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10/03/2019 Loretta Logan, DPM, MPH
Welcome to the Future of Podiatry (Paul Kesselman, DPM)
As chair of the Department of Orthopedics and Pediatrics at the New York College of Podiatric Medicine (NYCPM) I feel it is necessary to respond to your recent comments regarding the current state of orthopedic training at the schools of podiatric medicine. While I agree with the consensus that the younger practitioners entering practice have placed surgery at the head of their treatment plans, the first sentence in point #1, “The undergraduate level of biomechanical training is apparently shameful as compared to when I was at ICPM 1977-1981” was particularly troubling.
I would be happy to share curriculum documents with you which show the evolution and expansion of orthopedic training from the time of then NYCPM chair Dr. Richard Schuster, and modified to its current design by successive chairs and my predecessors, Drs. Joseph D’Amico, Edward Rzonca, Mark Caselli, Justin Wernick, Russell Volpe and myself. I will assert that among the colleges of Podiatric Medicine, NYCPM consistently stands out as being a school that the students feel is “orthopedically heavy”, due to the rigorous classroom and clinic sessions delivered throughout the 4-year curriculum.
While we no longer ‘build (custom orthoses, in- house) from scratch’ from a neutral position cast, students are well-trained in casting and fabrication detail for fully prescription devices and are able to complete on the fly prescriptions using modifiable “blanks” to which they add posting, accommodation and other standard orthosis additions and features in our orthotic laboratory.
In response to your statement in point # 2, “Do students have any idea about orthotic materials, construction, how to cast (or scan correctly). I dare say no!”, I emphatically say yes! Our students have didactic lectures and workshops on casting, materials, footwear/pedorthics and orthotic fabrication delivered by clinicians who bring decades of experience to the craft. Our students also have over 500 hours of clinical rotations dedicated to biomechanics/orthopedic sciences and where full biomechanical exams and observational gait analysis are taught and routinely used to evaluate and treat both adult and pediatric patients. Our gait lab, which features current pressure mapping and video technology serves to assess patients whether for orthopedic prescription, diabetic or pre- surgical evaluation. It is our belief that this academic and clinical experience better serves orthopedic education (and the patient) than would time spent creating plaster molds, et al… especially considering that orthotic labs have also largely abandoned this in favor of digital and cad-cam technology.
I will also point out that NYCPM consistently leads in post-graduate education in orthopedic sciences. The annual Richard O. Schuster Biomechanics Seminar is an event unlike any other in North America and routinely showcases not only NYCPM faculty but highly regarded clinicians from around the country. NYCPM faculty participate nationally in exam development (APMLE and specialty board), evaluation of residency training standards and continuing education events where their expertise and passion for this domain is evident.
Hopefully, the information above will address the second statement in that same initial paragraph that your description of the ‘shameful’ state of podiatric orthopedics is based merely on your “…query of student residency interviews or externships over the past 10 years.” Could your frustration in questioning these particular students and their unacceptable responses be reflective of the fourth sentence in the same paragraph regarding the opinion that Dr. Aronson voiced stating it would take a ‘minimum’ of five years to master the subject?
During the 2018 Richard O. Shuster Biomechanics Seminar, I presented “An Analysis of the Biomechanics/Orthopedics Curriculum in the Colleges of Podiatric Medicine.” My research involved reaching out to each of the schools to obtain information on their curriculum in Biomechanics/Orthopedics from as far back as they could take me to the current day. My analysis concluded that the level and quality of training in the colleges of Podiatric Medicine showed that biomechanics/orthopedic sciences is being taught and with rigor and dedication at all schools. As a faculty member at one our sister institutions stated “the concern is at the handoff point (residency training) where the importance or expertise in biomechanics may be diluted or lost.”
Yes, there are issues with regard to residency programs not placing enough emphasis on the biomechanical exam as part of the pre-surgical workup (though I imagine that there are some programs who do this quite well.), however that is something that the Council will need to address. And yes, this is something that clearly needs to be accomplished as soon as possible.
While your letter does highlight several areas of deficiency within our field, I wanted to take this opportunity to address item # 1 and state unequivocally that there is nothing shameful about the biomechanical training at NYCPM. I hope this provides you with a better understanding of our approach here at NYCPM, where we strive to carry on the legacy of some of the iconic figures in podiatric biomechanics who have gone before us. I assure you it is a responsibility that is not taken lightly.
Loretta Logan, DPM, MPH, NY, NY
Other messages in this thread:
09/20/2019 Robert Kornfeld, DPM
Welcome to the Future of Podiatry (Paul Kesselman, DPM)
Dr. Kesselman's 10 points are right on the money. I had a patient who came to me for a second opinion recently. She had seen a young podiatrist who recommended surgery for an "IPK" sub 5th met head (metatarsal osteotomy). When she came to my office, the lesion was quite large and apparently had not been debrided. When I began to debride the lesion, I felt a click on my scalpel.
Further debridement revealed a piece of glass in the patient's foot which I easily removed. I told her she did not need surgery. She was very grateful but very angry that a doctor would recommend surgery without appropriate examination of the area of chief complaint. He x-rayed her foot and told her she needed surgery. There was no recommendation for conservative care of any kind.
I have been a podiatrist for over 39 years and in private solo practice for 37 years. In that time, I have seen a once viable, growing, and incredible profession sink to new lows every year. In my opinion, the 3-year surgical residencies have done much to diminish our medical skills and our rational approach to differential diagnosis. I've done thousands of surgeries in my career, but never without careful consideration to the mechanism of pathology.
I do believe the current path will eventually destroy the profession of podiatry. It isn't my problem, however. I am at the tail end of a great and lucrative career that I fashioned on my own so that I could be the best podiatrist I could be without influence from insurance companies and Medicare. I have a niche practice. I do not accept insurance of any kind. I work smart and not at all hard. I attempted many times to bring this information to the profession but was ignored by all the Colleges of Podiatric Medicine (as irrelevant). My practice is medical, not surgical at this point. Podiatry wanted to feel like "real" doctors and pushed the surgical agenda to self-destruction.
I attend the Schuster Biomechanics Seminar at NYCPM every year and gain invaluable knowledge from some of our most revered biomechanics experts. That has done more for my practice than my scalpel ever did.
I wish the future of podiatry the best of luck, but in my opinion, you have shot yourselves in the foot.
Robert Kornfeld, DPM, Robert Kornfeld, DPM
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