We hypothesized that the repetitive use of a toenail clipper by podiatric physicians could induce fatigue of the flexor digitorum superficialis (FDS) muscle, reducing the accuracy of toenail cutting.
We examined the consequences of cutting a plastic sheet, reproducing the resistance of thick toenails, with a podiatric medical clipper on the maximal handgrip force (Fmax) developed by the FDS muscle and an isometric handgrip sustained at 50% of Fmax, during which endurance to fatigue and changes in the power spectra of the surface FDS muscle electromyogram (root mean square and median frequency) were measured. The same participants randomly performed one or five runs of 30 successive cuttings, each on different days.
After the first and fifth cutting runs, Fmax increased, suggesting a post-tetanic potentiation. During the handgrip sustained at 50% of Fmax, we measured a significant reduction in the tension-time index after the first cutting run. Moreover, after the fifth cutting run, the tension-time index decrease was significantly accentuated, and the decrease in FDS muscle median frequency was enhanced. No median frequency decline was measured during the cutting runs.
These results suggest that the efficacy of occupational podiatric medical tasks progressively declines with the repetition of toenail cutting. We propose solutions to remedy this situation.
This study examined the differences between faculty and trained standardized patient (SP) evaluations on student professionalism during a second-year podiatric medicine standardized simulated patient encounter.
Forty-nine second-year podiatric medicine students were evaluated for their professionalism behavior. Eleven SPs performed an assessment in real-time, and one faculty member performed a secondary assessment after observing a videotape of the encounter. Five domains were chosen for evaluation from a validated professionalism assessment tool.
Significant differences were identified in the professionalism domains of “build a relationship” (P = .008), “gather information” (P = .001), and share information (P = .002), where the faculty scored the students higher than the SP for 24.5%, 18.9%, and 26.5% of the cases, respectively. In addition, the faculty scores were higher than the SP scores in all of the “gather information” subdomains; however, the difference in scores was significant only in the “question appropriately” (P = .001) and “listen and clarify” (P = .003) subdomains.
This study showed that professionalism scores for second-year podiatric medical students during a simulated patient encounter varied significantly between faculty and SPs. Further consideration needs to be given to determine the source of these differences.
The number of older individuals living in the United States is projected to increase significantly over the next few decades. To help meet the health-care needs of this growing population, podiatric medicine must assure the public of the availability of specially educated teachers and practitioners who can not only provide direct patient care, but also participate in establishing national policies and priorities pertaining to foot health. Fellowship training, the traditional educational model beyond the first professional degree and residency education, is one means of accomplishing this goal. This article proposes a model for a geriatric fellowship in podiatric medicine. Implementation of such fellowship training in geriatrics can help the podiatric medical profession pursue its mission and fulfill its responsibility to the public.