The Greatest Mistake Podiatric Medicine Ever Made

[mrfeet]

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I haven't posted in a while, but in lieu of recent events there are some things I want to say about the future of podiatric medical education. As a current podiatry student I see a lot of things going on at our schools right now; some good, some bad. Recently, it was decided that a new school should be opened in southern California at Western University. Now, while I'm proud of the fact that we have another podiatric medical college at a DO school, I find myself asking the question, "Why now?" For the first year in many years, we find ourselves facing a residency placement shortage. This year, 9 podiatric medical students will not get residencies. While some of you are thinking, "So what, that doesn't affect me" or "Those 9 students must be at the bottom of their class and don't deserve a residency," I assure you that those people who don't get a residency very much care. Furthermore, mathematically things will only get worse as more students graduate and more schools open their doors. The problem that these students face is one our forefathers did not as they CANNOT practice podiatric medicine without a residency.

The California School of Podiatric Medicine is currently on probation. They have managed to move twice since leaving San Francisco and they now find themselves affiliated with Samuel Merritt College. No disrespect to Samuel Merritt, but who the hell has heard of that institution? The Scholl College of Podiatric Medicine now finds itself as a part of Rosalind Franklin University. No disrespect, but who the hell has heard of Rosalind Franklin University? This brings me to the point of this thread.

The greatest mistake that podiatric medical education has made is NOT ALIGNING ITSELF WITH MAJOR UNIVERSITIES AND TEACHING HOSPITALS. Aside from Temple, no other school has affiliation with a major university or teaching hospital, and no, I don't go to Temple. Podiatric Medicine needs to follow the steps of dentistry, osteopathic medicine, and optometry. Though once obscure professions, they now have schools at major universities such as Harvard, Michigan State, Oklahoma State, UAB, and so forth. Why has podiatric medicine not followed this trend? Why do we now find our schools at obscure institutions that no one has heard of outside of a 50 mile radius of the school?

There are many reforms that podiatric medical education needs to make including: admission standards, MCAT mandate, educational parity, etc. Adding more schools, however, is not the solution.

 

[moodent]

NYCPM is affiliated with Columbia University

 

[OSUDDS]

lulz

just like OCPM is affiliated with Case Western and the Cleveland Clinic

 

[IlizaRob]

1. Im not sure where you got your statistics regarding students vs residency spots this year, but I dont think you are correct. Are you sure you dont mean that some students will not get a 3yr residency this year? Im pretty sure that all students will get either a PMS 36 or 24.

2. Dr. Harkless was pretty close to starting the new school (which is now going to be in Pamona, CA) as a part of the University of Texas - San Antonio. However, as I understand it, the CPME denied his request to affiliate the school with the University because it was a state school and the state would mandate the college of podiatric medicine to lower tuition. CPME felt that it would be unfair to other colleges. Thats my understanding, someone correct me if I am wrong.

I understand your concerns mrfeet, but I am still completely in favor of the new Pamona school. If anything, we should tell some schools like NYCPM to cap their enrollment. That would be best for everyone.

 

[MrFeeties]

Podiatric medical schools are all private institutions. It has been debated ad nauseum at Scholl about the collective wisdom to move the school out of the city and to merge with Rosalind Franklin. I personally am more apt to say "I go to Scholl" than I go to the Dr. William M Scholl College of Podiatric Medicine at Rosalind Franklin University." If anything because monosyllabic responses are time maximizers!

First of all, the name change from Finch University to Rosalind Franklin University happened like 4 years ago as part of a merger/restructuring deal that shed the Finch name in respone to some scandalous activity by institutional board members. Essentially, a large amount of people haven't heard of Rosalind Franklin University because it's only been around for a couple years. Yet still, Scholl is closely intertwined with the Chicago Medical School (which has strikingly high USMLE passing rates), and moving the school allowed greater access to research and teaching resources.

Plus it keeps students out of the downtown bars, which I personally am thankful for because a lot of my financial aid check would have gone right down the loo.

I've also caught wind of a shortage of residency spots, but that's more of an issue with teaching hospitals. Accreditation of residency slots is a lengthy process and I'm assuming the APMA is going to start leaning on COTH hospitals and students alike to push for programs to take on an additional resident or 2. If anything we ned MORE podiatric medical schools to keep up with demand.

Another thing to keep in mind with major teaching hospitals is that podiatry always gets caught up in the "who has a bigger schlong" contest with ortho. It's hard to compete with larger ortho programs who are trying to get cases for their residents. The ortho program at my alma mater which has a huge teaching hospital refers most of their LE cases to the private practice podiatrists in town anyways...

just my $.02
mrfeeties (not to be confused with mrfeet)

 

[mrfeet]

Let me rephrase "affiliated" with "part of." I know that NYCPM and OCPM are affiliated with those institutions, but they are still not "part of them." When you can say you are the "Columbia University School of Podiatric Medicine" or the "Case Western University School of Podiatric Medicine" then you are a part of that university.

The only reason for this statement is the fact that institutions such as Columbia and Case Western would place much more stringent admissions requirements upon their member schools and would certainly not allow one of its colleges to lose its accreditation or go on probation. This has not happened at NYCPM or OCPM, but has happened at California with Samuel Merritt College.

As far as the story goes with Harkless at Texas, I think the CPME should be ashamed of itself for that being their reason not to endorse a school. We NEED podiatry schools at state institutions so that tuition will be lower. A lot of us are incurring copious amounts of debt to go to podiatry school. What about dental schools or medical schools? There are private schools and public schools. Obviously the public schools are cheaper, but students still flock to the private schools, such would be the case in podiatric medicine.

 

[gustydoc]

This year, 9 podiatric medical students will not get residencies.

This statement is simply incorrect. When the clas of 2008 graduates this spring there will be close to 80 spots that will go unfilled. It is true that there are currently more students than three year residency positions though. According to the CPME and COTH representatives that I spoke with, if the current number of residency positions does not increase the first possibility of a shortage will be with the class of 2011. Realizing that is a possibility, the CPME has begun to encourage current residencies with adequate surgical numbers to increase their positions and they are also attempting to assist current PM&S 24 programs to transition to 3 yr programs. Long story short, the APMA will not allow there to be a residency shortage again like there was in the 80's.
As for the rest of your post I agree with your suggestion that the profession would benefit from all schools being allied with larger medical schools and I do think that is the direction podiatric education is headed.

 

[Feli]

...I am still completely in favor of the new Pamona school. If anything, we should tell some schools like NYCPM to cap their enrollment. That would be best for everyone.

Yep. 👍

There's nothing wrong with opening or expanding quality podiatry programs, but unless the residency spots are there, some of the underachieving pod schools will have to downsize to compensate. If we end up with DPMs graduating and not getting residency training, that'll be pretty detrimental to the goals of the profession.

 

[jonwill]

Let me rephrase "affiliated" with "part of." I know that NYCPM and OCPM are affiliated with those institutions, but they are still not "part of them." When you can say you are the "Columbia University School of Podiatric Medicine" or the "Case Western University School of Podiatric Medicine" then you are a part of that university.

The only reason for this statement is the fact that institutions such as Columbia and Case Western would place much more stringent admissions requirements upon their member schools and would certainly not allow one of its colleges to lose its accreditation or go on probation. This has not happened at NYCPM or OCPM, but has happened at California with Samuel Merritt College.

As far as the story goes with Harkless at Texas, I think the CPME should be ashamed of itself for that being their reason not to endorse a school. We NEED podiatry schools at state institutions so that tuition will be lower. A lot of us are incurring copious amounts of debt to go to podiatry school. What about dental schools or medical schools? There are private schools and public schools. Obviously the public schools are cheaper, but students still flock to the private schools, such would be the case in podiatric medicine.

CPMS is "part of" DMU which is the largest medical school in the State of Iowa so I would say that it is affiliated with a major medical school. I think that the current residency situation is respectable. Not everyone should get or wants a 3 year program. What needs to be prevented is graduating more students than residency slots (2 and 3 year). The new school does bring that into question. As students, you should all be writing to the APMA and CPME.

THE APMSA NEEDS TO PASS AN EXTERNAL RESOLUTION ON THE MATTER. It is their job to represent the future of the profession. I was told that it was brought up at the last meeting but the majority "didn't want to cause trouble". What they fail to understand is that not causing trouble now may result in a lot more trouble down the road. And it may cause some students training.

I do believe that the profession is in need of some reform concerning enrollment caps, board reform, etc. But having said that, I don't think there is anything to panic about yet.

 

[Dr_Feelgood]

CPMS is "part of" DMU which is the largest medical school in the State of Iowa so I would say that it is affiliated with a major medical school. I think that the current residency situation is respectable. Not everyone should get or wants a 3 year program. What needs to be prevented is graduating more students than residency slots (2 and 3 year). The new school does bring that into question. As students, you should all be writing to the APMA and CPME.

THE APMSA NEEDS TO PASS AN EXTERNAL RESOLUTION ON THE MATTER. It is their job to represent the future of the profession. I was told that it was brought up at the last meeting but the majority "didn't want to cause trouble". What they fail to understand is that not causing trouble now may result in a lot more trouble down the road. And it may cause some students training.

I do believe that the profession is in need of some reform concerning enrollment caps, board reform, etc. But having said that, I don't think there is anything to panic about yet.

It is also the #15 largest in the nation.

 

[narkotiks]

I haven't posted in a while, but in lieu of recent events there are some things I want to say about the future of podiatric medical education. As a current podiatry student I see a lot of things going on at our schools right now; some good, some bad. Recently, it was decided that a new school should be opened in southern California at Western University. Now, while I'm proud of the fact that we have another podiatric medical college at a DO school, I find myself asking the question, "Why now?" For the first year in many years, we find ourselves facing a residency placement shortage. This year, 9 podiatric medical students will not get residencies. While some of you are thinking, "So what, that doesn't affect me" or "Those 9 students must be at the bottom of their class and don't deserve a residency," I assure you that those people who don't get a residency very much care. Furthermore, mathematically things will only get worse as more students graduate and more schools open their doors. The problem that these students face is one our forefathers did not as they CANNOT practice podiatric medicine without a residency.

The California School of Podiatric Medicine is currently on probation. They have managed to move twice since leaving San Francisco and they now find themselves affiliated with Samuel Merritt College. No disrespect to Samuel Merritt, but who the hell has heard of that institution? The Scholl College of Podiatric Medicine now finds itself as a part of Rosalind Franklin University. No disrespect, but who the hell has heard of Rosalind Franklin University? This brings me to the point of this thread.

The greatest mistake that podiatric medical education has made is NOT ALIGNING ITSELF WITH MAJOR UNIVERSITIES AND TEACHING HOSPITALS. Aside from Temple, no other school has affiliation with a major university or teaching hospital, and no, I don't go to Temple. Podiatric Medicine needs to follow the steps of dentistry, osteopathic medicine, and optometry. Though once obscure professions, they now have schools at major universities such as Harvard, Michigan State, Oklahoma State, UAB, and so forth. Why has podiatric medicine not followed this trend? Why do we now find our schools at obscure institutions that no one has heard of outside of a 50 mile radius of the school?

There are many reforms that podiatric medical education needs to make including: admission standards, MCAT mandate, educational parity, etc. Adding more schools, however, is not the solution.

good points. further down the post, someone starts talking about schlong contests (bring it on by the way😀). don't you think an affiliation with a big school would just start the contest early? let's be honest here--as pod students, we are where dental school was about 10 years ago. cycles people, cycles. dental school was in trouble. schools closed, sub-par applicants were admitted, etc. now, stats to get in are very much respectable. i know ocpm is denying students this year which gives me some hope. we are in a bit of a rut, and i see us pulling out of it, however slow it may seem. increasing admissions standards and making pod students higher caliber does not happen over night, and i am pleased to see that things are going up. give it 5 years and i think requirements will be comparable to some of the other disciplines. im happy about that.
i maintain that affiliation with large schools is largely unimportant. keep in mind that someone somewhere is providing us an opportunity to learn podiatric medicine fundamentals in exchange for a margin of our tuition. a profit needs to be turned in order to keep things going. the state school idea is great, and i second the shame on apma for not working something like that out with texas. my point about affiliation is that entering an affiliation with a large institution will probably speed the rise of our tuition, and we come in at the bottom of the barrel. certainly many of us have been questioned about MD-v-DPM. most of us don't care that we are "just" DPM. hell, i chose the profession, and i am proud of it (i use those situations as teaching opportunities, maybe i'll get to message their feet someday!) so if we are fine having a degree which is "inferior" to MD in the eyes of some, why on earth do we need an affiliation with harvard?? i like the fact that we share professors with case dental and med at ocpm, and think that to be a perfect marriage of good education and cost efficiency and isn't that different from having case western on the letterhead. i guarantee that if a pod school were to be affiliated with a large institution, the tuition would be very similar to that of and MD and DMD program at that institution...no thanks.
we hear the residency discussion often, and i think that it be a real thing. i don't think people factor in attrition rate in speaking about this. due to our class sizes at ocpm, our attrition number is something like 20 over four years. the first year class here lost 3 students after the first semester! i would not sweat the residency issue--again, give it some time, and things will resolve. if they don't, i bet we could motion a class action and perhaps resolve things that way. i agree that we all need to be writing to apma and cpme and getting some buzz going from our end.
back to the affiliation thingy, who decides what institution would be respectable and reasonably "worthy" of podiatry education's grace? i've been around quite a bit, and until i started looking into podiatry, i had NEVER heard of sam merritt(?), franklin, or even case! i just don't see a benefit large enough to merit a 100% increase in tuition, just to be looked at as inferior. IT HAPPENS!
DMUers: is there perfect harmony b/t you and the DO students? be honest.

and thus ends my novel

 

[Dr_Feelgood]

DMUers: is there perfect harmony b/t you and the DO students? be honest.

There is always class loyalty but it is very harmonious. It was not always this way. When the program first opened there were more problems. Since we do everything together, many don't even know who is a DO and who is a DPM. Heck, I was asked what I thought about DO tests through my 2nd year, of course I would always tell them it was easy that I had a high 90 in the class. 😀

 

[mrfeet]

There have been some great points brought up to my original post, and I think everyone for their input. However, I must refute one argument that was made about podiatry schools being at schools, such as Harvard, and it being more expensive and podiatry students being at the bottom of the barrel due to an "inferior" degree. Well, I can tell you that this assertion is simply not valid when you weigh the pros and cons of being at a major teaching hospital.

If you're at Harvard (even as a podiatry student) you have access to the medical library, facilities, labs, etc. So what if the med students look down their noses at you; you can still hang a Harvard diploma on your wall and everyone will respect the medical training you received. At Temple, students have access to a myriad of resources just because they are part of a major university in a major urban center.

No offense to the DMUer's, but come on guys, you don't even have a teaching hospital at the school, which is why so many DO schools can open their doors because they don't have to be directly affiliated with a teaching hospital. I have been to Des Moines and DMU and it might be the 15th largest medical school in the country, but no one outside of the midwest has heard of DMU. When I told my doctor I was interviewing there, he said, "oh, so you decided to go to chiropractic school I see."

Sorry, I know I'll catch heat for that one.

 

[Dr_Feelgood]

No offense to the DMUer's, but come on guys, you don't even have a teaching hospital at the school, which is why so many DO schools can open their doors because they don't have to be directly affiliated with a teaching hospital. I have been to Des Moines and DMU and it might be the 15th largest medical school in the country, but no one outside of the midwest has heard of DMU. When I told my doctor I was interviewing there, he said, "oh, so you decided to go to chiropractic school I see."

Sorry, I know I'll catch heat for that one.

I take no offense and I agree. But can be said about many schools, I didn't know that Southern Illinois University in Carbondale (I found out when I was looking at the SIU basketball team).

You are also right about DO programs and not having an strong affiliation with a hospital. I think that is one of th best things about DMU, freedom. We don't have to work at an affiliated hospital and are free to do what we want. But both the DOs, DPMs, and PAs fill the halls of Broadlawns Medical Center. I would highly recommend that externship for anyone. It is hands down the best externship in the nation b/c you are not competing with residents and get to learn from very well known doctors such as Mandracchia, Rogers, Bevilacqua, and Mandi.

 

[dpmgrad]

This statement is simply incorrect. When the clas of 2008 graduates this spring there will be close to 80 spots that will go unfilled. It is true that there are currently more students than three year residency positions though. According to the CPME and COTH representatives that I spoke with, if the current number of residency positions does not increase the first possibility of a shortage will be with the class of 2011. Realizing that is a possibility, the CPME has begun to encourage current residencies with adequate surgical numbers to increase their positions and they are also attempting to assist current PM&S 24 programs to transition to 3 yr programs. Long story short, the APMA will not allow there to be a residency shortage again like there was in the 80's.
As for the rest of your post I agree with your suggestion that the profession would benefit from all schools being allied with larger medical schools and I do think that is the direction podiatric education is headed.

Gustydoc, the statement that mrfeet made about not having enough residency spots for the Class of 2008 is actually true. This was announced to all of the residency directors at the CRIPS meeting. At the start of the CASPR cycle for Class of 2008, there were more residency positions than applicants. However, due to closure of some residency programs, there are now less positions than applicants. I can't recall exactly what that number is but it is rather small.

 

[narkotiks]

I take no offense and I agree. But can be said about many schools, I didn't know that Southern Illinois University in Carbondale (I found out when I was looking at the SIU basketball team).

You are also right about DO programs and not having an strong affiliation with a hospital. I think that is one of th best things about DMU, freedom. We don't have to work at an affiliated hospital and are free to do what we want. But both the DOs, DPMs, and PAs fill the halls of Broadlawns Medical Center. I would highly recommend that externship for anyone. It is hands down the best externship in the nation b/c you are not competing with residents and get to learn from very well known doctors such as Mandracchia, Rogers, Bevilacqua, and Mandi.

I love the freedom idea! the "looking down their nose thing" isn't a big deal for most of us, because i really do think that a lot of pod students actually want to practice podiatry. BUT, if you don't care what people think about your profession, what difference does it make if your degree says harvard or Ohio college of podiatric medicine. why is one better than the other in terms of the actual education one receives? how could harvard or columbia suddenly offer pod, and suddenly be better than the other schools, just by virtue of the college? patients rarely care, and since the board exams are the "keeper of the gate" i dare say that only few slide by that shouldn't be practicing, at least initially. where did your GP go? did he pass all of his boards the first time trying? the point is that all of the schools offer a great education, and it is basically up to the individual to take advantage of the opportunity. affiliation and the institution which awards the degree are of little importance in the big picture.
i don't know about the other schools, but i know i have access to the materials that i need right now. our labs are great, especially in our new building, and the bottom line is that we are able to learn what we need to learn. a big nice medical library may very well be beneficial during residency, and hopefully many of the residency programs have some access to such a resource. during pod school however, such a library isn't really necessary. i have gone to the case med library before and browsed for extra material to help me through classes. they had nothing there of any significance to what i need. here is some perspective: physio, for example, hasn't changed much so why in god's name do you need access to 12 editions of physio books from 15 different authors? same goes for many of the subjects we study, a few excluded. at ocpm, we usually get a handout of some sort which is more or less a paraphrase of the chapter in our book. i usually read the chapter, and then use the instructor presentation to draw from the reading what he/she finds important or wants us to know. my grades and my confidence in mastery of material are both high. i don't see how a medical library would be beneficial as a 1-4 year podiatry student. even though ocpm isn't really "affiliated" to case, we can still go to the library and use their resources, not that it helps much. it just isn't that important! the schools have subscriptions to journals, so when doing case studies etc, you have the latest. tell me how the affiliation/library would be an exponential benefit, considering the cost factors... the major teaching hospital affiliation is beneficial during residency, and just isn't necessary during our first 4 years.
you don't think cost of tuition and things would rise? again, college is big business for many, and if they can milk us, they will. there is no way in hell harvard would offer a DPM program at $25k/year. their base for med school is $38,600, and columbia is is $43k! it would be very close to those numbers, i promise.

 

[Feli]

... i don't see how a medical library would be beneficial as a 1-4 year podiatry student...

🙁^

WOW... I really think your views will change by the time you become a clinical student.
Podiatry encompasses a lot more than just the bunions and gout you read about in most pod journals. You need internal med, ortho, vascular, endocrinology, inf dz, etc journals. The more you have available, the better. Podiatrists sure don't just publish ingrown toenail case studies in JAPMA nowadays. The profession is making major strides into mainstream EBM and contributing to its literature, especially in the realm of the diabetic foot care.

...affiliation and the institution which awards the degree are of little importance in the big picture...

I think that you are sorely missing what the true benefits of an integrated program are. Aside from the sharing of resources, the biggest and most important factors are the increased exposure, appreciation, and respect for the podiatric profession... undergrad students, other health professions students, attendings, patients, the community.

 

[jonwill]

Gustydoc, the statement that mrfeet made about not having enough residency spots for the Class of 2008 is actually true. This was announced to all of the residency directors at the CRIPS meeting. At the start of the CASPR cycle for Class of 2008, there were more residency positions than applicants. However, due to closure of some residency programs, there are now less positions than applicants. I can't recall exactly what that number is but it is rather small.

So would you agree that this all needs to be better regulated at this point? Where is the problem? I know this happened back in the 80s and early 90s but at that time, residency was not a pre-req to practice. Now, almost all state laws require it. What are your thoughts?

I'm interested in your point of view since you are directly involved in residency training.

 

[mrfeet]

Gustydoc, the statement that mrfeet made about not having enough residency spots for the Class of 2008 is actually true. This was announced to all of the residency directors at the CRIPS meeting. At the start of the CASPR cycle for Class of 2008, there were more residency positions than applicants. However, due to closure of some residency programs, there are now less positions than applicants. I can't recall exactly what that number is but it is rather small.

Thanks for backing me up on this. I knew I wasn't imagining that statement. I also think that many people responding to this post are missing the point in relation to having podiatry schools at more reputable institutions. Can a podiatrist receive as good of an education at the Ohio College of Podiatric Medicine as he can at the Harvard School of Podiatric Medicine? Sure he can, but it's not just about the education, it's also about the RESOURCES!!!

The exposure to the resources that one receives at larger, teaching hospitals is insurmountable. You can't put a price tag on experience!

 

[Stafocker]

Thanks for backing me up on this. I knew I wasn't imagining that statement. I also think that many people responding to this post are missing the point in relation to having podiatry schools at more reputable institutions. Can a podiatrist receive as good of an education at the Ohio College of Podiatric Medicine as he can at the Harvard School of Podiatric Medicine? Sure he can, but it's not just about the education, it's also about the RESOURCES!!!

The exposure to the resources that one receives at larger, teaching hospitals is insurmountable. You can't put a price tag on experience!

We can't change where the pods schools are, but as long as these residencies continue to improve, it certainly helps our profession's cause.

(there's more great programs out there, this is just a shout-out to programs afflilated with "big name" universities, not necessarily the best ones, but any that are, if you know more, list them out or just check that caspr site).

 

[Dr_Feelgood]

Since they've missed that boat, it's great to see that more and more residencies of "podiatric medicine and surgery" not just called "podiatry" are popping up at great institutions. Harvard has three programs, two of which are pretty good (incoming ACFAS pres at one of them), UPenn of course, Georgetown (i think Krabmas can answer more about that), Loyola, Rush (fyi = Rush North Shore in Chicago), UPMC (😉), etc, etc. There are many more, but that's just a few off the top of my head, OSU, UWashington (Seattle, but i'm not sure how much, but any affliation with Sig Hansen is tremendous), UFlorida, Yale, UTHCSA (the classic one) etc. Each one has their own level of integration into the system but the exposure should help lift the educational standards even higher. Seriously, just 10 years ago, the amount of positive change in the medical/academic world for pods has been tremendous, and future residents should be encouraged and sense their privilege at being at these institutions.

We can't change where the pods schools are, but as long as these residencies continue to improve, it certainly helps our profession's cause.

(there's more great programs out there, this is just a shout-out to programs afflilated with "big name" universities, not necessarily the best ones, but any that are, if you know more, list them out or just check that caspr site).

There is no affiliation with U of Wash directly. Pod residents do get to work with Dr. Hansen for three months in their third year (which is an amazing opportunity) and they attended Dr. Hansen's radiology rounds every Monday. That affiliation is more with Harborview Medical Center than the university.

One thing that maybe unappreciated that you mentioned is the role of residencies in medical education. Residency is were you learn how to practice medicine. School is only were you learn the basics and create opportunities to get to the best residency possible. I don't think that the location of pod schools play as big of a role as the location of the residencies.

 

[narkotiks]

There is no affiliation with U of Wash directly. Pod residents do get to work with Dr. Hansen for three months in their third year (which is an amazing opportunity) and they attended Dr. Hansen's radiology rounds every Monday. That affiliation is more with Harborview Medical Center than the university.

One thing that maybe unappreciated that you mentioned is the role of residencies in medical education. Residency is were you learn how to practice medicine. School is only were you learn the basics and create opportunities to get to the best residency possible. I don't think that the location of pod schools play as big of a role as the location of the residencies.

thank you! you are much more concise than i! that is what i have been trying to say. a residency affiliated with a big school/hospital would be far more valuable, TO ME, than to have such an affiliation while in pod school. i just don't think it would be as beneficial as some make it out to be. the costs would far out weigh the benefits until you are actually learning how to practice medicine. respect from academia can lick me...even amongst the 8 schools now is a continuum (enter schlong contest) and while students are usually cordial, i think we all have a good idea how our schools are viewed by each other. the 1-4 pod stuff is a foundation, and i don't see it as being nearly as important to have huge resources there compared to residency. but, if it will make you feel better, i concede that we need to earn respect from our medical peers, and by affiliating our pod schools with the long heritage many schools have established, we will be respected by other doctors, and with the unbelievably better resources they must have, we may very well eliminate the need for residency training at all. (yes im being a dick.) it just doesn't matter that much, except maybe to my old man who recently had a cyst removed from his foot by a grad of a school that is barely hanging on to one end of the aforementioned continuum , and ended up with some serious infection from the procedure. i bet he would agree with some of you that if dr. Y had the exposure to a multi-million dollar micro lab and endless cases of books and professors and diplomas from ivy league schools the infection never would have happened....i bet

 

[krabmas]

NYCPM is affiliated with Columbia University

NYCPM is affiliated with Columbia Presbyterian Hospital System. Not specifically the University. The Hospital and the University are separate entities. NYCPM students do not rotate at that hospital either.

 

[krabmas]

thank you! you are much more concise than i! that is what i have been trying to say. a residency affiliated with a big school/hospital would be far more valuable, TO ME, than to have such an affiliation while in pod school. i just don't think it would be as beneficial as some make it out to be. the costs would far out weigh the benefits until you are actually learning how to practice medicine. respect from academia can lick me...even amongst the 8 schools now is a continuum (enter schlong contest) and while students are usually cordial, i think we all have a good idea how our schools are viewed by each other. the 1-4 pod stuff is a foundation, and i don't see it as being nearly as important to have huge resources there compared to residency. but, if it will make you feel better, i concede that we need to earn respect from our medical peers, and by affiliating our pod schools with the long heritage many schools have established, we will be respected by other doctors, and with the unbelievably better resources they must have, we may very well eliminate the need for residency training at all. (yes im being a dick.) it just doesn't matter that much, except maybe to my old man who recently had a cyst removed from his foot by a grad of a school that is barely hanging on to one end of the aforementioned continuum , and ended up with some serious infection from the procedure. i bet he would agree with some of you that if dr. Y had the exposure to a multi-million dollar micro lab and endless cases of books and professors and diplomas from ivy league schools the infection never would have happened....i bet

2% of all patients that have surgery will get an infection. It s_ck's that he was in that 2%.

 

[Stafocker]

2% of all patients that have surgery will get an infection. It s_ck's that he was in that 2%.

is "suck" censored?

 

[mrfeet]

There was a previous post that stated how the CPME decided not to approve a podiatry school at the University of Texas because it is a state institution and this would drastically reduce tuition. Did anyone know that Temple is technically a public, state-funded institution. Though tuition at Temple is not drastically reduced and is in line with the other pod schools it is nonetheless a state institution. Doesn't anyone find the logic of the CPME not to approve a school at a state university to be a little, well let's say, "DUMB?"
😎

 

[narkotiks]

2% of all patients that have surgery will get an infection. It s_ck's that he was in that 2%.

is it only 2%? it seems like our micro teacher last year was telling us it was quite a bit higher. he told us that the the most litigation against podiatrists involves infection. that stuff happens.

 

[dpmgrad]

So would you agree that this all needs to be better regulated at this point? Where is the problem? I know this happened back in the 80s and early 90s but at that time, residency was not a pre-req to practice. Now, almost all state laws require it. What are your thoughts?

I'm interested in your point of view since you are directly involved in residency training.

I agree with you that the number of residency positions and number of students graduating from Podiatry schools need to be regulated. Since CPME switched over to the model where every single Podiatry student graduate will be trained in some form of Podiatric Surgery (PM&S-24 vs PM&S-36), I think that some of the older programs are having a hard time switching over to the new model. As a result, some of these programs have either merged with other residency programs or simply closed when the last of the residents finished his/her training. Many people think that it is easy for a big solid program to simply convert over to the new model without any problems. In reality, I do know some very solid programs that were put on probation based on the fact they lacked certain paperwork or whatever else that the CPME evaluation committee felt that residency program violated based on the CPME 320 document. There are also many hospital either closing or are no longer support residency training due to economic or clinical issues. With the upcoming Medicare cut, it will be interesting how this will impact the residency training at the various hospitals since most (if not all) of the residency programs are funded by Medicare. Lastly, some programs have simply closed because it had hard time attracting any candidates (let alone qualified candidates) to fill the positions. This is a problem for the past few years when there was a surplus of residency positions and lack of students to fill them. It is also not that easy to simply start a new residency program also because the new programs need to find adequate resources to support resident's training. For example, under the PM&S-24/36 model, all residents must include behavioral science (psych) rotation, which is required for the ABPOPPM. Under the old PSR-12/24/24+ models, behavioral science was not a requirement. It is not so simple as creating a new residency program in a hospital where there are tons of Podiatric Surgical cases. My point here is that it is not so easy to simply create more residency positions. The only good news from the residency program end is that some of the well established larger Podiatric residency programs are trying to increase their number of positions to accomodate for potential increase in number of Podiatry school graduates. Unless CPME reverts back to the older residency model where there are non surgical Podiatric residency programs or something is done at the school level, I will forsee a continual shortage of residency positions.

Since, we are going to have more students than residency positions, I agree with jonwill that we need to do something at the school level. Enrollment caps is one idea. I know that size of the incoming TUSPM classes have been smaller than when I was a student. We used to start out with over 100 students and the numbers go down from there due to attrition. Enrollment cap might hurt certain schools that are dependent on student tuition. I still have mixed feelings about the creation of a new Podiatry school. It is great to see another Podiatry school being part of an university with medical school. However, this will only add more numbers to the amount of graduating Podiatry students. I think that we should focus on the existing 8 schools and get each school up to certain standards (curriculum, clinical training, enrollment, selectivity, etc...).

I hope that all of this will get regulated better soon. If not, we will be heading back to the residency shortage situation back in the 80's and early 90's as jonwill said. Lastly, we have to becareful also not to create an excess of residency positions.

 

[Dr_Feelgood]

is it only 2%? it seems like our micro teacher last year was telling us it was quite a bit higher. he told us that the the most litigation against podiatrists involves infection. that stuff happens.

It is just 2%. Some foot and ankle procedures have higher than normal infection rates such as ankle arthroscopy or ankle/STJ arthrodesis. There are some good articles on Pubmed on surgical site infections.

Most litigation, I believe, revolves around miscommunication.

 

[krabmas]

It is just 2%. Some foot and ankle procedures have higher than normal infection rates such as ankle arthroscopy or ankle/STJ arthrodesis. There are some good articles on Pubmed on surgical site infections.

Most litigation, I believe, revolves around miscommunication.

I agree. I also think that the litigation comes from surgeons missing infections before they blow-up.

The foot is inherintly (sp?) dirty. There is a reason that the toes are covered during rearfoot and ankle procedures. There is actually one article that shoes there is no difference in infection rates if the toes are covered or not, but no-one follows it.

For a presentation that I did a few months ago I looked up the number of post-op infections reported to the CDC and the number of people that undergo surgery in the US and after some division the rate was 0.02% but everyone always quotes 2%. ?????

 

[gustydoc]

Gustydoc, the statement that mrfeet made about not having enough residency spots for the Class of 2008 is actually true. This was announced to all of the residency directors at the CRIPS meeting. At the start of the CASPR cycle for Class of 2008, there were more residency positions than applicants. However, due to closure of some residency programs, there are now less positions than applicants. I can't recall exactly what that number is but it is rather small.

That's interesting I was basing what I said on the winter 2007 APMSA house of delegates meeting. All the representatives who spoke with us assured us that there would be a surplus of spots for the next few years and that the gears were already in motion to prepare for the increase of students in the future. Sounds like your info is more recent though. My bad. Glad I got my spot for next year locked down. 😀

 

[dpmgrad]

According to some rumors, there might be some new programs that may be accepting applicants through the scramble since they missed the deadline to be included in the CASPR directory. If this is true, this might help out with the residency position deficit for Class of 2008. Congrats gustydoc for securing a residency position.

 

[Stafocker]

The foot is inherintly (sp?) dirty. There is a reason that the toes are covered during rearfoot and ankle procedures. There is actually one article that shoes there is no difference in infection rates if the toes are covered or not, but no-one follows it.
?????

I might be more about the soft tissue envelope around the ankle more than about the toes being inheriently dirty.

 

[krabmas]

I might be more about the soft tissue envelope around the ankle more than about the toes being inheriently dirty.

The studies from JBJS that looked into different scrub types for patient's feet took cultures from the toes, the dorsum of the foot and the ankle. The toes were the dirtiest - grew the most bacteria.

 

[Stafocker]

The studies from JBJS that looked into different scrub types for patient's feet took cultures from the toes, the dorsum of the foot and the ankle. The toes were the dirtiest - grew the most bacteria.

cool info, which article?

 

[Stafocker]

The foot is inherintly (sp?) dirty. There is a reason that the toes are covered during rearfoot and ankle procedures. There is actually one article that shoes there is no difference in infection rates if the toes are covered or not, but no-one follows it.

For a presentation that I did a few months ago I looked up the number of post-op infections reported to the CDC and the number of people that undergo surgery in the US and after some division the rate was 0.02% but everyone always quotes 2%. ?????

if there's no difference..... what's the reason toes are covered?

 

[Dr_Feelgood]

if there's no difference..... what's the reason toes are covered?

There is no reason. Goucher et al found no significant difference in complications

 

[Stafocker]

The studies from JBJS that looked into different scrub types for patient's feet took cultures from the toes, the dorsum of the foot and the ankle. The toes were the dirtiest - grew the most bacteria.

Efficacy of Surgical Preparation Solutions in Foot and Ankle Surgery
Roger V. Ostrander, MD1, Michael J. Botte, MD2 and Michael E. Brage, MD3

this one? yeah, the toes grew the most bacteria compared to other parts of the forefoot and the ant. tibia, but it's talking about which prep solution to use to lower the chances, not really talking about why foot & ankle has more infections. they didn't test it before the apply the prep, only after, and it was funded by some prep-company.

http://www.orthosupersite.com/view.asp?rid=21117

here's an article about comparing Hip Arthroplasties and Ankle Arthroplasties infection rates.

none of this really answer the question completely, but it should add more for all the current Pod students of what you need to read, quote, and be able to have a reference to back up everything you might say in an interview. Any students have any articles on the subject of foot/ankle infection rates?

 

[Stafocker]

There is no reason. Goucher et al found no significant difference in complications

that's what i thought

 

[krabmas]

Preoperative Skin Preparation of
the Foot and Ankle: Bristles
and Alcohol Are Better

http://www.ejbjs.org/cgi/reprint/87/5/986

and

Efficacy of Surgical Preparation Solutions in Foot and Ankle Surgery
Roger V. Ostrander, Michael J. Botte, and Michael E. Brage
J Bone Joint Surg Am. 2005;87:980-985.

http://www.ejbjs.org/cgi/reprint/87/5/980