06/17/2025    Rod Tomczak, DPM, ME, EdD

Updating Podiatric Medical Education

RE: Updating Podiatric Medical Education
From: Rod Tomczak, DPM, ME, EdD

I have recently been criticized for my views on
podiatric medical education with the same old
trite and hackneyed medieval jargon. For example,
“It’s easy to criticize….”, “Monday morning
quarterbacking…”, “Come join the team rather than
sit at home and judge,” “That’s not been proven to
work in podiatry,” and of course, “Where are your
positive suggestions rather than negative
disparagements?” The information we get on a daily
basis pertains to the 99% residency placement
rates. We all know by now there are a lot more
residencies available than there are graduating
students to fill them. The residency match table
has turned 180°. Not long ago, it was students who
suffered a blow to their self-esteem when they
were left out in the cold by not matching and had
to scramble on their own for post-graduate
training. Often this involved placement in a non-
approved preceptorship of which there were some
great ones, but not CPME-approved for board
certification through the ABFAS route. Now,
residency directors feel embarrassing slaps across
the face when nobody chooses their program. The
sentence, “Whom did you match with?” has taken on
a whole new meaning. Today AACPM boasts a 99%
residency match rate for graduating students. What
happened to the 1%?

Residencies are funded by Medicare and hospitals
pick up very lucrative funds to pay indirect and
direct costs which are what the hospital receives
for having a resident and residency directors are
funded as well as a resident’s salary. It’s an
economic blow to everyone when no resident matches
and shows up July 1. The medical director of the
hospital calls the residency director to the
carpet and wants to know why not one of the
podiatry graduates wanted to come to Slow Stream
Hospital. Determining what the combined direct and
indirect costs are can mean the hospital loses
about $150,000 per resident per year. Figuring out
the exact reimbursement to the hospital is like
trying to figure what the average podiatrist
earns.

CPME publishes on the web something called
Programmatic Outcomes. One part of this
publication is the piece called Four Year
Graduation Rates for each of the nine colleges
that graduated classes in 2022-2024. The average
graduation rate for the nine colleges is 80%.
That’s about one percentage point above a hard
“C.” grade. Many podiatrists reading this will
remember that almost every entering freshman
graduated in May four years from entering. Three
of the nine current schools were in the 70%
graduation rate and one in the 60% range. The
first thing I want to know is why. Did they fail
out? Is there anybody who interviews for podiatry
admission today who is not accepted? Temple and
Des Moines had a graduation rate of 90% or more.
Are they more exclusive in acceptance and actually
reject some students?

If the last 50 years of medical literature tell us
anything there are some accurate predictors of
student success based on GPA, organic chemistry
grades and MCAT scores. Are schools paying
attention to these predictors or do the schools
accept anyone and allow an immediately at risk
student to start incurring massive debt? This
student does help the school meet another year’s
payroll. If these last two suppositions are
correct, I posit we have crossed into the moral
gray zone and are now on the wrong side of
encouraging lifelong credit problems. Our
collective conscience has gone the way of mycotic
nail dust and may be irretrievable. The end
justifies the means and every moral platitude is
junk mail.

There is an equally interesting National Board
trick which may or may not be in use. This could
be as secretive as how and who gets a product Seal
of Approval by the APMA. We older podiatrists
remember the whole podiatry class showing up
somewhere at the end of the summer of our second
year to take National Boards for two days. Ten
schools took part 1 National Boards and had an
overall pass rate of 90% which is much harder than
part 2 where the pass was 98%. We all remember
those part 1 scores being used for residency
selection. In MD programs, and DPM also I suppose,
all students must pass part 1 before being allowed
in the clinic or to move to year three. If you
can’t pass a retake, you are failed out of school
or must repeat a year. As a student you are
allowed to pay tuition and keep going until you
can’t pay, leave or reach the maximum number of
attempts allowed then forced to leave.

Another trick is to administer “practice” tests
and if you can’t pass those, your application for
part 1 is not approved by the school, but you have
already paid two years tuition. Caveat emptor,
Applicant.

Let’s put all the academic gamesmanship aside and
look for some answers. Teaching and learning ideas
some of us knew would work were proven true in MD
and DO schools because of the impact of COVID on
medical education. Caribbean schools contributed
to the epistemological truth of medical education
and some continue today. No one wants to
quarantine in a tight room with 150 of their
closest friends who have just come from seeing
really sick patients and have not had time to
shower. These ideas can be used or modified to
serve podiatric education today.

Suppose a live lecture is scheduled for Tuesday
morning. But you can ZOOM the lecture Monday night
at home because the lecture is being given live to
no one in the classroom. In fact, you can ZOOM all
four Tuesday morning lectures starting Monday
afternoon. Correct, the live lecture is given to
an empty room by the teacher. On Tuesday you can
attend the lecture again or attend a small group
case-based session with your group of eight
students to discuss the lecture and solve patient
cases related problems based on that particular
lecture.

Students love problem-based learning (PBL). Ohio
State could not find enough facilitators (one PhD
and one clinician) to host 15 first year and 15
second year groups. Of course there is always
pushback from insecure faculty who will tell you
they can’t be sure a student learns everything
they need to learn in pbl, but if students attend
their lectures they will learn everything that
needs to be learned. Why? Just look how
prestigious and learned the lecturer is. I
disproved this in my dissertation and in numerous
medical education articles published in reputable,
not obscure throw away, journals.

If podiatrists teaching at the schools wanted to
all work together and synchronize schedules, an
absorption gastroenterology lecture could be given
live Monday night to no live audience at PCPM and
ZOOMED to the other schools across the country and
students could attend another showing Tuesday or
attend a small group discussion. A lecture on
peristalsis might be given at Des Moines on Monday
and ZOOMED to the other schools and the same
protocol followed as the absorption lecture. We
could do the same for third year students with
bunion procedures and devote a week on the topic
and have academic lectures from all the schools
but not repeat the topics at all eleven schools.
In order to form this academic consortium egos
would have to be deflated, but the economic
rewards for the schools, especially when there are
thirty students in a class in Florida would be
unbelievable. All the schools could be salvaged
until applicant pools get back to where they
should be.

Another alternative would be to offer more ZOOM
lectures. Students could come to school two days
per week where they could see clinic patients and
put some meaning behind the sometimes-tedious
lectures. Immediate applicability
Another option to make podiatry school more
attractive is to invert the curriculum. Day one of
podiatry school would be what is now day one of
the third-year clinics with some of the fourth
year inserted. The idea behind this is to bring a
lot more meaning to the basic sciences which start
on day one of the second year. We all felt the
basic sciences were irrelevant as do most medical
students. The main reason for not doing this is
because it’s never been done that way before. We
are not turning students with scalpels and power
equipment loose in a room full of bunions. The
main reason for doing this is that the entire
concept is attractive to potential students. You
know, those souls who keep the schools open but
today we don’t see so many applying.

We all know we can produce an incredible product
that is very important to society. How much does
it cost to put 20 students in a classroom? How
much does it cost to put 25 students in a
classroom? No more than 20. Suppose we offer
reluctant students a plan where they could attend
podiatry school for a year, hopefully full of
clinical experiences with germane clinical
readings at home and testing like we test third
year students now.

Consider this offer. Don’t let the school act like
they are doing a favor by even interviewing the
student. We could offer students their money back
after one year if they think they don’t like
podiatry and they leave school. No risk for
tuition-only loans. They borrow to live on and pay
that back also. Would the schools attract more
students than ones not offering the program? I
think so. All of a sudden, faculty would have to
work very hard to make students happy about their
experience. Students, knowing their risk is
diminished may just swing the pendulum back to
where podiatry applications deserve to be.

The literature proves that students don’t need us
as much for hands on guidance as we think they do
and can learn an awful lot on their own. Students
that have access to an independent study
curriculum rather than suffer through the being
hovered over drone experience do just as well as
the close contact helicopter experience. Once
again, it’s the teacher who worries because they
fear being replaced. They are not needed like they
thought. Faculty are needed, but in a newly
defined role. Faculty have more time for research
and writing and getting grants. Students are a
newly defined entity, so why not faculty?
Somebody, somewhere, decided what adult podiatry
students want and need because it’s what those
teachers wanted or felt they needed when they were
in school.

Malcolm Knowles, the father of adult education
penned the seminal works on the topic of adult
education. The basis of his work was soldiers who
came home from WWII and took advantage of the GI
Bill. These were soldiers who hit Normandy or
Pacific beaches, fought their way to Berlin or
Japan and became adults along the way. They
weren’t kids anymore. Educators felt teaching
adults was so important they gave it its own name,
andragogy as opposed to pedagogy which is the
theory of Piagetian child learning. Knowles came
up with a few concepts we might think about
including when we make decisions about podiatric
education.
1. Students move from being dependent learners to
independent self-directed learners.
2. Adult learners bring a plethora of experience
to the learning experience and can apply this
proficiency to the learning situation.
3. Students have a readiness to learn and are
eager to start the process.
4. Students move from subject centeredness to
problem centeredness and are anxious to put what
they have learned to immediate use. They are not
satisfied with the delayed application of the
material.
5. The motivation to learn is internal. They do
not have to be in school but choose to be.

Along with these concepts are principles of adult
learning:
1. Adults need to be involved in the planning and
evaluation of their instruction. I was on the
curriculum committee for four years at OCPM. There
was never a meeting to my knowledge.
2. Experiences, including mistakes, are a basis
for learning.
3. Adults are more interested in subject matter
that has immediate applicability to job or life;
hence traditional third year clinic swapped for
the traditional year one could work very well.
4. Adult learning is problem-centered rather than
content oriented.

These ideas can have a profound impact on the way
the curriculum is developed and delivered. I’m
sure the CPME response to these suggestions will
be that we already do some of these, Well, of
course you do. CPME has a history of radical
educational thought. When I introduced problem-
based learning into the third-year podiatric
medicine and surgery at Des Moines I was
personally threatened with rescinding our
accreditation before members of the visitation
committee even read the documents or set foot on
the campus. This occurred at the ABFAS
examinations in Chicago where I was an oral
examiner. Always open to new ideas, that’s
podiatry. I will expound on the nine ideas above,
but in the meantime ponder the conclusion I have
come to. It is easier to move a cemetery than
change podiatric minds concerning education.

Rod Tomczak, DPM, MD, EdD, Columbus, OH

Other messages in this thread:

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06/20/2025    Lawrence J. Kansky, DPM, JD

Updating Podiatric Medical Education (Rod Tomczak, DPM, MD, EdD)

While I have never met Rod Tomczak DPM, MD, EdD, I
fully support his opinions about our podiatry
profession, that he writes about in this forum.
From my perspective, Dr. Tomczak speaks the truth.
It is unfortunate, that because he appears not to
be politically connected, and because he exposes
what is actually happening at our podiatry schools
and in our profession, he gets irrationally
attacked over and over again, by other writers to
PM News. What a shame.

When I attended podiatry school at what is now the
Temple School of Podiatric Medicine, (formerly
PCPM), on a full National Health Service
Scholarship, from 1979 to 1983, I did everything
right. I served a one year residency, became board
certified by ABPS, became a fellow of ACFAS, and
in 1993 was elected Chief of Surgery at St.
Joseph's Hospital. However, my educational
experience and training was nothing close to that
which my wife and two (2) daughters received in
becoming non-podiatric doctors.

Many of my podiatric teachers and clinicians were
quite intellectually inferior. For example, I had
a psychology professor who invited students to his
office to discuss the wrong answers they chose on
his exams. After one exam, I went to this
professor' s office and he told me two (2) things:
first, that I knew the correct answers to the
questions I got wrong but I just did not want to
pick the correct answers, and second, that I
needed to get down on my knees in front of him and
become " born again"! I ran away as fast as I
could!

Another day, I had an experienced podiatric
orthopedic (stupid term) clinician, a licensed PA.
podiatrist, to oversee me for a patient I had who
was scheduled for a casting for orthotics. I
proceeded to cast this patient as I was taught, in
a non-weight-bearing neutral position. Then as
required, I brought the created plaster casts out
to this esteemed clinician for evaluation. This
licensed podiatrist told me my casts were
"horrible" and not in neutral position, so go back
and do the casts again, which I did. He told me
these 2nd casts were better than my 1st casts but
still not good enough, so I was instructed to go
back and take casts for a 3rd time.

However, this time, I chose to hide in bathroom
and not do a 3rd casting because I felt this duly
licensed podiatric clinician had no idea what he
was doing. After about 15 minutes, I took my 1st
casting out to this clinician to be evaluated,
(that he already said were horrible), and this
time he said these casts were "excellent"! The
only thing I learned was that this podiatric
clinician was an idiot.

Also, during my time at PCPM, there was a guidance
counselor, who made male students strip down to
their underwear while he was counseling them.
This was common knowledge. How was this okay?
Unfortunately, there was and students still tell
me, much wrong with podiatric education and
podiatric practice. So, now it takes 7 years after
4 years of college to become an office-based
podiatrist. This is ridiculous. This time period
should be reduced down to the same as dentistry,
optometry, veterinary medicine etc.

The number of podiatry schools should be reduced,
and podiatry schools should only hire the very
best educated and trained podiatrists and
professors, to prevent against the harming and
disillusionment of students.

As an attorney, past and present podiatric
students have contacted me for advice. For the
past decade, I have been an invited lecturer in
Hershey Medical School's Law and Medicine class,
where I teach 4th year medical students how to
avoid legal trouble that they can find themselves
in, through no fault of their own. I tell them my
personal story of being charged with I crime I did
not commit, and how this experience propelled me
through law school, enabling me to graduate with
honors in just 2 years.

Like Dr. Rod Tomczak, I have contacted some big
shot podiatrists and podiatric residency programs
to offer my perspective and help, with no
response. Our podiatric profession is doomed if
it continues to refuse to face the truth and not
do everything possible to improve. Politics is
okay for interdisciplinary purposes. But politics
should not play any role in the education or
training of future podiatrist. Every podiatric
student deserves to be respected, treated fairly,
well educated, and most importantly always told
the truth. (Wasting money to create a marketing
video is not the answer, as pre- med college
students are not stupid).

Thank you again Dr. Tomczak. I am proudly on your
side, and look forward to reading more of your
transparent, very reasonable, and truthful
opinions.

Lawrence J. Kansky, DPM, JD, Kingston, PA