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Many regard empathy as a critical component of comprehensive health care. Much interest has been generated in the field of medical empathy, in particular as it relates to education. Many desirable outcomes correlate with perceived empathy during the patient encounter, but paradoxically, empathy levels have been reported to decline during the years of medical education. Several new approaches have been described in the literature that intend to teach or develop empathy skills in health-care students.
PubMed, PsycINFO, and Google Scholar databases were searched for the terms empathy education, medical education, medical student, podiatric medical education, medical empathy, compassion, emotional intelligence, biopsychosocial model, and bedside manner. After implementing inclusion and exclusion criteria, articles were selected for preparation of a literature review. Analysis of the podiatric medical education on empathy was conducted by reviewing descriptions of all courses listed on each of the nine US podiatric medical schools' Web sites. The 2018 Curricular Guide for Podiatric Medical Education was analyzed.
In this review, we examine the current state of empathy from a context of medical education in general, followed by a specific analysis in podiatric medicine. We define key terms, describe the measuring of empathy in medicine, explore outcomes of empathy in the health-care setting, review the reports of a decline in medical education, and highlight some of the current efforts to develop the skill in education. An overview of empathy in the podiatric medical curriculum is presented.
To improve the quality of care that physicians provide, a transformation in podiatric medical education is necessary. A variety of tools are available for education reform with the target of developing empathy skills in podiatric medical students.
Short-term medical missions are common in medical educational settings and could possibly affect student learning. Little research has been conducted about the potential of these missions on students’ transformative learning, in particular as it relates to empathy and multicultural awareness.
Eight podiatric medical students who participated in short-term medical missions in 2008 and 2009 completed an electronic survey to investigate the effect of their experience as it relates to their learning. The empathy and multicultural awareness impact of the mission experience was emphasized. Qualitative questions in the survey were coded, themed, and triangulated with the quantitative responses.
Six students (75%) “strongly agreed” that participating in the medical mission was a significant positive experience in their podiatric medical training. Six students felt that their experiences in serving these communities increased their personal awareness of multicultural/diversity needs in general. All of the students agreed that they will become better podiatric physicians because of their experiences in the medical missions. The qualitative data also indicate that the experience had an effect on the students’ views of health care and increased empathy toward their patients.
Short-term medical missions could play a significant role in the transformative learning experience in podiatric medical education. This could affect the empathy and multicultural awareness of podiatric medical students. Further and more extensive evaluations of the potential impact of short-term medical missions in podiatric medical education should be explored because it could influence curriculum and global health in the field of podiatric medicine. (J Am Podiatr Med Assoc 102(1): 39–46, 2012)
Plantar Verrucae in Patients with Human Immunodeficiency Virus
Clinical Presentation and Treatment Response
Several previous studies have yielded data showing that plantar and other cutaneous verrucae follow a more aggressive course in patients infected with human immunodeficiency virus (HIV) than in uninfected individuals. A pilot study was undertaken to identify trends in a sample population that would support this characterization of plantar verrucae in HIV+ patients and to determine whether there are differences in treatment response between HIV+ and HIV− patients. The results show that the HIV+ patients in the study presented with a significantly greater number and total area of lesions than did the HIV− patients. Furthermore, the HIV+ patients experienced a greater frequency of recurrence of their lesions following treatment with surgical curettage. These findings should provide the foundation for other extensive, multicenter studies to further characterize the treatment response of these lesions in HIV+ patients and to develop effective guidelines for their management. (J Am Podiatr Med Assoc 91(2): 79-84, 2001)
Implementation of highly active antiretroviral therapy (HAART) significantly increased the life expectancy of those living with human immunodeficiency virus (HIV). Except for prevalence, scientific reports regarding clinical manifestations of plantar verrucae in the post-HAART era are lacking. The objective of this study was to compare clinical manifestations of plantar verrucae between HIV-infected and noninfected individuals and then to compare these findings with those observed before the implementation of HAART.
Nineteen patients with plantar verrucae (ten with HIV and nine without HIV) were examined to determine the size, number, and clinical type of verrucae present. The two groups were first compared with each other and then with previously collected data from a similar analysis conducted in 1995, before the implementation of HAART. Statistical significance was determined using the Fisher exact test or the Wilcoxon rank sum test.
No significant differences were observed in the size, number, or clinical type of verrucae between HIV-negative and HIV-positive patients. Compared with the 1995 data, there was a significant decrease in the number of verrucae lesions per individual and a nonsignificant decrease in the average size of verrucae in HIV-positive patients.
Study results indicate that the implementation of HAART has impacted the clinical manifestations of plantar verrucae in HIV-positive individuals. Further analyses with a larger number of patients are required to confirm and substantiate these findings.
Background: Since the implementation of highly active antiretroviral therapy (HAART), the life expectancy of patients with human immunodeficiency virus (HIV) has significantly increased. This is likely to cause changes in podiatric medical manifestations, such as plantar verrucae, in this population.
Methods: Attendees at a San Francisco street fair in 2008 provided information about HIV status and the presence of verrucae via a survey. A total of 504 surveys were analyzed and compared with 1995 data, before HAART implementation. We examined if there was a statistically significant change in the increased likelihood of plantar verrucae in HIV-positive patients from 1995 to 2008. Then we examined the likelihood of HIV-positive patients (compared to HIV-negative patients) presenting with plantar verrucae in 2008, by using logistic regression, and controlling for age, sex, and race/ethnicity.
Results: Patients with HIV infection were 5.2 times more likely to present with plantar verrucae compared to patients without HIV infection in 2008 (95% confidence interval, 2.5–11.0, P < .0001) and 10.0 times more likely in 1995 (95% confidence interval, 3.4–29.0, P < .0001). This decrease in likelihood over time was not statistically significantly different (P = .33). Logistic regression analysis controlling for the covariates of age, race, and sex showed that patients with HIV in 2008 were 4.5 times more likely to present with verrucae compared to patients without HIV (95% confidence interval, 2.1–9.9, P = .0002).
Conclusions: Patients with HIV infection in 2008 are still significantly more likely to present with plantar verrucae after controlling for age, race, and sex. This increased likelihood has not changed significantly across time. Because HAART has increased the life expectancy of patients with HIV, this group of patients with plantar verrucae will continue to represent a significant population in the practice of podiatric medicine. (J Am Podiatr Med Assoc 101(1): 35–40, 2011)
Although an increased prevalence of plantar verrucae has been associated with human immunodeficiency virus (HIV) infection, human papillomavirus (HPV) typing studies have not been published about this patient population. We sought to determine the prevalence of HPV types in plantar verrucae of HIV-positive (HIV+) and HIV-negative (HIV–) individuals.
Thirty-nine plantar verruca lesions in 17 individuals were examined. Nine participants were HIV+ and eight were HIV–. Detection of HPV was performed by polymerase chain reaction using two sets of primers: MY09/MY11. The type of HPV was determined by hybridization to 38 different HPV types. Clinical types of verrucae were correlated to the HPV strain identified in each lesion.
Of the 39 plantar verruca samples, 38 typed to HPV-2, HPV-27, and HPV-57 strains in HIV+ and HIV– individuals. Specifically, a large proportion of the samples from HIV– individuals typed as HPV-27 (87.5%), and HPV-2 was the predominant type identified in HIV+ individuals (50%). No rare or atypical HPV types were found in either group. We identified HPV-2 and HPV-27 in 96% of verruca plantaris clinical type. Mosaic warts typed to HPV-27 and HPV-57, and 80% of punctate verrucae typed to HPV-57.
This study presents an increased prevalence of HPV-2, HPV-27, and HPV-57 in plantar verrucae in this study population and provides insight into the occurrence of these types in HIV+ and HIV– individuals.
Background: Verrucae are caused by infection of epidermal keratinocytes by human papilloma virus (HPV). Although there are currently more than 100 known types of HPV, certain lesions are consistently caused by infection with one or a few types. Recent studies have identified the presence of unusual HPV types in anogenital and cervical condylomata (warts) of patients infected with human immunodeficiency virus (HIV). Although cutaneous verrucae are typically caused by HPV-1, HPV-2, and HPV-4, infection with HIV may predispose an individual to infection with an unusual HPV type.
Methods: We report the detection of a rare HPV type in a clinically aggressive plantar verruca from an HIV-positive patient. The viral DNA from this specimen was analyzed to identify the predominant HPV type. To complete this analysis, HPV DNA was extracted from the formalin-fixed specimen, followed by polymerase chain reaction with consensus HPV primers and digestion with a specific group of restriction endonucleases. The fragments were separated on an agarose gel, and the restriction fragment length polymorphism pattern was compared with known patterns for identification of the specific HPV type.
Results: Identification of HPV-69, an HPV type previously reported to be rare and associated with dysplastic lesions, was confirmed by HPV DNA dot-blot hybridization with specific DNA probes for each known HPV type.
Conclusions: Plantar verrucae in HIV-positive patients may be associated with unusual HPV types and should be analyzed and treated aggressively given the potential for a more distinct clinical manifestation. Additional lesional analysis studies are needed. (J Am Podiatr Med Assoc 99(1): 8–12, 2009)