Thoughts on the Evolving Future of Podiatric Residency Education
Just as the world of health care continues to evolve, so does residency training. In this column, the panelists comment on their observations and experiences surrounding what tenets of training are likely to persist, versus how technology and innovation will move residencies forward.
Clinical Editor: David Bernstein, DPM, FACFAS
Panelists: Karla De La Mata, DPM, Samuel Gorelik, DPM, and Shailer B. Martin II, DPM, MS
Q: How much has new technology changed your residency education? What modalities do you see as remaining or growing in the future of podiatric residency programs?
A:
Shailer B. Martin, DPM, MS notes that he has seen technology evolve at an exponential pace to keep up with the demands of an ever-changing health care system, especially in light of the COVID-19 pandemic. Residents experienced limits in direct access to clinical care as a result of the associated hospital restrictions and safety concerns, and he shares that his institution used both video and computer communication systems to bridge that gap.
“Our clinic was equipped with high resolution audio/video equipment, which has allowed our patients to better communicate their concerns and has given our residents and providers the ability to assess these concerns visually in a safe and distanced setting,” he says. “Additionally, my institution has invested in the successful integration of our electronic medical records and patient access portal, which has given patients greater access to communicate directly with their providers, access lab and imaging results, and manage upcoming appointments and bills.”
In addition to the enhancement of clinical experiences, Samuel Gorelik, DPM add that new technology has changed the way residents are taught, as it allows for accessibility to attendings and regular academic sessions when restrictions may arise.
“It also makes it easier for people to participate in academics when (a resident is) off-site,” he says. “I think Zoom will continue to be implemented to allow for academic sessions to be more open to students who may not have been able to visit the program. It may eventually be used as a way to have academics while everyone is in separate locations, instead of having to schedule a time when everyone is able to meet at one location.”
Karla De La Mata began her residency training shortly after the initial peak of the COVID-19 pandemic and relates that technology, in a way, has “saved the day.”
“The last quarter of my podiatric school education and most academic sessions during my first residency year would not have been successful without the use of virtual meeting platforms and online simulations,” she explains. “I believe that virtual meeting platforms such as Zoom and Microsoft Teams will only continue to grow and play a larger role in podiatric education. In addition to the convenience and simplicity of being able to join a meeting, it has allowed for collaboration amongst multiple departments in one hospital, and even amongst colleagues, across different health networks and facilities.”
Q: Do you feel podiatric residency programs will increase their training time in the future (ie, 4 years instead of 3)?
A:
Drs. Gorelik and De La Mata do not feel this increase in training time is likely.
“I think that residents are looking to go into practice as soon as possible,” says Dr. Gorelik. “Given this fact, residents and applicants have to plan to be in training for 4 to 5 years once they include fellowship versus going to a 3-year residency program and going into practice. I think most of the changes that will occur will be on the podiatry school level as they continue to work on standardizing the training for podiatry students and making them more similar to allopathic and osteopathic students.”
In fact, Dr. De La Mata adds that she has observed some programs moving away from a 48-month curriculum.
“There is a certain level of confidence and comfort that comes along with entering your final year of residency training,” she shares. “What then pushes us beyond our comfort zone is knowing that we will soon start practicing as an attending, and that newfound level of responsibility is what motivates us to excel because we must learn to practice independently.”
Dr. Martin feels that historical evidence may suggest an increase in residency training time is impending.1,2
“Our past may very well hold the answer to the future,” he says. “Looking back to the year 1956, newly graduated podiatric practitioners desiring further training and education relied on apprenticeships and practice partnerships for such experiences. However, with the opening of Civic Hospital in Detroit in 1956, a new era of post-graduate training was brought into being. What started as weekend workshops and training courses, soon evolved into the first 6-month residency program, and by the mid to late-1960s, 9- and 12-month programs were beginning to gain traction. By 1969, the first 3-year residency training program in foot and ankle surgery was developed, creating a minimum standard that was universally adopted by 2013.”1,2
Dr. Martin believes this pattern is in part due to the expansion of scope of practice and the increasing specialization of medicine at-large.
Q: What characteristics do you feel are ideal in attending physicians and directors that will bring podiatric residencies into the future?
A:
Dr. De La Mata feels that patience and willingness to try new treatment modalities, along with focusing on evidence-based medicine over dogma are important virtues.
“Especially as new trainees, it is easy to implement the practices of others simply because it might seem less risky, but if we have mentors that can explain the “why” behind every aspect of care, we might be less afraid to try new modalities as long as we understand the “why,” as well,” she explains.
Among the critical characteristics that directors and attending physicians must possess to foster healthy and successful residency programs, Dr. Martin agrees, is patience. He says this is vital to navigate the delicate interconnections that bridge medicine and education, finding effective ways to instruct young practitioners, while also ensuring the highest quality of care.
“I learned the importance of patience firsthand as a young resident, during a challenging clinical encounter,” shares Dr. Martin. “I was tasked with seeing a patient in the clinic who was returning for further workup of several complex and chronic concerns. During my initial workup, the patient became tearful, frustrated, and combative, stating that she felt alone and forgotten in her struggle. With a quick glance at the clock in the room, aware of the very busy clinic schedule ahead, I struggled to find the right tools necessary to both calm and reassure the patient, while also acquiring a thorough and efficient assessment. After discussing with my attending physician, he calmly said that our patients and their well-being come first, and while we specialize in podiatric health, we take care of people. The future of health care is in human connection, and true connections take patience.”
Knowledge, confidence, and problem-solving skills, and an even-keeled temperament are among features of effective educators, says Dr. Gorelik. The ability to adapt to unexpected situations is also of benefit, along with objectivity in the process.
“I also think that it is important for attendings to be invested in the residents’ education,” he adds. “This includes being involved in academics and keeping them on their toes. This also extends to the attending continually working to improve themselves, whether it is going to conferences, learning new techniques, and trying new methods.”
He goes on to say that many of these characteristics can be attributed to a good residency director, including strong leadership, willingness to accept criticism. One of the keys to a good director is someone who has good leadership and willingness to accept constructive feedback and concerns. This open-minded approach goes a long way, he explains.
Q: What technologies, techniques, or approaches do you feel are necessary to allow trainees to prepare for new and upcoming procedures?
A:
Overall, the panelists feel that a combination of classic training pathways and new technology permeate their educational process.
“I think (one of) the most effective ways of residents preparing for performing new procedures is to first read on it, watch a video on it, and then perform it in a cadaver lab,” says Dr. Gorelik. “In the cadaver lab, it is preferable to have it done with an attending who has done it themselves before so that they can provide tips on issues that may arise. Preparation beforehand is definitely key. A combination of McGlamry's (textbook) and YouTube for surgical techniques is very helpful to read or watch before performing the case on my own.”
Dr. Martin feels the future of surgical training is tactile, through hands-on experiences.
“Residency programs that can incorporate innovative technologies and tactile experiences into their educational models will be well-equipped to instruct young surgeons of the future,” he says.
He agrees that cadaver labs are an excellent resource. In addition to these educational approaches, newer technologies, such as 3D printing, may provide hands-on opportunities to better understand foot and ankle pathologies, giving trainees and new practitioners another tool to aid in surgical planning.
Dr. De La Mata points out the value of careful planning prior to learning a new procedure or technique, using tools such as imaging studies. She also echoes the enthusiasm towards patient-specific hardware as a promising development in the field.
Q: In your opinion, what feature of a program makes it most appealing and/or the strongest today? Do you feel this will remain true in the future?
A:
Dr. Martin feels that the strongest and most appealing residency programs today share one essential quality; that of diversity.
“Residency, as with any educational experience or institution, is strengthened by its ability to provide a multiplicity of experiences,” he says. “Exposure to great diversity in patient populations, pathologies, and treatment approaches is paramount in fostering critical thinking and problem-solving skills, which are necessary competencies in an increasingly complex medical world.”
Dr. Gorelik looks towards the depth of involvement of the residents as a key factor.
“I am a big proponent of ‘see one, do one, teach one,’” he explains.
He adds that the time spent in residency training aims to give residents the foundation for the rest of their careers. Dr. Gorelik says in his experience, his comfort and knowledge base greatly increased once he started doing procedures myself instead of watching the attending do the procedure.
Dr. De La Mata is the Chief Resident at Lenox Hill Hospital at Northwell Health in New York City.
Dr. Gorelik is a Chief Resident at St. Vincent Hospital in Worcester, MA.
Dr. Martin is a 3rd year podiatry resident at Gundersen Health System in La Crosse, WI.
References
- Kanat I, Nielson D, Kaplan G. History of the Nation’s First Podiatric Hospital and Residency Program. APMA News. 2006;27(5). Available at: http://www.drzelen.com/docs/A%20History%20of%20the%20Nations%20First%20Podiatric%20Hospital%20and%20Residency%20Program.pdf
- Podiatric Medicine and Surgery Residency. Emory University School of Medicine. Available at : https://med.emory.edu/departments/orthopaedics/education/residency/podiatry/index.html
