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The basic principles of a single-lobe flap are discussed along with the description of a modified slide-swing rotational flap. This rotation flap is called the Schrudde flap, and it has many applications in the treatment of skin defects of the foot and ankle. This rotation skin flap procedure provides excellent end results with high patient acceptance.
Over the past decade, the evaluation of teaching has increased in importance in US medical schools. In this review, research on student ratings, teaching portfolios, and peer review of teaching is presented in the context of instructional scholarship. Five principles for designing a comprehensive system to evaluate teaching are discussed, along with the impact of such systems on teaching improvement and academic promotions.
Professional competence evaluation should involve attention to its intellectual and social context, and not just worry about technical fine points. The author frames professional competence evaluation broadly, containing sections on social issues, conceptual problems, and technical matters. The author uses illustrations from podiatric medicine and from other professions that have similar concerns about the evaluation of practitioner competence. Several suggestions are given for improving evaluating practices.
Background: Student self-assessment is viewed as an important tool in medical education. We sought to identify the relationship between student academic performance and third-year clinical performance self-assessment. No such study exists in podiatric medical education.
Methods: Third-year podiatric medical students from the classes of 2012 through 2014 completed a self-assessment of their performance for each of five broad clinical podiatric medical domains (Professionalism, Medicine, Radiology, Surgery, and Biomechanics/Orthopedics). The assessment was completed after students finished the first 12 weeks of their third-year clinical rotations (PRE) and a second time at the conclusion of the third year (POST). The mean self-assessment score for PRE and POST surveys for all combined domains was determined for each student. This mean was compared with the student's 3-year cumulative grade point average (GPA). Students' clinical experiences for the year were essentially identical.
Results: No statistically significant correlation was identified between cumulative GPA and the PRE and POST clinical self-assessments or with the change between PRE and POST assessments based on the Pearson correlation test for each class separately or on the pooled data.
Conclusions: Published studies in allopathic medical education have shown that students with lower GPAs tend to rate their clinical performance higher in initial clinical performance self-assessment. Our results show that student academic performance was not correlated with clinical performance self-assessment. These findings may be due to the explicit description of successful clinical competency completion, the orientation students receive before the start of clinical training, and the continuous feedback received from clinical preceptors.
Background:
In this explorative study, we assessed the effect and feasibility of using motivational interviewing to improve footwear adherence in persons with diabetes who are at high risk for foot ulceration and show low adherence to wearing prescribed custom-made footwear.
Methods:
Thirteen individuals with diabetes, ulcer history, and low footwear adherence (ie, <80% of steps taken in prescription footwear) were randomly assigned to standard education (ie, verbal and written instructions) or to standard education plus two 45-min sessions of motivational interviewing. Adherence was objectively measured over 7 days using ankle- and shoe-worn sensors and was calculated as the percentage of total steps that prescribed footwear was worn. Adherence was assessed at home and away from home at baseline and 1 week and 3 months after the intervention. Feasibility was assessed for interviewer proficiency to apply motivational interviewing and for protocol executability.
Results:
Median (range) baseline, 1-week, and 3-month adherence at home was 49% (6%–63%), 84% (5%–98%), and 40% (4%–80%), respectively, in the motivational interviewing group and 35% (13%–64%), 33% (15%–55%), and 31% (3%–66%), respectively, in the standard education group. Baseline, 1-week, and 3-month adherence away from home was 91% (79%–100%), 97% (62%–99%) and 92% (86%–98%), respectively, in the motivational interviewing group and 78% (32%–97%), 91% (28%–98%), and 93% (57%–100%), respectively, in the standard education group. None of the differences were statistically significant. Interviewer proficiency was good, and the protocol could be successfully executed in the given time frame.
Conclusions:
Footwear adherence at home increases 1 week after motivational interviewing to clinically relevant but not statistically significant levels (ie, 80%) but then returns over time to baseline levels. Away from home, adherence is already sufficient at baseline and remains so over time. The use of motivational interviewing seems feasible for the given purpose and patient group. These findings provide input to larger trials and provisionally suggest that additional or adjunctive therapy may be needed to better preserve adherence.
Podiatric Medical Students’ Perceptions of Professionalism in the Clinical Setting
A Qualitative Analysis
Background:
The teaching and assessment of professionalism have become central areas of research and practice in medicine and in allopathic and osteopathic undergraduate and graduate medical education generally. In contrast, discussion of professionalism as it relates to podiatric medical education is nearly nonexistent in the literature.
Methods:
A study of podiatric medical students’ perceptions of professionalism-related issues in the clinical setting was performed using a qualitative analysis. A written survey was sent to 88 students who had recently completed their clinical training experiences. The survey was completed anonymously, and all identifying information was redacted before analysis of the data, which was performed using thematic content analysis with constant comparative analysis. In addition, basic demographic information was acquired as part of the data collection process.
Results:
Sixty-six students (75%) responded and agreed to participate in the survey. Students provided written reports of lapses in professional behavior that they had witnessed, heard about, or been personally involved in performing. The study confirmed that podiatric medical students had experienced various types of professional lapses in behavior, and six predominant themes were identified.
Conclusions:
This study, which was performed with a selected group of individuals at a single institution, serves as an initial assessment of the needs of podiatric medical students and will be useful for developing professionalism-related instructional activities that could benefit students in the future. (J Am Podiatr Med Assoc 102(6): 434–445, 2012)
Background:
This study sought to identify the nature and extent of diabetes-related knowledge and self-care practices in people living with type 2 diabetes who attend primary-care clinics and to determine whether a correlation between the two exists.
Methods:
In a nonexperimental prospective study, the Diabetes Knowledge Questionnaire and the Summary of Diabetes Self-care Activities were used to assess knowledge and self-management in 50 patients.
Results:
The mean diabetes knowledge score was 14.40 out of a total of 24 and the mean self-care activities score was 2.89 out of a total of 7, indicating a deficit in a number of key areas in the management of diabetes. There was no statistically significant correlation between diabetes knowledge score and diabetes self-care activities (r = 0.190, P = 0.187). On analysis of the individual subscales, a significant relationship resulted between diabetes knowledge score and diet (r = 0.324, P = 0.022) but physical activity (r = 0.179, P = 0.214), blood sugar testing (r = 0.231, P = 0.107) and footcare (r = 0.189, P = 0.189) gave no significant results. On further analysis, education level was significantly correlated to diabetes knowledge score (r = 0.374, P = 0.007) and self-care activities score (r = 0.317, P = 0.025) while age was significantly correlated to diabetes knowledge score (P = 0.008) and self-care activities score (P = 0.035).
Conclusions:
Integrating theories of behavior change into educational interventions at the primary-care level may translate to improved care, reduced long-term complications, and better quality of life.
This paper presents a selection of Internet resources covering most of the subject areas found in standard medical education curricula. Basic sciences sites are emphasized, but clinical resources are also included. Reported sites were judged based on their potential to enhance the learning process, provide practice questions or study guides for examinations, or aid in the preparation of papers. In addition to podiatric medical students, residents and practitioners who require a quick reference source to either the basic science foundations of podiatric medicine or the clinical side of podiatric practice may find this paper useful. (J Am Podiatr Med Assoc 91(6): 316-323, 2001)
A review of 12 cases of bony tumors involving the talus is presented. Giant cell tumor was the most common tumor. Malignant tumors should be treated by surgical ablation followed by chemotherapy. There are good results after excision or curettage and bone grafting in the treatment of benign neoplasms. Giant cell tumors, if diagnosed early, can be treated by curettage and bone grafting, but if there is talar collapse, a talectomy can be performed.
Background:
Studies have established a positive association between peripheral neuropathy and diabetes mellitus. The purpose of the present investigation is to determine the predictor variables for demographic characteristics of individuals with diabetes mellitus and peripheral neuropathy.
Methods:
Frequency and χ2 statistic analyses were conducted on the data to determine significance of predictor variables.
Results:
Among individuals with and without diabetes mellitus, men are more at risk to develop complications related to peripheral neuropathy, such as foot insensate areas and numbness in extremities. Diabetic individuals older than 61 years are at higher risk than other age groups. Among diabetic patients with peripheral neuropathy, women are more likely to have emotional disorders such as panic, anxiety disorder, and depression than men of the same age or younger.
Conclusions:
Predictor variables will assist clinicians in better diagnosing peripheral neuropathy, contributing to more effective treatments and shortening of healing time. Diagnostic measures to be taken into consideration include race, age, education, marital status, duration of diabetes mellitus, numbness in hands or feet, participation in moderate physical activity, and use of tobacco. (J Am Podiatr Med Assoc 103(5): 355–360, 2013)
