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

Other messages in this thread:

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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