Teaching Science to the Next Generation.

Teaching science to the next generation begins with foundations laid in podiatric medical school. Interest and immersion in research continues to develop through residency as trainees prepare for cases, participate in journal clubs, present posters and articles, and attend conferences. Having adequate training is essential to production of quality research. Although challenges and barriers exist, numerous resources are available at all levels of practice to guide those who are interested in contributing to the body of literature that supports the profession. Ensuring a robust pipeline of future clinician scientists is critical to the future of the profession.

The Resident-Run Clinic in Podiatric Medical Foot and Ankle Surgery Residency Training: A Study of Resident-Perceived Benefit.

BACKGROUND: Resident-run clinics provide autonomy and skill development for resident physicians. Many residency programs have such a clinic. No study has been performed investigating the effectiveness of these clinics in podiatric medical residency training. The purpose of this study was to gauge the resident physician-perceived benefit of such a clinic. METHODS: A survey examining aspects of a resident-run clinic and resident clinical performance was distributed to all Doctor of Podiatric Medicine residency programs recognized by the Council on Podiatric Medical Education. To be included, a program must have had a contact e-mail listed in the Central Application Service for Podiatric Residencies residency contact directory; 208 residency programs met the criteria. Statistical analysis was performed using independent-samples t tests or Mann-Whitney U tests and χ2 tests. Significance was set a priori at P < .05. RESULTS: Of 97 residents included, 58 (59.79%) had a resident-run clinic. Of those, 89.66% of residents stated they liked having such a clinic, and 53.85% of those without a resident-run clinic stated they would like to have one. No statistically significant differences were noted between groups in how many patients each resident felt they could manage per hour or regarding their level of confidence in the following clinical scenarios: billing, coding, writing a note, placing orders, conversing with a patient, working with staff, diagnosing and treating basic pathology, and diagnosing and treating unique pathology. CONCLUSIONS: Resident-run clinics provide autonomy and skill development for podiatric medical residents. This preliminary study found there was no difference in resident-perceived benefit of such a clinic. Further research is needed to understand the utility of a resident-run clinic in podiatric medical residency training.

Podiatric Medicine and Surgery Resident-Authored Publications in The Journal of Foot and Ankle Surgery: A Systematic Review.

Since its introduction into the medical community, the Podiatric Medicine and Surgery residency has strived to graduate the most advanced and learned foot and ankle surgeons. From increasing length of training, to assuring didactics and education are sufficiently incorporated into the residency, the Council on Podiatric Medical Education has overseen this transition. One area of interest, podiatric medicine and research, remains central to this training and contributes to the field of foot and ankle surgery through journal publications. The purpose of this review was to identify Podiatric Medicine and Surgery resident-authored publication rates, trends, and geographic distribution. All published case reports, original research articles, review articles, and tips, quips, and pearls in The Journal of Foot and Ankle Surgery from January 2009 to December 2018 were reviewed. Podiatric Medicine and Surgery residents comprised 8% of all authors. Residents contributed to and published as first authors in 22% and 11% of all manuscripts, respectively. An increasing trend in resident authors, resident-authored manuscripts, and resident-first-authored manuscripts was observed. From before the mandated 3-year residency to after, the proportion of resident-authored manuscripts to all manuscripts declined from 9.99% to 7.21%; however, among these resident-authored publications, the rate of first-authorship increased from 45.32% to 51.36%. To the best of our knowledge, this is the first and only study to examine publication rates among foot and ankle surgery residents.

Clinical Teaching Collaborative Program with California School of Podiatric Medicine and the Samuel Merritt University Motion Analysis Research Center.

At Samuel Merritt University (SMU), the California School of Podiatric Medicine (CSPM) collaborates with Motion Analysis Research Center to integrate hands-on quantitative clinical biomechanics research experience into the podiatric medical training program. This partnership provides an active learning environment to demonstrate the importance of critical thinking and evidence-based medicine and to demonstrate the role of research in providing patients with the best treatment options available. This article provides examples of CSPM podiatry students learning through engagement in clinical quantitative biomechanics laboratory sessions and research projects at the SMU Motion Analysis Research Center.

Development and Evaluation of a Surgical Direct Assessment Tool for Resident Training.

In podiatric residency training, minimum activity volume numbers are used to assess surgical competency. The purpose of this study was to develop a standardized direct assessment form as a complement to minimum activity volume numbers. Sixteen attending physicians completed 121 direct assessment forms, evaluating six podiatric medicine and surgery residents. Evaluation scores were highly correlated with residency year. Resident feedback was positive, with the open-response portion identified as especially useful. Although further efforts may help refine this approach, the use of standardized, competency-based direct assessment has the potential to improve the training of podiatric medicine and surgery residents.

The Use of Virtual Reality in Podiatric Medical Education.

Virtual reality in medical education is a recent development that significantly improves surgical skills, which translates to improved outcomes in the operating room (OR). The development of the Western University of Health Sciences virtual OR provides podiatric medical students basic OR knowledge and skills through performing basic surgical procedures. This new method of presenting content in podiatric medical education enhances the learning experience in a less stressful environment. The virtual reality experience allows students to gain experience without undue risk to the patient. Thus students can improve competency while focusing on the experience instead of the potentially overwhelming OR setting.

Effectiveness of the Cadaver Lab in Podiatric Surgery Residency Programs.

Since the inception of the first surgical training system by Sir William Stewart Halsted, resident surgical skill development has been promulgated in teaching hospitals. Currently, the Council on Podiatric Medical Education does not mandate the availability of a cadaver lab as a residency curriculum requirement. The purpose of the present study is to assess the structure of the cadaver lab and availability in the current podiatric surgical training programs. A survey was sent electronically to 229 American Association of Colleges of Podiatric Medicine-approved residency programs, excluding OhioHealth, across all residency programs. A total of 173 (6.9%) residents from 74 (32.3%) residency programs completed the survey. This survey analyzed the characteristics and perception of the current state of cadaver lab in podiatric residency. The most reported type of cadaver labs available were medical company sponsored and hospital sponsored. Other hands-on training, including inanimate simulators (n = 24) and animal models (n = 5), was also reported. Overall, 87.9% of the surveyed residents found that cadaver lab is either extremely beneficial (57.8%) or somewhat beneficial (30.1%). The most important factors perceived in a successful cadaver lab were faculty instruction (n = 78), accessibility of lab (n = 46), and availability of instrumentation/hardware (n = 26). This qualitative survey is the first study to address the uniformity, perception, and potential value of the cadaver lab in a podiatric surgical residency.

Wound healing elective: an opportunity to improve medical education curriculum to better manage the increasing burden of chronic wounds.

Chronic wounds are highly prevalent and have become a public health crisis. Successful treatment of chronic wounds requires that healthcare providers study both the pathophysiology of wound healing and maintain knowledge of the most current wound care guidelines set forth by the Agency for Healthcare Research and Quality. Unfortunately, medical students currently receive limited wound care training. A focused and well-organized course integrating a diverse group of medical and surgical faculty, residents, and medical students in the clinical years has been created to address this growing medical issue. The goal of such curricular innovations is to help future physicians gain exposure to chronic wounds and develop crucial clinical skills so they enter residency prepared to offer basic treatments and prevent rapid deterioration of the many wounds they will encounter.

Lower limb vascular assessment techniques of podiatrists in the United Kingdom: a national survey.

BACKGROUND: Podiatric vascular assessment practices in the United Kingdom (UK) are currently unknown. This study aimed to describe the current practices for performing lower limb vascular assessments by podiatrists in the UK, and, to investigate the effect of practitioner characteristics, including education level and practice setting, on the choice of tests used for these assessments. METHODS: A cross-sectional observational online survey of registered podiatrists in the UK was conducted using SurveyMonkey® between 1st of July and 5th of October 2018. Item content related to: practitioner characteristics, vascular testing methods, barriers to completing vascular assessment, interpretation of vascular assessment techniques, education provision and ongoing management and referral pathways. Descriptive statistics were performed, and multinomial logistic regression analyses were used to determine whether practitioner characteristics could predict the choice of vascular tests used. RESULTS: Five hundred and eighty five participants accessed the online survey. After drop-outs and exclusions, 307 participants were included in the analyses. Comprehensive vascular assessments had most commonly been performed once (15.8%) or twice (10.4%) in the past week. The most common indicators for performing vascular assessment were symptoms of suspected claudication (89.3%), suspected rest pain (86.0%) and history of diabetes (85.3%). The most common barrier to performing vascular assessment was time constraints (52.4%). Doppler examination (72.3%) was the most frequently reported assessment type, with ankle-brachial index (31.9%) and toe brachial index (5.9%) less frequently performed. There were variable interpretations of vascular test results. The most common topic for education was smoking cessation (69.5%). Most participants (72.2%) were confident in determining ongoing management, with the majority referring to the patient's general practitioner (67.6%). Practitioner characteristics did not predict the types of vascular tests performed. CONCLUSION: The majority of vascular assessments currently performed by podiatrists in the UK are inconsistent with UK or international vascular guidelines and recommendations. Despite this, most podiatrists felt confident in diagnosing, referring and managing patients with peripheral arterial disease (PAD), however many felt they needed more education to feel confident to assist patients with PAD to manage their cardiovascular risk factors.

An Evaluation of Off-Service Rotations in Podiatric Medicine and Surgery Residency Training.

Residency training in podiatric medicine and surgery includes 3years of comprehensive training. Complementing their podiatric medicine and surgery training, residents complete a series of required nonpodiatric, or off-service, rotations in a range of specialties. However, there has been a lack of formal investigation of these off-service rotation experiences. An online survey was developed and distributed to both program directors and residents nationwide. The survey instrument covered various aspects of off-service rotations, including rotation value, length, goals and objectives, activities, feedback, and resident satisfaction. In total, 122 of 222 directors responded and 151 of 243 residents responded. Resident responses reflected the impact of podiatric responsibilities during off-service rotations and the importance of hands-on, interactive, and dedicated learning opportunities during these rotations. Both similarities and differences were appreciated with regard to perceived rotation value between resident and director perspectives. Perceived satisfaction of certain rotations was correlated with rotation length, feedback, specific rotation activities, and whether residents received goals and objectives. Though perhaps neglected, the off-service rotation experience is an important part of the podiatric medical and surgical residency experience. Considering the perspectives of both directors and residents can be helpful in directing these experiences and in considering future changes.

The podiatric surgery theatre environment in the UK; is it conducive to learning? A quantitative study using the surgical theatre educational environment measure (STEEM).

BACKGROUND: In 2015 the Health and Care Professions Council (HCPC) reported that annotation of the register for podiatric surgery would improve the way in which risks are currently managed. The academic institutions provide the teaching environment for the 'learnt' Diploma in principles of podiatric surgery however the podiatric surgery departments facilitate the production of the next generation of podiatric surgeons. This research aimed to identify the major elements that contribute to the educational environment, and find and utilise a valid assessment tool which could identify discrete areas to be targeted for improvement as well as being used for monitoring of the environment. METHODS: A quantitative study using the Surgical Theatre Educational Environment Measure (STEEM) via an online tool was utilised for podiatrists working within podiatric surgery, podiatric surgical trainees and podiatric surgeons working towards the Certificate of Completion of Podiatric Surgery Training (CCPST) with a view to assessing the educational environment within the podiatric surgical theatre in the UK. RESULTS: 16/33 responses with a response rate of 48.4% the overall STEEM mean score was 122/160. Four subscales included teaching and training, learning opportunities, atmosphere, and workload/supervision/support were measured. The overall mean score of 76.73% suggests the learning environment may be considered satisfactory; however, areas for potential improvement are identifiable. Results reveal strengths such as a non-discriminatory surgical theatre atmosphere on racial grounds. CONCLUSIONS: Perception was of a very satisfactory 'Atmosphere' within the theatre environment and a very satisfactory 'opportunity to assist' within the podiatric surgery theatre environment. The STEEM has potential to be applied further as a quality assessment tool whose results could be used to demonstrate part of the HCPC standards.

Fourth-Year Podiatric Medical Student Perspectives on Clerkships and Residency Selection.

BACKGROUND: The fourth year of podiatric medical school is an important period in the education of the podiatric medical student, a period that consists largely of month-long clerkships. Nonetheless, there has been limited formal study of the quality of learning experiences during this period. Furthermore, there is limited knowledge of how podiatric medical students evaluate residency programs during clerkships. METHODS: An online survey was developed and distributed electronically to fourth-year podiatric medical school students. The focus of the survey was the quality of learning experiences during externships, and decision making in ranking residency programs. RESULTS: The most valuable learning experiences during clerkships were interactions with attending physicians, interactions with residents, and general feedback in surgery. Students self-identified that they most improved in the following areas during clerkships: forefoot surgery, clinical podiatry skills, and rearfoot surgery. The areas in which students improved the least were research, pediatrics, and practice management. The three most important factors students considered as they created their rank list were hands-on resident participation in surgical training, the attitude and personality of the residents, and the attitude and personality of the attending physicians. A range of surgical interest was identified among students, and students lacking in surgical interest self-reported less improvement in various surgical topics. CONCLUSIONS: The perspectives of fourth-year podiatric medical students are currently an underused resource. Improved understanding can help residency programs improve the quality of associated learning experiences and can make their programs more appealing to potential residency candidates.

Podiatric Adverse Events and Foot Care in Cancer Patients and Survivors Awareness, Education, and Literature Review.

Cancer is one of the leading causes of mortality and morbidity worldwide. Recent improved therapies have resulted in more patients surviving cancer and living longer. Despite these advances, the majority of patients will develop adverse events from anticancer therapies. Foot alterations, including nail toxicities, hand-foot syndrome, edema, xerosis, hyperkeratosis, and neuropathy, are frequent among cancer patients. These untoward conditions may negatively impact quality of life, and in some cases may result in the interruption or discontinuation of cancer treatments. Appropriate prevention, diagnosis, and management of podiatric adverse events are essential to maintain foot function and health-related quality of life, both of which are critical for the care of cancer patients and survivors. This article shows results related to complaint and impact on quality of life of the Oncology Foot Care program and reviews publications specific to podiatric adverse events related to cancer treatments.

The Perception of the Scope of Practice of Podiatric Medicine in a Large Teaching Hospital Demonstrated by Internal Medicine Residents and Patients.

BACKGROUND:: The scope of podiatric practice has changed significantly in the past couple of decades. Despite the increased quality of training, many people outside of podiatry may not realize what our scope of practice entails. METHODS:: We conducted a survey consisting of 10 items and asked internal medicine residents at Rush University Medical Center and patients whether they would feel comfortable consulting podiatrists, or being treated for each issue. RESULTS:: The results for residents are as follows: 1) toenail fungus, 35% yes and 65% no; 2) diabetic wound care, 87.5% yes and 12.5% no; 3) bunion surgery, 90% yes and 10% no; 4) ankle fracture surgery, 25% yes and 75% no; 5) calcaneal fracture surgery, 50% yes and 50% no; 6) tarsal tunnel nerve surgery, 62.5% yes and 37.5% no; 7) lower extremity arterial bypass, 5% yes and 95% no; 8) below-knee amputation, 5% yes and 95% no; 9) transmetatarsal amputation, 67.5% yes and 32.5% no; and 10) venous stasis wound care, 65% yes and 35% no. The results for patients are as follows: 1) toenail fungus, 72.5% yes and 27.5% no; 2) diabetic wound care, 70% yes and 30% no; 3) bunion surgery, 62.5% yes and 37.5% no; 4) ankle fracture surgery, 57.5% yes and 42.5% no; 5) calcaneal fracture surgery, 55% yes and 45% no; 6) tarsal tunnel nerve surgery, 50% yes and 50% no; 7) lower extremity arterial bypass, 32.5% yes and 67.5% no; 8) below-knee amputation, 27.5% yes and 72.5% no; 9) transmetatarsal amputation, 52.5% yes and 47.5% no; and 10) venous stasis wound care, 32.5% yes and 67.5% no. CONCLUSIONS:: Internal medicine residents and patients do not have an accurate perception of the scope of podiatric medicine. This proves that, as a profession, we need to raise awareness about what the podiatric scope of medicine actually entails.

Transitioning From a Level II to Level I Trauma Center Increases Resident Patient Exposure.

Increased patient exposure has been shown to improve residency training as determined by better patient outcomes. The transition of John Peter Smith Hospital from a level II to a level I trauma center in 2009 provided a unique opportunity to investigate the direct effects of increased patient exposure on residency training in a relatively controlled setting. We evaluated the effect of the transition to a level I trauma center on residency training. In 2014, we examined the annual facility reports and separated the data into 2 groups: level II (2001 to 2008) and level I (2010 to 2013). The primary outcome measures were patient volume, surgical volume, patient acuity, and scholarly activity by the residents. The patient volume in all units increased significantly (p < .05 for all) after the transition to a level I center. The surgical volume increased significantly for the general surgery, orthopedics, and podiatry departments (p < .05 for all) but remained unchanged in the gynecology and oral maxillofacial surgery departments. The volume measures were performed on all 98 residents (100%). Patient acuity and scholarly activity increased by 17% and 52%, respectively; however, the differences in these data were not statistically significant. The scholarly activity per resident was measured for the orthopedic and podiatry departments. For those departments, the total number of residents was 30, and scholarly activity was measured for 100% of them. Overall, resident education improved when the hospital transitioned to a level I trauma center, although certain subspecialties benefited more than did others from this transition.

What Is the Current Role and Factors for Success of the Journal Club in Podiatric Foot and Ankle Surgery Residency Training Programs?

The journal club (JC) is a traditional part of postgraduate medical education, although little has been written on its current role in podiatric surgical training programs. The goal of the present study was to determine how JCs are conducted and the factors associated with their success. Anonymous electronic surveys were distributed to all podiatric foot and ankle surgical training program directors in the United States with a valid e-mail address. A total of 202 surveys were initially e-mailed to training program directors, with a second and third round sent to those who did not respond. The eventual response rate was 47.5%. The variables associated with success included high faculty attendance, dissemination of articles in advance, and regularly scheduled meetings. Of the residency programs that responded, 39.0% provided some type of handout or supplemental session and 39.8% provided supplemental session or handouts regarding the process of critical review, epidemiology, or biostatistics. A structured review instrument or checklist was used to guide critical appraisal in 21.5% of the JCs, and 11.8% of the programs provided feedback to residents. The JC was perceived by residency directors to be valuable and worthy of maintaining. Residency directors perceived the following factors to be associated with a successful JC: faculty participation, a designated leader, mandatory attendance, dissemination of materials in advance, and regularly scheduled meetings. Areas cited for improvement included implementation of a structured review instrument, delineation of clear goals, and periodic evaluation. We believe these findings could aid residency directors interested in maximizing the educational benefits of their JC.

A randomised controlled trial of sensory awareness training and additional motor practice for learning scalpel skills in podiatry students.

BACKGROUND: The process of using a scalpel, like all other motor activities, is dependent upon the successful integration of afferent (sensory), cognitive and efferent (motor) processes. During learning of these skills, even if motor practice is carefully monitored there is still an inherent risk involved. It is also possible that this strategy could reinforce high levels of anxiety experienced by the student and affect student self-efficacy, causing detrimental effects on motor learning. An alternative training strategy could be through targeting sensory rather than motor processes. METHODS: Second year podiatry students who were about to commence learning scalpel skills were recruited. Participants were randomly allocated into sensory awareness training (Sensory), additional motor practice (Motor) or usual teaching only (Control) groups. Participants were then evaluated on psychological measures (Intrinsic Motivation Inventory) and dexterity measures (Purdue Pegboard, Grooved Pegboard Test and a grip-lift task). RESULTS: A total of 44 participants were included in the study. There were no baseline differences or significant differences between the three groups over time on the Perceived Competence, Effort/ Importance or Pressure/ Tension, psychological measures. All groups showed a significant increase in Perceived Competence over time (F1,41 = 13.796, p = 0.001). Only one variable for the grip-lift task (Preload Duration for the non-dominant hand) showed a significant difference over time between the groups (F2,41 = 3.280, p = 0.038), specifically, Motor and Control groups. CONCLUSIONS: The use of sensory awareness training, or additional motor practice did not provide a more effective alternative compared with usual teaching. Further research may be warranted using more engaged training, provision of supervision and greater participant numbers. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12616001428459 . Registered 13th October 2016. Registered Retrospectively.