The objective of this study was to investigate the rate of attrition within podiatric medicine and surgery residency training programs.
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 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.
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.
A sclerotome is an anatomical concept that defines an area of bone supplied by a single spinal nerve. Similar to the familiar dermatomes, sclerotomes provide an element of depth to the sensory innervation of the lower extremity based on the deep fascia as an embryologic boundary. Anatomical knowledge of sclerotomes can be used clinically in the diagnosis and treatment of pain and in the perioperative setting. Specifically, a modified version of the classic Mayo block is presented to highlight an active anatomical approach to peripheral nerve blockade. (J Am Podiatr Med Assoc 99(3): 232–235, 2009)
This investigation presents a review of all of the clinical outcome measures used by authors and published in the Journal of the American Podiatric Medical Association and the Journal of Foot and Ankle Surgery from January 1, 2011, to December 31, 2015. Of 1,336 articles published during this time frame, 655 (49.0%) were classified as original research and included in this analysis. Of these 655 articles, 151 (23.1%) included at least one clinical outcome measure. Thirty-seven unique clinical outcome scales were used by authors and published during this period. The most frequently reported scales in the 151 included articles were the American Orthopaedic Foot and Ankle Society scales (54.3%; n = 82), visual analog scale (35.8%; n = 54), Medical Outcomes Study Short Form Health Survey (any version) (10.6%; n = 16), Foot Function Index (5.3%; n = 8), Maryland Foot Score (4.0%; n = 6), and Olerud and Molander scoring system (4.0%; n = 6). Twenty-four articles (15.9%) used some form of original/subjective measure of patient satisfaction/expectation. The results of this investigation detail the considerable variety of clinical outcome measurement tools used by authors in the Journal of the American Podiatric Medical Association and the Journal of Foot and Ankle Surgery and might support the need for a shift toward the consistent use of a smaller number of valid, reliable, and clinically useful scales in the podiatric medical literature.
The topic of pain management remains a minor component of the formal education and training of residents and physicians in the United States. Misguided attitudes concerning acute and chronic pain management, in addition to reservations about the legal aspects of pain management, often translate into a “fear of the unknown” when it comes to narcotic prescription. The intentionally limited scope of this review is to promote an understanding of the laws regulating pain management practices in the United States and to provide recommendations for appropriate pain management assessment and documentation based on the Model Policy for the Use of Controlled Substances for the Treatment of Pain established by the Federation of State Medical Boards of the United States. (J Am Podiatr Med Assoc 100(6): 511–517, 2010)
Although clinical findings, laboratory serum markers, and radiographic images are also used, the purported gold standard or standard reference test for the diagnosis of gout is microscopic analysis of aspirated joint fluid. This observational investigation sought to identify the level of agreement with the microscopic analysis of joint fluid aspirate for the diagnosis of gout in the lower extremity between two departments in a single health-care center.
A retrospective medical record review identified consecutive patients seen for suspected gout who underwent diagnostic joint aspiration. Patients were included if a lower-extremity joint synovial fluid sample was obtained and were excluded if they were not independently evaluated by both the departments of rheumatology and pathology. We categorized the documented joint fluid findings into four groups: no crystals, sodium urate crystals, calcium pyrophosphate dihydrate crystals, or both sodium urate and calcium pyrophosphate dihydrate crystals. We defined a “clinically significant disagreement” as one department observing any type of crystals and the other department observing no crystals.
We observed a clinically significant disagreement rate of 23.26% (intraclass correlation coefficient = 0.496). The department of rheumatology was more likely to observe the presence of crystals in a sample compared with the department of pathology (88.37% versus 65.12%; P = .02).
These results provide evidence that microscopic analysis of joint fluid aspirate might lack the accuracy and reliability needed to be considered a gold standard diagnostic test for gout in the lower extremity.
The effect of lower-extremity pathology and surgical intervention on automobile driving function has been a topic of contemporary interest in the medical literature. The objective of this review was to summarize the topic of driving function in the setting of lower-extremity impairment. Included studies involved lower-extremity immobilization devices, elective and traumatic lower-limb surgery, chronic musculoskeletal pathology, and diabetes as it relates to the foot and ankle, focusing on the effect each may have on driving function. We also discuss the basic US state regulations with respect to impaired driving and changes to automobile structure that can be made in the setting of lower-extremity pathology.
Background: Digital deformities represent a common presenting pathology and target for surgical intervention in podiatric medicine and surgery. The objective of this investigation was to compare the radiographic width of the heads of the lesser digit proximal phalanges.
Methods: One hundred and fifty consecutive feet with a diagnosis of digital deformity and performance of weight-bearing radiographs were analyzed. The maximum width of the heads of the lesser digit proximal phalanges were recorded from the radiographs utilizing computerized digital software.
Results: The mean±standard deviation (range) of the head of the second digit proximal phalanx was 9.74±0.87 mm (7.94-11.78), of the head of the third digit proximal phalanx was 9.00±0.91 mm (7.27-10.94), of the head of the fourth digit proximal phalanx was 8.49±1.01 mm (5.57-10.73), and of the head of the fifth digit proximal phalanx was 8.67±0.89 mm (6.50-11.75). The width of the head of the proximal phalanx decreased from the second digit to the third digit (p<0.001), decreased from the third digit to the fourth digit (p<0.001), and then increased from the fourth digit to the fifth digit (p=0.032).
Conclusions: The results of this investigation provide evidence in support of an anatomic and structural contribution to digital deformities. The width of the heads of the lesser digit proximal phalanges decreased from the second to the third to the fourth toes, and then subsequently increased with the fifth proximal phalangeal head.
The primary objective of this investigation was to objectify perceived stresses of students enrolled at a US college of podiatric medicine.
Following preliminary pilot data collection and representative student interviews, the Perceived Stress Scale and a newly developed survey consisting of 46 potential stresses were administered to students. Participants were asked to identify up to ten items from the survey that caused them the most stress and to further identify up to three of these ten that they considered to be the most stressful.
A response rate of 71.5% (261 of 365) was observed. Specific results demonstrate that levels of perceived stress in podiatric medical students are higher than those in the general population, as well as some potential trends with respect to specific perceived stresses that change over time.
The results of this investigation provide quantitative evidence of perceived levels of stress and specific stresses of students enrolled at a US college of podiatric medicine. We hope that these findings increase awareness of stress in podiatric medicine, lead to colleges of podiatric medicine taking active steps to improve student stress education, and lead to future investigations of stress and mental health in the field of podiatric medicine.
The objective of this investigation was to determine the level of agreement between a systematic clinical Doppler examination of the foot and ankle and diagnostic peripheral angiography.
The described Doppler examination technique attempted to determine the patency, quality, and direction of the flow through the dorsalis pedis artery, posterior tibial artery, terminal branches of the peroneal artery, and vascular arch of the foot. These results were then compared with angiographic distal run-off images as interpreted by a blinded vascular surgeon.
Levels of agreement with respect to artery patency/quality ranged from 64.0% to 84.0%. Sensitivity ranged from 53.8% to 84.2%, and specificity ranged from 64.7% to 91.7%. Agreement with respect to arterial flow direction ranged from 73.3% to 90.5%.
We interpret these results to indicate that this comprehensive physical examination technique of the arterial flow to the foot and ankle with a Doppler device might serve as a reasonable initial surrogate to diagnostic angiography in some patients with peripheral arterial disease.
A patient “handoff,” or the “sign-out” process, is an episode during which the responsibility of a patient transitions from one health-care provider to another. These are important events that affect patient safety, particularly because a significant proportion of adverse events have been associated with a relative lack of physician communication. The objective of this investigation was to survey podiatric surgical residency programs with respect to patient care handoff and sign-out practices.
A survey was initially developed and subsequently administered to the chief residents of 40 Council on Podiatric Medical Education–approved podiatric surgical residency programs attempting to elucidate patient care handoff protocols and procedures and on-call practices.
Although it was most common for patient care handoffs to occur in person (60.0%), programs also reported that handoffs regularly occurred by telephone (52.5%) and with no direct personal communication whatsoever other than the electronic passing of information (50.0%). In fact, 27.5% of programs reported that their most common means of patient care handoff was without direct resident communication and was instead purely electronic. We observed that few residents reported receiving formal education or assessment/feedback (17.5%) regarding their handoff proficiency, and only 5.0% of programs reported that attending physicians regularly took part in the handoff/sign-out process. Although most programs felt that their sign-out practices were safe and effective, 67.5% also believed that their process could be improved.
These results provide unique information on a potentially underappreciated aspect of podiatric medical education and might point to some common deficiencies regarding the development of interprofessional communication within our profession during residency training.