our 3rd/4th year of pod school. But now that my PGY-1 year is coming to a close... I'm feeling confident in "basic" medical management. Our residency is teaching hospital based and we are held to high standards when we are off-service. Internal medicine was a struggle, surgery was getting up there, and vascular was a quantum leap...after that, every other off service rotation was piece of cake. It's unfortunate that the other services see our struggles before we mature in our training. We were co-interns with everybody (peds, IM, ENT, ortho, etc) and none of them struggled like we did in the beginning of the year. I hated playing "catch up." For some folks, it may paint a negative picture of podiatry.

In short, yes.. I feel you!