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08/05/2021 Allen Jacobs, DPM
We Have Met the Enemy and It Is Us (Tilden H Sokoloff, MD, DPM)
Using phrases such as “those with no vision” or referring to those in disagreement with the students taking the USMLE test as “the enemy” serve no useful purpose. The concerns expressed by those opposed to the white paper should be considered seriously as they represent concerns about the future of this profession.
Dr. Sokoloff consistently refers to the advances made by the California Podiatric medical Association. However I do have some questions. Do the students graduating the podiatry colleges in California take the USMLE examination? The answer is no. Are podiatrists in California still considered a podiatrist with no advanced delineation of privileges beyond that typical for podiatry in the state of California? Again, the answer is no. Are the colleges of podiatry in the state of California approved by the liaison committee on medical education which approves medical schools? The answer is no. Are the residencies in podiatry in the state of California approved by ACGME? Again, the answer is no.
Those of us who question the proposition within the white paper are not anti-growth of our profession. They are individuals who care very much about this profession and very much about the DPM degree and what it represents. Rather than resorting to ad hominem personal attacks, we should consider seriously the potential validity of alternate opinions. Alternate opinions should be respected.
I suggest that those supporting our students taking the USMLE examination look at the sample questions available online, as I did. I would ask that you seriously consider whether or not you believe podiatry school graduates would successfully pass this examination.
I suggest you look at the high failure rate for this examination in foreign medical school graduates. In order to pass USMLE examination, significant changes would be required in the schools of podiatry. So far as I am aware the Deans of the colleges have never been consulted regarding the ability to make such changes without sacrificing basic podiatry training.
More importantly, in the end, what is to be gained by making substantial changes in our college curricula, residency training, and fellowship training if in the end we are still defined as a podiatrist with limited privileges? Do you actually foresee the day that a foot and ankle orthopedic surgeon will refer to a podiatrist as their “total equal“.
Perhaps a clear understanding of the eventual benefits oh by our students taking the USMLE should be better defined
Allen Jacobs, DPM, St. Louis, MO
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08/09/2021 Eddie Davis, DPM
We Have Met the Enemy and It Is Us (Tilden H Sokoloff, MD, DPM)
Sorry, I am a bit of a latecomer to this discussion but after reading Barry Block's editorial, “We Have Met The Enemy and It is Us” as well as Tilden Sokoloff’s response, more questions arise.
According to the Wikipedia article on the USMLE: “The USMLE assesses a physician's ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care. Examination committees composed of medical educators and clinicians from across the United States and its territories create the examination materials each year. At least two committees critically appraise each test item or case, revising or discarding any materials that are in doubt. The program intends to provide state medical boards in the United States with a common examination for all licensure applicants. However, as of 2021, physicians with a DO degree do not require it for licensure.”
There are 3 parts to the USMLE. The third part is the last step in licensure per the Wikepedia article:
USMLE Step 3 is the final exam in the USMLE sequence and assesses whether medical school students or graduates can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings . So those with a DO degree are not required to take USMLE for licensure. Yes, they have an alternative exam. DPMs who take USMLE Part 3, still have a limited license despite taking an exam designed to determine the ability to practice via an unrestricted or unlimited license. Dr. Sokoloff states that “no podiatric physician out of training for more than the past 10 years will qualify to take the examinations.” Why? What happens to our knowledge base after 10 years?
What happens to those who invested in a podiatric education who are more than 10 years from the end of training? How are we enhancing the opportunities of future students by having them take an exam that does not provide a scope of practice commensurate with the intent of the exam? Sorry Tilden, but I am not “kicking and screaming.” I am looking for a reasoned discussion of the proposed changes and how that not only benefits future students, but the profession as a whole.
Eddie Davis, DPM, San Antonio, TX
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