A Closer Look At The State Of Podiatric Residency Training

Alan Catanzariti, DPM, FACFAS, and Robert Mendicino, DPM, FACFAS

Does Research Receive Enough Emphasis In Residency Training?

Advances in podiatric medicine and surgery are dependent on the creativity and innovation of individuals who have the foresight and commitment to investigate, develop and implement new technologies to improve patient care. We need to have research and research training in podiatric residency training programs. Podiatric residents should be exposed during their clinical training to the process of creativity and innovation that is the basis of research.

   Research is the lifeblood of every scientific organization and ours is no exception. Residents should participate in research, not necessarily to become researchers or academic practitioners, but rather to foster critical thinking. Research is the tool that validates who we are and keeps us relevant in the healthcare conversation. This is especially true as the healthcare environment becomes more competitive.

   Barske and Baumhauer recently reviewed literature published on the foot and ankle.1 The authors focused on 117 articles in seven North American podiatric and orthopedic journals, including the Journal of the American Podiatric Medical Association and the Journal of Foot and Ankle Surgery. They concluded that Foot and Ankle International, an orthopedic journal, published higher quality studies with a higher level of evidence in comparison to podiatry journals. Furthermore, they state that MDs produced the majority of published clinical foot and ankle research.

   Baumhauer is a foot and ankle orthopedist and the article, which was published in Foot and Ankle International, is somewhat self-serving. Nonetheless, the message is clear. Our competitors clearly understand the value and importance of research.

   The demand for maximum quality care in combination with the need for prudent use of resources has increased pressure on physicians to ensure that clinical practice is based on sound evidence. Therapeutic advances, an exponentially increasing volume of research data and increasing expectations from patients and third-party payers to provide the best possible care place high demands on physicians to provide care that is based on the best current evidence. Podiatry research needs to contribute to this growing body of evidence. This should begin in our residency training programs.

   Our profession needs an organization that can fund seed and starter grants for pilot experiments exclusively for residency programs. Although the American College of Foot and Ankle Surgeons (ACFAS) has a program somewhat like this, the grant money is open to all ACFAS members.

Possible Solutions For Fostering More Research Opportunities

Our biggest dilemma in developing a research culture is limited resources. Political, socioeconomic and cultural changes have increased financial pressures on those hospitals that support graduate medical education.

   Many barriers exist. With the rising cost of doing business, we often focus on increasing our clinical productivity to help offset rising costs and declining reimbursement. Many of us involved in residency education just do not have time to dedicate solely to research. This in turn affects our mentorship and modeling relative to research. We currently provide dedicated research time to our second- and third-year residents to focus exclusively on research. This has worked out rather well.

   Furthermore, we have formalized our research process to make it more conducive for our residents to participate in research. Those programs located within larger academic health centers can utilize resources provided through the institutional review boards, graduate medical education committees or research departments.

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