President's Perspective April 2015

Richard Derner, DPM FACFAS

"Do the Right Thing" — Spike Lee
Richard Derner, DPM, FACFAS
ACFAS President

Often times, my two boys and I talk about movies and quote famous movie lines—something I’ve learned is not uncommon, especially among friends. To my wife’s chagrin, we continue to quote famous movie lines frequently. They almost always make us think and sometimes laugh. Therefore, I have decided to start my President Perspectives with a famous movie quote and relate it to a relevant topic affecting our profession.

As we mature, we are told or reminded most often by our parents and mentors to “do the right thing,” and we soon realize that “right thing” requires a great deal of work. Human nature sometimes leads us to take the easy way out, and we often do, not realizing there are consequences. Once we understand the ramifications of not doing what’s right, we’re often surprised, maybe even shocked. This gives way to an epiphany and realization of what was truly needed or should have been done initially. But doing the right thing at first, although sometimes difficult, pays off in the end.

Every six years, the Council on Podiatric Medical Education (CPME) reviews its residency standards (Documents 320 and 330). The last major revision in 2009 is when the three-year residency was standardized with a specific number of surgery cases required. I firmly believe the 2009 revisions were a giant and historic step forward in podiatry’s movement to full professional parity.

In late 2014, CPME released its next round of revisions to be adopted in 2015. ACFAS is now reviewing CPME’s proposed changes, but we see one glaring problem—lowering of case requirements for residency matriculation. For years, residents and programs have been using a quantitative assessment for determining the quality of a program. The number of cases or procedures alone doesn’t provide much detail of the progress of a resident, nor does it give an idea if a resident should be granted a certificate for graduation or move up to the next year. That being said, surgery case numbers are important in giving experience in the training process.

As in golf, repetition of a poor swing often results in errant shots and a high handicap. The amount of swings doesn’t guarantee a lower handicap or improvement but getting instruction from a trained professional usually does. To this point, higher caseload doesn’t necessarily result in a better surgeon either. However, it at least gives more opportunities to further one’s experience and hand-on experience with a trained instructor.

Resident training should be standardized in a manner that quality can be assessed and quantity is an adjunct. If a resident requires  additional help in order to progress to the next year, more cases aren’t necessarily the right answer alone. Quality training is critical for residents to better their surgical technique and continued training may be required in a specific procedure if there are obvious roadblocks toward improvement.

There are a few reasons being bandied about as to why CPME would consider lowering the requirements for residents—and none of them really make sense to me. The residency shortage is improving, slowly but surely, as most of us have seen. In my opinion, the lowering of surgical cases required will not increase slots for residents. This will only lower the quality of ALL our graduates.

CPME’s proposal to cut the number of surgical cases in half to create a separate category is not doing the right thing. We have come too far as a profession to consider going backward in the training of future foot and ankle surgeons. ACFAS has continued to enhance the education and training of foot and ankle surgeons with many of its offerings. We don’t feel going backward in training or offering less is an option, neither should CPME.

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