Becoming a podiatrist: an exploration of the practices and processes which underpin the acquisition of a professional identity.

BACKGROUND: Undergraduate podiatry degrees are designed to enable students to become professional podiatrists. To be successful students must manage academic and practical activity to ultimately acquire a professional identity. Little is known about the practices and processes which underpin the acquisition of a professional podiatry identity. It is the aim of this paper to begin to address this absence of knowledge. Community of Practice theory, arguably the dominant contemporary learning theory, represents identity shift as an interaction of imagination, engagement and alignment which enables students to successfully participate in higher education, and ultimately, the professional context. This success is underpinned through assisting students to develop an enabling identity in their learning and doing. METHODS: Here we present findings that emerged from a yearlong ethnography in a successful higher education podiatry department. The project followed students and staff in the classroom and the clinic and explored their experiences through interviews. RESULTS: The findings suggest that the journey to professional identity is facilitated through meaningful learning relationships between staff and students and clarity around professional practices. Here we discuss how those relationships form and enable undergraduates to become podiatrists. CONCLUSIONS: Our findings offer a model for the transition from student to professional and highlight the importance of relationship and experience in becoming a podiatrist. There is a paucity of research around not only podiatry but also other allied health professions around this topic and given the increasing emphasis around employability skills in HE, more research in a range of contexts is needed.

Independent prescribing in the UK: insights from the Department of Health Allied Health Professions Medicines Project team.

BACKGROUND: The UK medicines legislation was amended ten years ago (2013) to allow podiatrists and physiotherapists independent prescribing rights, the first of the allied health professions to do so. Non-medical prescribing formed one part of a broader policy agenda promoting role flexibility in response to the challenge of an ageing population and the need to maintain effective health provision in the face of a contracting workforce. AIM: The aim of this study was to outline the experiences of the Department of Health AHP medicines project board team in working towards independent prescribing for podiatry and physiotherapy, with a particular focus on the challenges encountered. METHODS: In depth, open-ended interviews were conducted with eight of the core members of the project team, drawn from those individuals who served throughout the duration of the project (2010-2013). Included were the former Department of Health Chief and Deputy Chief Allied Health Professions Officers; the Department of Health Engagement and Communications Officer; representatives of the Health and Care Professions Council; the Medicines and Healthcare products Regulatory Agency; the Council of Deans of Health; the Royal College of Podiatry and the Chartered Society of Physiotherapy (The team also included the representative of the Allied Health Professions Federation. However, as that representative is also a researcher in this study, he has recused himself from any role as a participant.). Data were transcribed and subject to a thematic analysis. RESULTS: A complex picture of the project emerged revealing a range of obstacles and challenges, including inter-professional role boundary tensions and negative prior assumptions about the two professions. Success hinged upon the adoption of a dual strategy involving submission of a robust case of need focused on patient benefit coupled with the careful management of professional expectations. Underpinning theory from the sociology of the professions offers a supportive explanatory framework for understanding the relationships between the various stakeholders involved. CONCLUSIONS: Ultimately, success depended upon aligning the project aims with healthcare policy through a clear focus on patient benefit. Balancing competing professional and policy demands through a continual emphasis on improved patient care laid the foundations for future projects by other allied health professions.

2012 financial outlook: physicians and podiatrists.

Although the nationally unadjusted average Medicare allowable rates have not increased or decreased significantly, the new codes, the new coding regulations, the NCCI edits, and the Medicare contractors' local coverage determinations (LCDs) will greatly impact physicians' and podiatrists' revenue in 2012. Therefore, every wound care physician and podiatrist should take the time to update their charge sheets and their data entry systems with correct codes, units, and appropriate charges (that account for all the resources needed to perform each service or procedure). They should carefully read the LCDs that are pertinent to the work they perform. If the LCDs contain language that is unclear or incorrect, physicians and podiatrists should contact the Medicare contractor medical director and request a revision through the LCD Reconsideration Process. Medicare has stabilized the MPFS allowable rates for 2012-now physicians and podiatrists must do their part to implement the new coding, payment, and coverage regulations. To be sure that the entire revenue process is working properly, physicians and podiatrists should conduct quarterly, if not monthly, audits of their revenue cycle. Healthcare providers will maintain a healthy revenue cycle by conducting internal audits before outside auditors conduct audits that result in repayments that could have been prevented.

A conceptual framework for contemporary professional foot care practice: ''The value based digital foot care framework''.

BACKGROUND: A small minority of countries around the globe have podiatry as a recognized profession, hence, there are considerable differences among these countries when it comes to the curricula, the duration of training and legislation regulating the profession. The growth in research led evidence based practice, and the emerging digital landscape of health care practice, occur alongside trends in disease and health behaviours that strongly impact on foot health. As such, the changing complex role of the podiatrist requires critical reflection on current frameworks of practice and whether they are fit for purpose. This commentary presents a conceptual framework which sets the scene for further development of concepts in a podiatry context, reflecting contemporary health care beliefs and the changing expectations of health care and society. The proposed conceptual framework for podiatry practice utilizes the metaphor of an electronic circuit to reflect the vast and complex interconnections between factors that affect practice and professional behaviours. The framework helps in portraying and defining drivers of practice, actual practice as well potential barriers for current and future practice. The circuit emphasis the interconnectedness/interaction of three clusters: 1) internal factors, 2) interaction factors, 3) external factors. CONCLUSION: Whatever promise this new framework holds, it will only be realised through conscious development of community consensus, respectful dialogue, constructive critical appraisal, and maintaining passion and focus on improving the health of people with foot related problems.

Attrition in Podiatric Medicine and Surgery Residency.

BACKGROUND: The objective of this study was to investigate the rate of attrition within podiatric medicine and surgery residency training programs. METHODS: Between the academic years 2006-2007 and 2015-2016, the Temple University School of Podiatric Medicine matched 780 graduates into 163 different residency training programs. Program directors from these sites were individually contacted by e-mail and asked whether the specific Temple University School of Podiatric Medicine graduates who originally matched with their program 1) completed the program, 2) transferred to another program, 3) quit the program, or 4) were fired from the program. RESULTS: Results were returned with respect to 614 (78.7%) of the 780 graduates, representing 103 (63.2%) of the 163 training programs. Program directors reported that 573 (93.3%) of the 614 graduates completed the program, 17 (2.8%) transferred from the program, six (1.0%) quit the program, five (0.8%) were fired by the program, and 13 (2.1%) matched but never started the program. This equates to an annual attrition rate of 0.46% for residents who started the podiatric residency training program that they matched with. CONCLUSIONS: We conclude that the rate of attrition in podiatric medicine and surgery residency training appears to be relatively low or at least in line with other medical specialties, and hope that this information leads to other investigations examining attrition, specifically as it relates to physician-specific and program-specific risk factors for attrition.

Women in Podiatry and Medicine.

The role of female physicians has advanced among western medicine. Women now constitute a majority within medical schools, and the number of women in podiatric medicine and surgery has increased over the last 5 decades. Conversely, female physicians continue to face barriers to closing the gender gap. They have lower academic standings and fewer publications, receive less awards/grants, are underrepresented in leadership positions, have a lower incidence pursuing surgical specialties, and receive lower compensation. Women experience an increased rate of burnout, gender discrimination, and sexual harassment. Increasing awareness of the gender gap is vital to the enhancement of the medical community.

Projections of the supply of and demand for podiatric physicians in the United States, 2005 to 2030.

BACKGROUND: An unanticipated decrease in applications to podiatric medical schools in the late 1990s has resulted in a decline in the number of podiatric physicians per capita in the United States. This study explores the implications of five possible scenarios for addressing this decline. METHODS: With the help of an advisory committee and data from the American Podiatric Medical Association, projections of the supply of podiatric physicians were developed using five different scenarios of the future. Projections of several factors related to the demand for podiatric physicians were also developed based on a review of the literature. RESULTS: The projections reveal that unless the number of graduations of new podiatric physicians increases dramatically, the supply will not keep up with the increasing demand for their services. CONCLUSION: The growing supply-demand gap revealed by this study will be an important challenge for the podiatric medical profession to overcome during the next couple of decades.

2007 podiatric practice survey: statistical results.

This report presents the results of the 2007 Podiatric Practice Survey conducted from April to May 2007 by the American Podiatric Medical Association. A total of 3,043 members responded to this survey.

A train-the-trainer model for integrating evidence-based medicine training into podiatric medical education.

This article presents the development, implementation, and evaluation of a national evidence-based medicine faculty-development program for podiatric medical educators. Ten faculty members representing six accredited colleges of podiatric medicine, one podiatric medical residency program, and a Veterans Affairs podiatry service participated in a 2-day workshop, which included facilitated discussions, minilectures, hands-on exercises, implementation planning, and support after the workshop. Participants' evidence-based medicine skills were measured by retrospective self-reported ratings before and after the workshop. Participants also reported their implementation of "commitments to change" on follow-up surveys at 3 and 12 months. Participants' evidence-based medicine practice and teaching skills improved after the intervention. They listed a total of 84 commitments to change, most of which related to the program objectives. By 12 months after the workshop, participants as a group had fully implemented 24 commitments (32%), partially implemented 36 (48%), and failed to implement 15 (20%) of a total of 75 commitments with follow-up data. The most common barriers to change at 12 months were insufficient resources, systems problems, and short patient visit times. A train-the-trainer faculty-development program can improve self-reported evidence-based medicine skills and behaviors and affect curriculum reform at podiatric medical educational institutions.

Evidence-Based Approach to Advanced Wound Care Products.

There is increasing pressure from industry to use advanced wound care products and technologies. Many are very expensive but promise to reduce overall costs associated with wound care. Compelling anecdotal evidence is provided that inevitably shows wounds that failed all other treatments but responded positively to the subject product. Evidence-based medicine is the standard by which physician-scientists must make their clinical care decisions. In an attempt to provide policy makers with the most current evidence on advanced wound care products, the Department of Veteran Affairs conducted an Evidence-based Synthesis Program review of advanced wound care products. This paper suggests how to take this information and apply it to policy to drive evidence-based care to improve outcomes and fiduciary responsibility.

The role of podiatric medicine in the health-care team. A paradigm shift.

As physicians, podiatric medical doctors should not define themselves as medical professionals who treat the foot and ankle but rather as medical professionals who prevent, diagnose, and treat people who have foot and ankle problems. Patients who come to see podiatric physicians often have other health-care issues, and because of the education and training that doctors of podiatric medicine receive, they are uniquely qualified to identify and respond to findings not only related to the pedal extremity but also that may affect overall health, have a major effect on quality of life, and even help reduce overall health-care costs. The role of podiatric medicine as a truly integrated branch of medical care needs to be reassessed.

Surgery by non-surgeons: podiatric surgery in Connecticut.

In order to determine the standards for credentialing, privilege delineation, and quality assurance of podiatric surgery in Connecticut, a questionnaire was mailed to all acute care hospitals, with a 100% institutional response. Of 38 hospitals, 25 currently have granted clinical privileges to podiatrists. Full podiatric surgical programs exist in 12 hospitals; multitiered privileges in seven hospitals differentiate podiatrists with and without postgraduate surgical residency training. Credentialing, privilege delineation, and quality assurance generally is conducted through the chief of surgery or chief of orthopedics, with participation of staff podiatrists. Based on the Connecticut experience, recommendations are made regarding establishment of new podiatric surgical programs.

The representation of Hispanics in the health professions.

Hispanics are the country's second largest and fastest growing minority group. This investigation was conducted to review the preprofessional educational experience of Hispanics as well as their representation in the nation's schools of health professions. Findings revealed that Hispanics are the most undereducated major segment of the US population. The majority of all young Hispanics (60% to 75%) do not attend college at all and of those who do attend, less than 10% graduate. Deliberate policy decisions and a concerted national effort to recruit and train minority students in the health professions has resulted in a significant increase in the number of minority health professionals practicing in our country. However, available data clearly point to an underrepresentation of Hispanics in most of the health professions.