Why We Need More Emphasis On The Practical Practice Of Podiatry

The terms practicum, practice and practical all come from the common Greek root, praktikos, which means “to practice.” Although the words have very different meanings, all three are necessary components in becoming a successful podiatrist. At times, during the training necessary to becoming a podiatric physician, we overlook these fundamentals and they become overshadowed by the quest to master the more complex podiatric medical theories and skills.

   The concept of implementing a practicum — or “a course of study designed especially for the preparation of clinicians that involves the supervised practical application of previously studied theory for the enhancement of education” — is not a novel idea. The podiatric medicine and surgery residency is a form of practicum that has evolved over time.

   While it is obvious that such hands-on training remains pertinent to producing competent doctors, this varies from program to program. There is no “perfect” residency program and it is up to the individual resident to seek out opportunities to better his or her education. Fortunately, during the quest to become a podiatrist, there are many opportunities to apply classroom knowledge into practical, real-life situations. Such experiences are invaluable to becoming an exceptional podiatric physician.

   A great proportion of podiatric residency models focuses on the teaching and acquisition of the knowledge and physical skills necessary to perform surgical procedures successfully. With the implementation of a minimum of three years of residency training, there is a reasonable length of time to practice clinical and surgical skills. Recently, there has been a push to increase exposure to surgical procedures during residency with a stronger concentration on rearfoot and ankle procedures.

   While it is definitely advantageous to have such training, there may be limitations to its usefulness beyond residency. For example, the environment in which you will practice will greatly affect the etiologies that you will encounter. For example, urban cities differ greatly in patient population than smaller rural areas. There may also be differences in the types of conditions you will treat.

   In addition, regulations at the state and even local hospital level unfortunately impact podiatric surgeons’ privileges to perform certain procedures. Perhaps the continued efforts to train podiatrists adequately during residency in not only forefoot surgery but rearfoot and ankle surgery as well will lead to increased privileges.

   With the implementation of the American Podiatric Medical Association’s Vision 2015 program, the lengthened residency term will increase the emphasis on “practice,” a fundamental aspect of becoming a good podiatric physician. A common saying in the podiatry world is that “there is a reason why it is called practicing medicine.” Learning in the world of health care is limitless and the requirements for continuing medical education credits and renewal of certification and licensure reiterate the importance of maintaining an insatiable quest for gaining knowledge.

   Another factor that one should consider while training to become a podiatrist is to learn practicality. One definition of practical is “likely to succeed or be effective in real circumstances; feasible.” For most, this is not an innate quality but rather a characteristic one gains through experience and exposure.

   Unfortunately, the teaching of practice management skills often does not receive much emphasis during residency. There is immense attention toward the teaching of surgical and clinical skills but less attention on practice management. The skills we learn in the operating room and clinic setting are completely different than those we need to manage a profitable medical practice. In addition, the topic does not get much attention during school either.

   Fortunately, there are credible reimbursement, coding and compliance seminars specifically for podiatry. During residency, it is important to take advantage of rotating through the offices of different attendings to observe firsthand how they run their practices. In order to run a profitable practice, you must learn how to treat patients efficiently and correctly.

   Each patient is unique and being able to offer the most appropriate treatment plan is a skill that one must learn. Although podiatric medical training focuses heavily on surgery, we should not instantaneously think of every patient as a surgical candidate.

   On the long road to becoming a podiatric physician, there are many skills to master. While one should explore more complex theories during residency, there should be adequate opportunities to practice the more basic skills and concepts as well.
You are best at what you practice most. Therefore, you should most frequently practice addressing what you will encounter the most.

   Dr. Ryans is a third-year resident at SSM DePaul Health Center in St. Louis.

   Dr. McCord retired in December 2008 from practice at the Centralia Medical Center in Centralia, Wash.