03/09/2023    William P Scherer, DPM, MS

AACPM Announces Release of Revised Curricular Guide

I read with great interest the 2023 AACPM
Curricular Guide for Podiatric Medical Education
and have some serious concerns as there seems to be
a significant disconnect in what we are expecting
podiatric medical students to learn and what
podiatrists actually do in private, group, and
clinical practice. Specifically, the dearth of
dermatology competencies and educational learning
objectives is the greatest oversight and weakness
in the document as the average podiatrist treats
skin and nail conditions far greater than any other
disorder (well over 50% of all patient encounters,
according to Medicare data), yet the AACPM does not
even include dermatology as a “Core Competency”
like radiology, orthopedics, surgery, geriatrics,
or behavioral medicine, and buries relatively few
dermatology learning objectives under a small
section of general medicine.

There are approximately 4,000 individual and
specific learning objectives covered in 248 pages
of the document, however there are only 58 learning
objectives for dermatology and 12 for
dermatopathology that are contained in less than 2
pages of the document. Only 6 short learning
objectives are focused on disorders of the nails,
and this is contrasted with 7 highly detailed and
much more comprehensive learning objectives focused
on breast disease, and 9 lengthy learning
objectives for male and female reproductive
disorders.

Shockingly, in the entire document, there is only
one single learning objective devoted to the
diagnosis and management of onychomycosis and this,
by far, is the number one most common condition
that podiatrists diagnose and treat. I was also
surprised that the document devoted 83 learning
objectives towards genitourinary infections and
STDs and began to wonder if we are heading down the
wrong track with regards to properly educating
podiatric medical students to become podiatrists.

Although there are another dozen or so dermatology
learning objectives covered under skin and soft
tissue infections, and surgery, they pale in
comparison to other subject areas such as 32 pages
on orthopedics with about 900 learning objectives,
22 pages on Surgery with over 500 learning
objectives, 5 pages on radiology with approximately
100 learning objectives, 20 pages on physiology
with about 400 objectives, and 12 pages on
biochemistry with approximately 240 learning
objectives.

It seems that the AACPM is putting tremendous focus
on making podiatric medical education content
comparable, or equivalent, to allopathic and
osteopathic medical education, however this has had
a detrimental effect on reducing or even
eliminating some actual real-world competencies and
learning objectives that podiatric medical students
will need to master to be successful in the
practice of podiatric medicine and surgery.
Additionally, the lack of sufficient dermatology
education is further compounded in residency as
most three-year residents are focused on
reconstructive bone and joint surgical cases and
are lucky if they spend a week or two in a
dermatology rotation.

I do applaud the time and tremendous effort that
Denise Freeman, DPM and the AACPM committee put
into creating and revising the Curricular Guide for
Podiatric Medical Education, however I believe the
document misses the mark in terms of lower
extremity dermatology educational competencies and
hope that this can be corrected and improved in
future editions.

William P Scherer, DPM, MS, Delray Beach, FL

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03/13/2023    Rod Tomczak, DPM, MD, EdD

AACPM Announces Release of Revised Curricular Guide

I want to take this opportunity to congratulate
Denise Freeman on the superb job of overseeing the
impossible task of constructing a Curriculum Guide
for the Colleges of Podiatric Medicine. She had a
most thankless task.

I was chair of the curricula committees for both
the DPM and DO colleges in Des Moines for six or
seven years and co-chair of the MD curriculum at
Ohio State University for a few years. I have
learned a few truths along the way.

• The medical school curriculum is malignant. If
not treated aggressively, it will grow at an
astronomical rate just like a malignant tumor.
Everyone on the committee is certain their
specialty is being short changed in the classroom
and needs more hours of exposure devoted to their
specialty. If a department can show they have more
contact hours in the curriculum, they deserve more
faculty members; hence a stronger department when
it comes to faculty votes and tenure. I spent
many hours arguing with a neuro-ophthalmologist
about lecture hours for second year students.

• Once a curriculum is in place, it is easier to
move a grave yard than it is to change that
curriculum.

• It takes a very brave soul to admit some contact
hours in his or her specialty can be cut. He or
she will be subject to derision and scorn by other
members of the department once the curriculum is
published.

• Medical schools today are preparing students for
the next level of training, not entry level into
practice like podiatric education was tasked to do
50 years ago. It is up to the residency and
fellowship faculty to help the new graduate learn
the more advanced clinical aspects of being a
podiatrist.

• Medical schools help students become lifelong
learners. Adult learners and podiatrists in
practice will discover what they need to know and
learn it. That might even be what the report from
a neurologist-ophthalmologist concerning your
diabetic patient with diabetic retinopathy means.

• Clinical faculty in medical school are probably
held to a higher standard of care than most
podiatrists. MD and DO residencies are divided
into two broad categories, community-based and
university-based. University-based graduates are
usually held in higher regard when it comes to
jobs. I can't count the number of times
podiatrists referred difficult cases to the ivory
tower for care. I remember seeing HIV patients
early on referred by local podiatrists because,
"Dr. Tomczak has special equipment to take care of
your ingrown toenail."

• These days potential faculty have to audition
before they are hired. They have to lecture in a
classroom, facilitate students in small groups and
discuss patients after they are seen in the
clinic. I have seen private practitioners with
the desire to teach break out in a cold sweat and
tremble when confronted by challenging students.
Thank God there are gifted teachers who are
willing to undergo the rigors of academia to
insure the future of the profession. Leonard Levy
lectured on the manifestations of foot pathology
to both DPM and DO students in every system at Des
Moines and saw patients a couple days a week in
the clinic.

• In the Curriculum Guide the words orthotic or
orthosis are mentioned nine times. That in no way
diminishes the importance of orthotics. Students
can watch a resident fit a patient or scan a
patient. Personally, I think they should learn how
to cast a patient to learn what the scanner and
computer are doing, but that could come later.

• Personally, the three most important pages in
the Curriculum Guide are pages 242-244.

Rod Tomczak, DPM, MD, EdD