Mandracchia

[krabmas]

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Foreword
Vincent J. Mandracchia, DPM, MS
Consulting Editor
Life is what happens while you are busy making other plans
—John Lennon


How many times has it happened to you? You are busy making plans, and
wham! Life either happens or passes you by—or, more importantly, makes the
plans for you. This occurs in our personal and professional lives, and I have
personally experienced this phenomenon in my professional life. Upon completion
of residency training, my plans turned to private practice and plans for a
podiatric generalist lifestyle. At that particular time, handling foot and especially
ankle trauma was low on the priority list. After all, trauma was the purview of the
orthopedic surgeon and not something that, although intriguing and exciting,
most, if any, podiatric surgeons handled. But once again, life happened, regardless
of other plans. Necessity is, after all, truly the mother of invention, and the supplyand-
demand theory demanded of podiatrists that they expertly handle foot and
ankle trauma.
I know first hand how true this is, working as a salaried podiatrist for a county
hospital with a large, uninsured population. When confronted by the emergency
department physician about the need to treat an ankle fracture, with no orthopedic
coverage available, it was necessary for us to bstep up to the plate.Q That was
14 years ago, and man, things have changed. Without a doubt, podiatry has found
a clearly defined place in the treatment of the most basic to the most complicated
0891-8422/06/$ – see front matter D 2006 Elsevier Inc. All rights reserved.
doi:10.1016/j.cpm.2006.01.014 podiatric.theclinics.com
Clin Podiatr Med Surg
23 (2006) xi– xiifoot and ankle trauma. In fact, at our hospital, podiatry is first call for all lowerextremity
trauma. Once again, life has happened, and plans have changed.
The podiatric colleges now offer specific foot and ankle trauma courses
preparing students to handle lower extremity trauma in their residencies. National
and state meetings of the College of Foot and Ankle Surgeons offer basic and
advanced training for the trauma podiatrist. In short, treating trauma has become
an unavoidable fact and a way of life for podiatrists.
This issue of the Clinics in Podiatric Medicine and Surgery is dedicated to
management of lower extremity trauma and complications. Drs. Thomas Zgonis
and Demetrios Polyzois have done an excellent job in gathering an international
cast of authors to cover these topics. I thank them for their dedication to the
dissemination of knowledge that is so important to our professional future.
As always, I encourage readers to use this issue as a reference and guide in their
day-to-day experiences dealing with the patient who has foot and ankle trauma.
Vincent J. Mandracchia, DPM, MS
Broadlawns Medical Center
1801 Hickman Road
Des Moines, IA 50314, USA
E-mail address: [email protected]
xii foreword

 

[jonwill]

Wow, this guy is a stud! What college is he a professor at? 🙂

 

[krabmas]

Foreword
McCarthy’s Principles and Practice of
Podiatric Onychopathy
Vincent J. Mandracchia, DPM, MS
Consulting Editor
It makes sense—not to me, but it makes sense!
—Corporal Randolph Agarn, F-Troop, 1966
bCan you do addition?Q the White Queen asked. bWhatTs one and one and
one and one and one and one and one and one and one?Q bI donTt know,Q said
Alice. bI lost count.Q
—Lewis Carroll, Through the Looking Glass
For as many years as I can remember, I have been intrigued by the phenomenon
of numbers as it pertains to our residency training programs.
Not a year goes by in which the current third-year resident comes to me in a
near panic because they donTt seem to have the bcorrectQ number of bA, B, or CQ
surgical cases. What is with that? Oh, I know what the bA, B, and CQ designations
mean, but the question remains: What is with that? I read the recent PresidentTs
address to the American College of Foot & Ankle Surgeons by Dr. Gary Jolly, a
man I greatly respect, and I agree with him 100%. Our postgraduate training
programs need to be fine-tuned. We need, as a profession, to recognize all of the
wonderful options our graduates have regarding the types of practice available to
them, each productive and rewarding in their own way. We need to acknowledge the need for and desire of certain individuals to advance their training beyond
the basic level and make those programs available to them—all the while
ensuring a certain level of quality that produces a podiatric physician and surgeon
capable of the respect and confidence of patients and colleagues. I donTt
feel that an absolute number of bBQ or bCQ cases determine that level of expertise
or confidence.
Make no mistake; I am a firm supporter of activity and surgical logs. I believe
that these logs help to quantify and qualify the types of cases and pathologies that
a resident has been exposed to. When our postgraduate training programs are
where they need to be—a minimum of 3 years—with specialty fellowship programs
available, then I think we can be confident in the foundation that our
graduates are building.
Placing letter designations on surgical and clinical cases doesnTt prove
experience. Thomas Carlyle wrote, bA witty statesman said, you might prove
anything by figures.Q Ensuring exposure in a quality postgraduate program does.
We are all products of our environment—if the environment is one of quality,
then so is the product (and vise versa).
I have vivid memories of my residency days; I imagine that we all do, both
good and bad. Our program, at the time, had the first-year resident rotating on
podiatry for 6 weeks and then switching to an outside rotation for 6 weeks. I
started on podiatry with a gung-ho attitude—I couldnTt wait to get in there and
bcut.Q I remembered the words of my mentor, Dr. Donald Green, that bsurgery
was a privilege and not a right,Q but that didnTt quite matter to me at that moment.
So I patiently waited for my turn. . . and waited and waited. My turn never came.
Not once during those first 6 weeks did I handle a knife. I brode the bicycle,Q
as they say, when referring to the assistantTs role holding retractors during the
case. Disappointment and then frustration set in. Finally I confronted my senior
resident regarding my anger at the situation—after all, wasnTt I the surgical
resident also? ShouldnTt I be allowed to bdoQ the surgery? WasnTt it my right? I
wanted to quit right then and there. My senior looked at me and said, bBefore you
quit, do me a favor and tell me how to do an Austin bunionectomy, step-by-step.Q
To my astonishment, I was able to recite each and every step, verbalizing the
correct instrument choice and surgical pearl to facilitate its effective usage. I had
learned and learned well from the repetition of exposure. By todayTs training
standards, I would have logged a bBQ for every one of those cases during my first
6 weeks of training. On paper, it would have looked as if I had accomplished
nothing much when I had indeed accomplished a tremendous amount. But
appearances are deceiving; what if I had bperformedQ one or two bunionectomies
and achieved a bCTT designation? To an outsider, it would appear as if my experiences
with the one or two bCQ surgical procedures was better than the many
that I had assisted in and observed. To take it one step further, what if I had
performed those two bunionectomies incorrectly, but still did at least 75% of the
case? Which is the better scenario?
I realize that we do not function under a perfect system and that the Council on
Podiatric Medical Education is doing its very best to qualify and quantify postgraduate education, and I applaud their efforts. However, the system needs to
be changed. Residency programs need to be standardized, and, most importantly,
we need to put the time and effort into truly evaluating resident progress, identifying
where more time and effort needs to be placed with each resident entrusted
to us. This is where I feel we can accurately demonstrate and qualify the
level at which a resident functions, not by the number of cases and not by the
number of bATs,Q bBTs,Q or bCTsQ that are recorded. IsnTt human nature such that
the potential exists to inaccurately, inadvertently, or intentionally mark a bCQ
when a bBQ would more accurately portray the amount of work done in a case? If
so, then how accurate is that system?
Warren Buffett once said, bSomeone is enjoying shade today because someone
planted a tree a long time ago.Q We need to plant that tree, set up our training
programs now so that our profession will reap the benefits for years to come. Let
us recognize how multifaceted our profession is and use that to our advantage so
that we train foot and ankle specialists who are truly the experts at every level of
lower extremity care.
Years ago I made the observation that you could go to a medical office
building and see the names of a general dentist, orthodontist, periodontist, and
pediatric dentist on the same sign, but you couldnTt get two podiatrists in the
same town who didnTt think badly of each other. That needs to change, and it will
with the foundations of training that we formulate today. Kudos to those who care
enough to make these changes.
This issue of the Clinics in Podiatric Medicine and Surgery focuses on the
recognition and treatment of onychomycosis. I am excited to have Myron
Bodman and Daniel McCarthy serve as Guest Editors, the latter of whom is one
of the icons of our profession. Onychomycosis is a prevalent, disfiguring, cosmetically
unacceptable, and at times potentially serious infectious process, especially
in the vascularly compromised or immunocompromized individual. As
podiatric physicians it is our ethical responsibility to properly diagnose and treat
onychomycosis using all the scientific methods available to us (not just by
palliation) to achieve the desired result for the benefit of our patients. I believe
this issue will give us the reference tool to do so.


Vincent J. Mandracchia, DPM, MS
Broadlawns Medical Center
1801 Hickman Road
Des Moines, IA 50314, USA
E-mail address: [email protected]