December 2010

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CPME Adopts Three-Year Residency Standard

By Brian McCurdy, Senior Editor

The Council on Podiatric Medical Education (CPME) recently approved residency changes that spell an end to the two- and three-year PM&S-24 and PM&S-36 programs. Starting July 1, 2011, podiatric residency programs will consist of a standard three-year Podiatric Medicine and Surgery Residency (PMSR) program.

   The CPME 320 document notes that completion of the PMSR program leads to certification by the American Board of Podiatric Orthopedics and Primary Podiatric Medicine (ABPOPPM), and being certified in foot surgery by the American Board of Podiatric Surgery (ABPS). In addition, the council says residencies that can provide a sufficient volume and diversity in reconstructive rearfoot and ankle (RRA) procedures may grant an added RRA credential and subsequently lead to RRA certification with the ABPS.

   Podiatrists may fulfill their PMSR requirements primarily in a healthcare institution approved by the Centers for Medicare and Medicaid Services (CMS) as opposed to being limited to institutions accredited by the Joint Commission or the American Osteopathic Association, according to the CPME 320 revisions.

   The CPME notes that during the two-year process of deliberations over residency requirements, it received over 150 written comments on the residency changes. The council has tentatively scheduled presentations on the CPME changes at meetings including the New York Clinical Conference, the American Podiatric Medical Association (APMA) House of Delegates, the Midwest Podiatry Conference and the APMA Annual Scientific Meeting.

   Michael Lee, DPM, the President of the American College of Foot and Ankle Surgeons (ACFAS), notes that the ACFAS has for years been advocating the move to a three-year residency standard.

    “Standardization will ensure, on paper at least, that all podiatric surgeons are equally trained,” says Dr. Lee, who is in private practice in Des Moines, Iowa. “The next big step is the standardization and quality of the programs. This is a huge step for professional parity but work remains.”

   Gary Rothenberg, DPM, feels the new residency model is very similar to the current PM&S-36, although he acknowledges that the existing two-year programs either need to increase volumes and rotation opportunities, or they will fold.

    “The changes clearly reflect the desire to standardize podiatric medical education through a time metric but as we all know, quantity does not equate to quality,” says Dr. Rothenberg, the Director of Residency Training and an Attending Podiatrist at the Miami Veterans Affairs Healthcare System in Miami. “There are very few changes that I can tell that speak to the ‘quality’ of education we are providing.”

   The de-emphasis on minimum activity volumes (MAV) and a re-emphasis on evaluation of competency is “the greatest challenge of the new document,” according to Jeffrey Robbins, DPM.

    “MAVs are patient care activity requirements that assure that the resident has been exposed to adequate diversity and volume of patient care,” Dr. Robbins cites the CPME 320 document as saying. “MAVs are not minimum repetitions to achieve competence … It is incumbent upon the director of podiatric medical education and the faculty to assure that the resident has achieved a competency, regardless of the number of repetitions that it takes for the given resident.”

   This statement implies that residency directors must engage in faculty development to ramp up direct observational skills and early recognition of resident deficiencies in knowledge, skills and non-cognitive elements, according to Dr. Robbins, the Director of Podiatry Service for the Department of Veterans Affairs Central Office and the Chief of the Podiatry Section at the Louis Stokes Cleveland Veterans Affairs Medical Center. Additionally, he notes that residency programs will need to emphasize self-learning skills and lifelong learning attitudes to both residents and faculty.

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Anonymoussays: December 26, 2010 at 10:31 pm

Regardless of residency changes, the bottom line is a good podiatrist is an EXPERT in both medicine and surgery for BELOW THE KNEE pathologies. A patient only cares that his or her's chief complaint BELOW THE KNEE feels better and functions normally again.

I look at a podiatrist as the BELOW THE KNEE doctor. I expect that BELOW THE KNEE doc to fix my BELOW THE KNEE problem with minimal to no complications, whether it requires medical and/or surgical treatments.

Also, a lot of podiatrists need to improve in dermatology, radiology, and biomechanics. Many podiatrists, both old and young, are not proficient in dermatology, radiology and biomechanics! It is shocking. Even after residency training!

So these BELOW THE KNEE doctors better show improvement in dermatology, radiology, and biomechanics with these CPME changes!

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