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Attrition from medical school remains a serious cause of concern for the medical education community. Thus, there is a need to improve our ability to select only those candidates who will succeed at medical school from many highly qualified and motivated applicants. This can be achieved, in part, by reducing the reliance on cognitive factors and increasing the use of noncognitive character traits in high-stakes admissions decisions. Herein we describe an analytic rubric that combines research-derived predictors of medical school success to generate a composite score for use in admissions decisions. The analytic rubric as described herein represents a significant step toward evidenced-based admissions that will facilitate a more consistent and transparent qualitative evaluation of medical school applicants beyond their grades and Medical College Admissions Test scores and contribute to a redesigned and improved admissions process.
Internet Resources for Podiatric Medical Students
A Second Update
In this article, we present a selection of Internet resources covering subject areas found in standard medical education curricula. Basic sciences and clinical resource sites are explored. We also review Web sites that offer useful materials that can be downloaded to handheld devices such as palmtop computers, smartphones, and portable media players. We judged the sites based on their potential to enhance the learning process, provide practice questions or study guides for examinations, or aid in the preparation of manuscripts. Medical students, residents, educators, and practitioners of podiatric medicine and surgery who require a quick reference source to either the basic science foundations of podiatric medicine or the clinical side of basic medicine, may find this paper useful. (J Am Podiatr Med Assoc 97(6): 486–492, 2007)
Background
The opioid epidemic has hit disastrous levels across the United States. Many attempts have been made to counteract this, including policy changes and modification of provider and patient behavior. The purpose of this study was to understand the current state of podiatric residents' knowledge regarding pain management and addiction.
Methods
This study used mixed quantitative-qualitative methods. Two focus groups were conducted with two podiatric residency programs to understand current issues and inform the creation of a survey. A 30-question survey was created and peer reviewed to assess general pain management knowledge, levels of confidence in pain management and addiction, and areas for improvement.
Results
Pain management education in podiatry is mainly focused on opioids. These concepts are often taught in a nonstandardized method, which does not often include nonopioid alternatives. Knowledge of risk factors for addiction was lacking, whereas knowledge of behaviors concerning for addiction was more bountiful. Thirty-three surveys were completed of a possible 39. A knowledge score was created from eight survey questions for a total of 10 points, with an average score of 4.61. There was no statistical difference between those with and without a pain management rotation. Nearly all residents felt comfortable managing surgical pain. The residents are “never” or “only occasionally” inquiring about risk factors for addiction. Questions asked also suggest that the residents are not thinking about their role within the opioid epidemic.
Conclusions
As the opioid epidemic grows, it is imperative to examine the causes and solutions to the problem. Focusing efforts on educating resident physicians is one method to address the issue. The results of this study show that pain management basics need to be reinforced and more time must be spent emphasizing the importance of thorough patient histories and educating patients when prescribing pain medication.
Sea urchin spine injuries have been reported in the hand and foot, but there are no published cases in the Achilles tendon. We report an unusual case of Achilles tendinopathy secondary to sea urchin spine injury. The patient had Achilles tendon pain that increased over time and was worsened with weightbearing activity. His left ankle plantarflexion was limited by pain. He had received medical care 3 months earlier to remove sea urchin spines after stepping on a long-spined sea urchin. Bedside ultrasound and imaging studies revealed that there were foreign bodies related to sea urchin spines on the surface of the tendon. The patient was given education about proper footwear and activity modification. His symptoms resolved over time, and he avoided surgical intervention.
Background
We sought to assess the perceptions that podiatric medical students had of the use of simulators after completing a third-year simulation rotation. This type of analysis has not been reported in the podiatric medicine educational literature. Another goal of this study was to influence the podiatric medical community to increase studies that help demonstrate the effectiveness of simulation in the podiatric medical curriculum.
Methods
Data from rotation evaluations of 44 students from the 2011-2012 academic year included student responses to 11 quantitative items and textual analysis of the students' written comments. Basic descriptive statistics of student responses to the quantitative items allowed for the analysis of central tendencies and variations. Textual analysis was performed on comments that were coded into themes based on similar properties and characteristics that the comments shared.
Results
The analysis revealed that the simulation sessions were well liked. All of the students who responded to the survey rated the overall simulation rotation as “superior.” Textual analysis of the students' comments showed that students enjoy simulation as an educational tool because it helps enhance their clinical skills while also applying their didactic education to a practical experience. Clear evidence was presented that students want more cases and time to spend in the simulation laboratory to continue increasing their medical skills.
Conclusions
The student perception of simulation is that it is an effective educational tool. Further testing is needed to prove simulation efficacy in a podiatric medical curriculum.
Foot Problems in Older Patients
A Focused Podogeriatric Assessment Study in Ambulatory Care
This study sought to demonstrate the prevalence of foot conditions in older individuals and their association with chronic risk diseases such as diabetes mellitus, peripheral arterial disease, and arthritis, and to develop care plans to reduce complications from local foot problems and chronic diseases. One thousand individuals older than 65 years who were ambulatory and not institutionalized underwent a standardized and validated podogeriatric examination assessment protocol or index. Overall, 74.6% of all patients had a history of pain, 57.2% were receiving current care for diabetes mellitus, 22.9% indicated current care for peripheral vascular disease, 94.2% had onychodystrophy, 64.2% had one or more foot deformities, 64.0% demonstrated some loss of protective sensation, and 81.7% had one or more symptoms and signs of peripheral arterial insufficiency. These findings demonstrate that foot problems in the older population result from disease, disability, and deformity related to multiple chronic diseases as well as changes associated with repetitive use and trauma. Older people are at a high risk of developing foot-related disease and should receive continuing foot assessment, education, surveillance, and care. (J Am Podiatr Med Assoc 94(3): 293–304, 2004)
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.
Double Crush Syndrome in the Lower Extremity
A Case Report
Upton and McComas first described double crush syndrome in 1973. The theory behind double crush syndrome postulated that a proximal lesion in a nerve would make that same nerve more vulnerable to additional distal lesions. Many of the studies investigating the possibility of the double crush syndrome involve lesions in the upper extremity with very few articles written specifically about double crush syndrome in the lower extremity. We present the case of a 33-year-old massage therapist who uses her feet to provide therapy to clients who presented to our clinic with symptoms consistent with tarsal tunnel syndrome. Her failure to progress in a satisfactory manner after a variety of therapies made us search for additional etiologies for her foot pain. In cases where tarsal tunnel persists after surgical therapy, the treating physician should search for more proximal lesions along the course of the nerve. (J Am Podiatr Med Assoc 102(4): 330–333, 2012)
Background: People with Down syndrome present skeletal abnormalities in their feet that can be analyzed by commonly used gold standard indices (the Hernández-Corvo index, the Chippaux-Smirak index, the Staheli arch index, and the Clarke angle) based on footprint measurements. The use of Photoshop CS5 software (Adobe Systems Software Ireland Ltd, Dublin, Ireland) to measure footprints has been validated in the general population. The present study aimed to assess the reliability and validity of this footprint assessment technique in the population with Down syndrome.
Methods: Using optical podography and photography, 44 footprints from 22 patients with Down syndrome (11 men [mean ± SD age, 23.82 ± 3.12 years] and 11 women [mean ± SD age, 24.82 ± 6.81 years]) were recorded in a static bipedal standing position. A blinded observer performed the measurements using a validated manual method three times during the 4-month study, with 2 months between measurements. Test-retest was used to check the reliability of the Photoshop CS5 software measurements. Validity and reliability were obtained by intraclass correlation coefficient (ICC).
Results: The reliability test for all of the indices showed very good values for the Photoshop CS5 method (ICC, 0.982–0.995). Validity testing also found no differences between the techniques (ICC, 0.988–0.999).
Conclusions: The Photoshop CS5 software method is reliable and valid for the study of footprints in young people with Down syndrome.
Background:
We investigated whether a forefoot off-loading postoperative shoe (FOPS) alters standing posture, ankle muscle activity, and static postural sway and whether any effects are altered by wearing a shoe raise on the contralateral side.
Methods:
Posture, ankle muscle activity, and postural sway were compared in 14 healthy participants wearing either a FOPS or a control shoe with or without a contralateral shoe raise. Participants were tested under different sensory and support surface conditions. Additionally, reductions in peak pressure under the forefoot while walking were assessed with and without a contralateral shoe raise to determine whether the FOPS continued to achieve its primary off-loading function.
Results:
Compared with the control condition, wearing a FOPS moved the center of pressure posteriorly, increased tibialis anterior muscle activity, and reduced ankle plantarflexor activity. These changes decreased when a contralateral shoe raise was added. No difference in postural sway was found between footwear conditions. Forefoot peak pressure was always reduced when wearing the FOPS.
Conclusions:
The posterior shift in center of pressure toward and behind the ankle joint axis is believed to result in the increase in tibialis anterior muscle activity that now acts as the primary stabilizer around the ankle. Instability may, therefore, increase in patients with weak tibialis anterior muscles (eg, diabetic neuropathy) who need to wear offloading devices for ulcer management. We suggest that the addition of a contralateral shoe raise fitted with a FOPS may potentially be beneficial in maintaining stability while off-loading the forefoot in this patient group. (J Am Podiatr Med Assoc 103(1): 36–42, 2013)
