Category Archive: Resident News to Use

Recommending the Proper Running Shoes

By Vinay Matai, DPM

With so many brands and styles of running shoes, recommending the correct one can be challenging and overwhelming. We can choose to refer the patient to a local running store or as podiatrists use our knowledge to educate him/her on choosing the proper footwear.

First, the patient needs to understand how complex the foot structure really is: 26 bones (28 with sesamoids), 33 joints and over 100 ligaments. As Leonardo DaVinci stated, “the human foot is a biomechanical masterpiece.”  Understanding the patient’s biomechanics are crucial in choosing the right shoe. A complete exam including a biomechanical exam and asking the patient specific questions will help determine the best type of shoe. Here are a few examples of questions you may ask to better understand your patient’s needs.

What type of activities do you plan on using the shoe for? Walking, running, high intensity interval training (HIIT), trail/mountain walking, or simply for standing up at work.

What is the most important feature of the shoe? The patient’s response is usually one of style, comfort, or support.

How old are your current shoes? Look at the treads of the shoe. Remember, the life of a shoe is approximately 300-500-mile range, but factors such as body weight and type of activity may affect the livelihood. Examining shoe wear and tear can tell if it’s expired.

What is your budget? This question can be sensitive and difficult to ask. To circumvent this, notice the patient’s shoes during the encounter. The brand and style can tell us price points without necessitating the question. Their shoes tell a story- the type of work they do or their buying pattern.

What shoe brands do you usually purchase? Brand loyalty is very important with millennials and even Generation X. This is important because if they are loyal to checks or stripes (Nike or Adidas), then you are going to want to suggest something that’s in-line with their psyche, or be prepared to spend a little more time convincing them that the brand they’ve been wearing for years will no longer meet their biomechanical needs.

Are you a runner? What are your speed goals? Will the shoe be used for distance running or sprinting? Is the patient training for a 5k or a half marathon? The weight of a shoe can affect race times- the heavier the shoe the slower the time.

Now that we’ve gained additional information, we must educate our patients on the types of running shoes and parts of a shoe. There are 3 main categories when it comes to athletic shoes: neutral, stability and motion control.  There are however a few more specialized categories such as minimalist, zero-gravity shoes, rocker bottom, track or trail shoes.

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Neutral:  Neutral shoes are great for a person with a normal or medium arch height. They can also work for mild pronators. Neutral shoes do not guide the foot, rather they allow the foot to move naturally within the shoe. The design is usually absent of a stabilizing frame or medial post.  One thing that varies among neutral shoes is the amount of cushioning and the weight of the shoe. Some people prefer a high cushion shoe while some may prefer a lower profile shoe with minimal cushioning. Notable examples of neutral shoes are the Nike Pegasus, Brooks Ghost, Asics Cumulus and a high cushion option is the Hoka Bondi.

Stability: Stability shoes are made with stability features such as a medial post or a stiffer material through the midsole. They often include guide rails which control side-to-side motion. This type of shoe is great for those with mild to moderate pronation or someone with normal to low arch height.  These shoes are more rigid than neutral shoes but not as rigid as a motion control shoe. Notable examples of stability shoes are New Balance 860v9, On Cloudflyer, Saucony Guide ISO 2, Nike Zoom Structure 22, Asics GT2000, Brooks Adrenaline GTS 19, and Hoka One One Arahi

Motion Control: Motion control shoes provide the most stability. If you have a patient with a symptomatic flat foot with a flexible deformity, this style should be recommended. Warning! These shoes can only be found in your specialty running store. Motion control shoes are for your mild to severe pronators and usually have a firm post that reinforces the arch, stiffer heels and a designed to counter overpronation. Often times shoe companies have a proprietary component that enhances their arch, for example  Hoka One One’s J-FRAME™ adds support by using a firmer density foam on the medial side all the way to the front of the shoe and extending back on the heel’s lateral side. Notable examples of motion control shoes are. Hoka One One Gaviota, ASICS GEL-Kayano, Brooks Addiction, and Saucony Omni

With these helpful tips, you can now speak with confidence in recommending brands or styles of shoes. I do recommend visiting local running stores and building relationships with their staff. Often you can pass discounts from running stores to your patients with your referral. Your local running store is also a great place to give small presentations and get to know local runners. It is a great opportunity to build your brand and market yourself for free.

A Surgeon’s Perspective on the Value of ABPM Certification

By: Stephanie Hook, DPM

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Everywhere you turn, people have their opinions and thoughts on what your future should hold.  Surely, your peers, residency director, attendings, friends and family all have your best interests in mind.  All this input can become overwhelming and cause decision-making to become more difficult.  You already must decide if you will specialize within podiatry, where you want to live, if you want to join a group or be a solo practitioner, and so much more.  On top of all of that, deciding which board examination to take can cause your head to be left absolutely spinning.

When I started residency, before three-year programs were the norm, I did not want to be a surgeon.  I matched in a two-year program at Catholic Health System/Sisters of Charity Hospital in Buffalo, New York.  I was excited to start my career journey at a program that was well recognized and accepted within the hospital.  I loved everything I was doing and could not wait to get into my own office and start helping patients.  I loved the “routine” care.  I even often stated that one of the things I loved most was when patients came in, I could treat them, and send them home feeling better.  Personally, I think seeing how you were able to help someone immediately was gratifying.  I thought that was the ideal career path for me.

Becoming a Surgeon

Imagine my surprise when, within one week of surgery rotation, I was hooked.  I knew I needed to be a surgeon. I don’t recall exactly when, but early in my residency, my director asked if I would be interested in completing a third year.  I jumped at the chance to get even more surgical exposure and training.  I then completed my three-year residency, learning surgery from podiatric and orthopedic attending physicians.

After completing my residency, I joined a podiatric practice in Central New York.  At the time, there were eight podiatrists within the group that covered eleven offices in the greater Syracuse area.  My practice picked up quickly and I worked hard building my practice and my reputation.  Within a couple of months in practice, my surgical volume soared.  I was doing cases as often as I wanted, but still spending many hours a week in the office.  It was the perfect balance for me.  This was the life I was meant to have.  As my time in the group continued, I became a part of four area hospitals and also began volunteering on some New York State Podiatric Medical Association committees.   Eight years into practice, I had wonderful patients, loved my job, and loved my life.

How could it get any better from there?  Three years ago, I was asked to join an orthopedic practice.  I am part of an extremely large group, again in the greater Syracuse area.  While they were originally looking to hire a non-surgical podiatrist, I asked for that to change.  I had performed surgery for eight years while building my reputation and patient relationships and didn’t want to sacrifice my current state of practice.  I dramatically increased the number of patients seen every week in this new group, and I am an appreciated colleague in an amazing company.  The support I have is so meaningful.  It allows me to grow as a podiatrist, but also gives me the opportunity to spread my wings.  Since joining my company, I have kept my same surgical volume, increased my office visits, and have still had time to become more involved.  I am now able to serve our great profession as a Trustee of the New York State Podiatric Medical Association, the Chair of the Public Education and Information Committee of the NYSPMA, and as the Student Chapter Coordinator of the American Association for Women Podiatrists.  I also serve the ABPM as a Membership Committee Sub-Chair, working with Crisis Communication and Audit Committee.  I still am affiliated with four hospitals and now also serve as the Podiatry Division Chief at Upstate Medical University Community Campus.  In my thirteenth year of practice since graduating residency, I have shaped my career to be exactly what I have hoped it could be.

One thing I have not mentioned yet is that I am single-boarded.  To keep this story as honest and forthcoming as possible, I originally decided to take a single board because I have test-taking anxiety.  The decision of which board to take was extremely simple for me.  When reviewing both boards, I found the American Board of Podiatric Medicine certification to be more comprehensive.  Just because surgery isn’t in the name does not mean that it is excluded from the certification.  I also examined what the boards are doing to help further our profession.  I have personally witnessed the ABPM work tirelessly to promote its members and our profession, which is yet another value I receive with my certification.

The Value of ABPM Certification

I believe my ABPM certification to be better for me as it is all-inclusive.  I also find that it is a more understandable and recognizable name for my patients.  There will be plenty of patients who will be dead set against the idea of surgery. There are, of course, plenty who do desire surgery.  I believe that the simple statement “Certified by the American Board of Podiatric Medicine” conveys to both of these patients that I am accomplished and recognized in my field- which is podiatry.  All podiatry.  In the years since achieving my ABPM certification, I have tossed around the idea of sitting for my surgical boards but have elected not to do so.  I have seen no negative impact on myself, my career, or my patients from my decision.

At the end of the day, you have to do what is best for you.  I can tell you that I would not change my choices.  I am proud to be a Diplomate of the American Board of Podiatric Medicine.  As I stated earlier, I am simply sharing my story so you can see how your choices are simply that- YOUR choices.  Choose the board(s) that make sense for you, your career, and your patients.

 

 

Clinical Presentation Skills: Avoiding Burnout as a Resident and/or Young Physician

by Priya Parthasarathy, DPM

I’ve seen it happen from my earliest days of residency- exceptional physicians with or without family obligations who struggle to cope with the constant demand of being a physician. But the statistics are staggering.

According to the American Medical Association (AMA) more than 40 percent of physicians are experiencing at least one sign of burnout and physicians suffer burnout 2 times more than other US professionals. In a 2014 survey of 504 medical residents at the University of North Carolina, 70 percent met criteria for burnout based on the Maslach Burnout Inventory, a common tool used to assess burnout.

The consequences of physician burnout are serious and wide-ranging. From poor job performance to—in the most extreme cases—medical error and clinician suicide. This piece will focus on a subset of the profession—residents and young physicians.

What is burnout?

Physician burnout is defined as a “syndrome of emotional exhaustion, depersonalization, and a sense of low personal accomplishment that leads to decreased effectiveness at work,” according to Shalafelt et al in the American Journal of Medicine.

It differs from depression because it primarily affects an individual’s relationship to one’s work and it most frequently occurs in people whose work requires an intense involvement with people – physicians, nurses, social workers, and teachers. Challenging circumstances at work are likely to spill over into one’s personal life. It is difficult to keep one’s professional and personal life separate.

Why does it affect Young Physicians and Residents?

Though young physicians and residents have only been in practice for a few years, they are still susceptible to burnout. It is certainly not an overnight change, but overtime, through an accumulation of factors. Physicians can burn out at any stage of their career due to endless documentation requirements, long hours, emotional strain of cases, and patient frustrations from lack of knowledge about their insurance providers. Recently, the new age of patient satisfaction surveys may lead to the practice of overtreatment. Physicians can burn out at any stage of their career. The triggers can be endless, but it is important the individual and the industry find ways to cope.

What are the symptoms of burn out?

Symptoms are different for everyone, but the literature outline’s exhaustion, cynicism, and becoming emotionally detached from patients as the most prevalent signs.

Lack of enthusiasm or motivation for work, frustration, passivity, detachment, reduced efficacy, behavioral extremes, mistakes, compassion fatigue, insomnia, depression and health issues are other symptoms described.

How does it happen?

The AMA highlights 7 scenarios which may put you at risk for burnout.

1. You have a high tolerance to stress.
2. Your practice is exceptionally chaotic.
3. You don’t agree with your boss’ values or leadership.
4. You are the emotional buffer.
5. Your job constantly interferes with family events.
6. You lack control over your work schedule and free time.
7. You don’t take care of yourself

As young doctors, it is important to consider these factors when choosing your place of work or next steps in your career. Yes, it may be impossible to check all these boxes off as you may focus more on salary, benefits and patient volume. Your well-being should be high on the list as well.

Coping mechanisms

Your mental health is important. Here are a few coping mechanisms that can help you avoid burnout.

1. Take your vacation

There are many reasons you may choose not to take a vacation, especially in your first few years out of practice. You may feel guilty because you are the “new hire,” or your place of work may have the attitude that vacation is a luxury. Common sentiments are, “I did not take a vacation for years when building my practice,” or “I have never taken a 2-week vacation.” These should not determine whether you take a vacation or not.

Personally, I am guilty of limiting my vacation. Being percentage based, when I do not work, I do not get paid. Nevertheless, this is not a reason to not take my deserved vacation. My husband and I feel that we overstress about our patients and the office on vacation. However, we have to learn to maintain a positive attitude and not think about work so much when we are away. As my acupuncturist (yes, I see an acupuncturist) says, “we treat our bodies like ATMs, we take and take and take but never deposit.” Think of vacation as paying yourself back for all the hard work that you do.

2. Exercise

Exercise is a common stress reliever for many people. It can be especially useful in coping with physician burnout. Working exercise into your day can be as easy as a 10-minute walk at lunch (if you get one) or building in efficient workouts such as HIIT (High Intensity Interval Training) into your schedule. If you continually neglect yourself, you may neglect your patients too. My husband and I have invested in a Peloton so we can jump on the bike for even 15-20 min. We found it is a great stress reliever and so time efficient.

3. Say “NO” more often

When I first started practice, I thought I had to say yes to everyone and everything. I did not want to be known as the lazy new associate as I was building my practice. I slowly began to realize that it is important to slow down and I don’t have to take on every case. It is crucial to set limits for yourself and respect your boundaries. It is important to remember that you don’t have to prove yourself to anyone.

4. Live within your means

This is a big one. Especially after you graduate residency, doctors are frequently expected to have the nice cars and big homes. We make the big bucks, right?
Reducing your monthly expenses will reduce the pressure on you to earn more income.
By reducing your spending, you will have less urgency to work to make money.
Furthermore, when you reduce your spending you may be able to cut down your work hours.

5. Find a place where you are happy

This one is particularly tricky to identify but necessary to prevent burnout. Whether you are at a large hospital or private practice, physicians need to feel as if the people leading them also share their values for medicine and patient care. Otherwise, their motivation can slowly wane.

6. Spend time with your family and loved ones

It is important to build and maintain connections with your family and friends. It is so easy to get caught up in the medicine or upper middle-class bubble. It may change your outlook on life.

7. Share and learn from other physicians

This is especially important in residency. You have an endless network of physicians to talk to about their work and their lives. Learn through their experiences. Attendings can discuss what fulfills them and how they handle fear and failure. We often talk about revisional surgeries and how to deal with complications, but we don’t discuss the effects it has on us mentally. It is important to hear how others deal with challenging situations. Promoting wellness in physician trainees is key to preventing burnout.

8. Therapy

We head to the Doctor, Dentist, Optometrist annually for a checkup. What about a mental health check? We often neglect the part of the body we use the most, our brains! Scheduling periodic mental health checks and finding a therapist you can turn to before you need one is a good proactive approach.

Resources

There are many resources available to you.

The APMA has a well-being index on their website. The “Well-Being Index” is a quick, confidential survey from the Mayo Clinic to access your own well-being and see how you compare with your peers. There are also many articles and resources on physician wellness. This is a free resource available to members.

https://www.apma.org/wellbeing

The AMA’s STEPS Forward™ open-access platform offers innovative strategies that allow physicians and their staff to thrive in the new health care environment.

https://www.ama-assn.org/topics/physician-burnout

Final thoughts

It is important to remember that we are both physicians and human beings. There will be nights that we will not be able to sleep worrying about a patient or a surgical outcome and that is ok because we are human. It is important to find your own method of separating your work and personal life. This is particularly challenging for those of you in residency. While residency can be a time of frequent self-doubt and feeling underappreciated, it is important to remember that your patients look to you for guidance as a doctor and you have earned that privilege.

It is also important to remember that the onus is not only on us as doctors but also on the health care community to work on solutions to this complex problem. My goal was to shed light on this very important topic and provide strategies that you can implement now, early in your career.

Clinical Presentation Skills: How to be a Stand Out Applicant for Employment

PGY-3 Year…Freedom at Last! Right? 

How to be a stand out applicant for employment

By: Jonathan D. Rouse, DPM, DABPM

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Your phone goes off in the middle of the night. You pop up immediately because you are a PGY-3 and you’re used to this lifestyle now. You’re just happy it’s not a pager going off…until you see it’s your junior PGY-1 calling. You pick up and they ask you how to order a medication in the EMR. Of course you’re happy to help because you are nice and empathetic. You get it; you were once a PGY-1 trying to figure out how the heck to input orders in the system.

We’ve all been in the trenches. The first day of residency, wide-eyed, scared and asking ourselves, “What did I get myself into?!” Then second year comes and you’re so used to the smell of wounds that you can probably eat lunch while treating them, although unsanitary and not recommended. By the end of your PGY-2 year, your confidence level is usually beginning to peak. Your PGY-3 year starts, and the feeling of being near the top of the food chain is ephemeral as you realize that you soon need to find a real job while still completing your training. While nothing can replace great training and confidence, there are some preparations that can aid you in standing out against other applicants.

Curriculum Vitae (CV)

The CV is a living breathing document. I personally view it as a professional diary as it shows everything that you have done in relation to your professional life. It’s hard to fill up during residency because you are so busy training, but it should be updated at least quarterly. Once in your PGY-3 year, it should be updated monthly. I recommend keeping a list on your phone of information to add, then once the time comes, you aren’t struggling to remember information. Also, when saving the file, I recommend putting the date last updated on the file so you are aware of the last time you made updates. Everything you do, whether it be workshops, cadaver labs, research, specialized trainings, published journal articles, pending journal articles, poster presentations, etc., needs to be on your CV. The bullet points should be quick and to the point, however, elaborating on your residency training is a good idea so as to not undersell or oversell yourself when the time comes to apply for employment.

Your CV is also a reflection of your organizational skills. It should have a natural flow and be separated into different headings such as: Education, Professional Training, Work Experience, Research Experience, etc. It should also be chronological within each sub-heading. The job you’re applying for may have 30+ applicants depending on the position; if the reviewer has to jump all over your CV to try to figure it out, it’s going in the trash. Proofread, proofread, and then proofread again. Then have your parents, spouse, best friend, whomever proofread it again.

Your professional references are also very important, so ensure you are selecting people that can speak positively about your professional and clinical skills. The interviewer(s) will more than likely contact your references to learn more about you as they will only get to know a little bit about you in your interview.

Cover Letter / Letter of Intent

A Cover Letter or Letter of Intent should be supplied with every employment opportunity you apply for along with your CV. Before applying, do your research so you can explain why you think you would fit into that particular practice / hospital. Explain how you think you can help the practice / hospital become successful with your skill set. This is a chance for you to sell yourself, so make it count! Again, proofread, proofread, proofread.

One of your best resources is the product reps in the area you are looking to work. They will know about job openings, personalities or different doctors, which surgical centers have the best food in the doctor’s lounge, etc. They are at your disposal and are full of information that can aid you. Nothing will make you look better than going into an interview and knowing nearly everything about someone’s practice or hospital. Just act surprised when they tell you they have Surf and Turf daily in the Doctors’ Lounge! (Do these even exist anymore)?

Logs

Once you meet the minimum required number for surgical procedures, biomechanicals, H&Ps, etc., you should stop logging right? WRONG! I believe you should try to log all encounters in residency. Perform a nail avulsion? Debride and perform cryoablation on verrucae? Put on an Ex-Fix (This is not a stand-alone surgical procedure)? Debride a wound and place a bioalternative? These should all be logged as category 6, (Other Podiatric Procedures).

Put a detailed explanation in the Notes on PRR when logged and you have a diary from residency. Your numbers matter! Imagine the strength of a cover letter with sentences such as: “Extremely comfortable in the clinic setting as well as the Operating Room; 10,000+ patients seen in clinic while performing over 800 surgical cases in Residency.”

Or if you happen to be applying to a Wound Care Center part time: “5,000+ patients seen in residency with greater than 25% of them obtaining bioalternative products to aid in healing. Comfortable managing complicated wounds and extremely knowledgeable about the different treatment modalities.”  Statements such as these will set you apart from other candidates as they may not have the data to support why they should be hired over you.

It’s great to be able to have data when interviewing. What if a practice is looking to expand and needs a Podiatrist with RRA experience? You have all of your rearfoot cases, but if logged correctly, you can pull out how many External Fixators, Delta Frames, etc completed in residency. If you can send prospective employers your logs or be able to pull data from them when they inquire about certain skill sets, you will stand out as the numbers speak for themselves.

Be Realistic

Every Doc thinks they deserve to make $1 million per year out of residency. The dues have been paid and now it’s time to get paid the big bucks! But guess what? You will likely be offered a lower salary than you were hoping for, especially if you are entering a practice system versus a hospital system. The reason for the lower salary is that the owner is taking a chance on you. The practice cannot afford to pay you $175,000 guaranteed salary your first year out of residency because you don’t even have any established patients yet! What you should be hoping for is a decent base salary and a good performance based bonus structure. That means the more money you bring into the practice, the bigger bonus you get, which should make you work harder so you can get paid! Do that for a year or two, and now you have some leverage to renegotiate your contract for a larger base salary.

Another problem I see is that a lot of residents are applying for high-volume trauma positions or Orthopedic group positions when they did not receive this type of training during residency. Yes, it can pay more, but if you aren’t qualified for the job, you’re going to be wasting time and money interviewing once and possibly twice for the job. Instead, you could be interviewing for a perfect job elsewhere before someone else snatches it up. Be realistic and honest about your skill set and personality and you will be able to find the right fit.

“Do I Need a Fellowship?”

I get this question A LOT from both residents and students. My answer is always the same: If you’ve had a well-rounded residency experience, you likely don’t need a fellowship. If you feel like you need more confidence in the operating room, go do a fellowship. If you had a void in your residency training and you are uncomfortable with it, go do a fellowship. If you want to be seen as The Expert in a certain subspecialty, go do a fellowship with a targeted focus. It is all a personal choice that only you can answer as you are going through your training.

Remember the Podiatric Roots

80% – 90% of most Podiatrists’ time is spent in clinic. The best thing you can do in residency starting Day One is to learn how to perform a good clinical exam and treat patients conservatively when possible. If you didn’t and you’re at the beginning of your PGY-3 year, you have time left to polish your skills. Most patients don’t want to have surgery unless they absolutely need it. Yes, you may be able to put in a Total Ankle Replacement in 2 hours with no jig and no fluoro, but can you give a proper Hallux anesthetic injection for a nail avulsion without the patient screaming? Don’t overlook where Podiatry came from by focusing too much on surgery. You should be able to teach the PGY-1s & PGY-2s how to do almost everything in clinic during your PGY-3 year. That’s when you know you’re ready.

Board Certification

Getting board certified as fast as possible is the most important professional accomplishment a recent residency graduate can obtain. It allows you to get on insurance plans quicker, get hospital privileges quicker, you will likely get a bump in your salary for being board certified, and it looks professional. The great thing about the ABPM is that you are able to take the qualification exam during residency and the certification exam the Fall after, thus becoming board certified as soon as 4 months after completion of residency. I like to refer to the ABPM as the “Board of What We Do Everyday.” It truly is the only certifying board that recognizes what we do on a daily basis and is one of two Podiatric board certifications recognized by the JCRSB (the other being ABFAS – which can take 1-7 years to obtain). It is important to get board certification quickly and in my opinion, every graduating resident should be signing up for and taking the exam. Dual board certification is very important and I believe all practicing Podiatrists should obtain both ABPM and ABFAS.

My hope is that each resident gets at least one nugget of information out of this article. My advice, especially for those just starting residency, is to remember that this is your last chance before you enter the real world. Once you get that residency certificate, you are practicing under your own license on your own patients. Soak up everything in residency and it will pay dividends for your future. And never forget, “Treat every patient like they’re your mother.”

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Jonathan D. Rouse, DPM is a Diplomate of the American Board of Podiatric Medicine. He is the Chief of Podiatry at the Captain James A. Lovell Federal Health Care Center in North Chicago, IL where he also serves as the Residency Director. He is active on multiple national committees and is very passionate about the growth of the field while still staying true to its roots.
You can follow Dr. Rouse’s adventures on Instagram by following @docrousedpm

ABPM Spotlight! Meet New Director, Bryan J. Roth, DPM

Bryan J. Roth, DPM

Bryan J. Roth, DPM

The ABPM welcomes Bryan J. Roth, DPM as the newest addition to the Board of Directors! Dr. Roth has been a Diplomate with the ABPM since 2015 and has since been actively involved in item writing and examination development for both the In-training and Qualification sub-committees. Currently, he is the subsection Chair for the ABPM Examination Committee’s Qualification Examination and serves the ABPM as a residency site evaluator for the Council on Podiatric Medical Education (CPME).

“Since becoming a Diplomate of the ABPM, my involvement on behalf of the organization has been challenging, engaging, and one I look forward to continue as a Director. I welcome the opportunity to serve as a Director of the ABPM to both shape the organization and, through it, to have a direct role in furthering the advancement of our future residents, physicians and profession.”

He received his Doctor of Podiatric Medicine (DPM) from the Ohio College of Podiatric Medicine, and completed a PM&S-36 residency at Maricopa Medical Center (MMC) in Phoenix, AZ. Outside of serving as an ABPM Director, Dr. Roth is active faculty at MMC within the Department of Surgery, where he serves as Chief of the Podiatry Service, as well as Director of the Creighton University-Arizona Health Education Alliance Podiatric Medicine and Surgery Residency Program.  Dr. Roth also serves both as a residency site evaluator and a surgical case reviewer for the ABFAS. He has authored multiple papers in both podiatric medicine and podiatric surgery.

ABPM Spotlight! Meet Director, Lee C. Rogers, DPM

Lee C. Rogers, DPM

Lee C. Rogers, DPM

Lee C. Rogers, DPM became a Diplomate of the ABPM in 2008. After serving several years on the ABPM Exam Committee, he was elected to the Board of Directors in 2015.

As a Director, Dr. Rogers led the initiative to start ABPM’s first Certificate of Added Qualification (CAQ), which was first offered in 2017, and is currently the sub-Chair of the CAQ in Amputation Prevention and Wound Care. He is also co-authored the ABPM’s document on Privileging and Credentialing Doctors of Podiatric Medicine which has been instrumental in helping ABPM Diplomates obtain and keep their hospital privileges.

“I have seen ABPM grow and it’s on the path to be the largest and most influential certifying board in podiatry within the next 5 years. As an ABPM Director, I will continue to be a leading force in efforts that will help to drive this change. I will also promote policies to help those podiatrists who are single-board-certified, by ABPM, like me.  I have been working to connect ABPM with the many international organizations of podiatrists.  We are now a very young organization, with 60% of our membership being less than 10 years out of residency.  I support getting our younger members involved in committees and nominating them for Board positions.  I advocate for improving processes in the Board Headquarters, including the adoption of new technology to make the busy lives of our Diplomates easier.”

Originally from Gallatin, Missouri, he completed his undergraduate education at Truman State University and received his Doctor of Podiatric Medicine (DPM) from Des Moines University in 2004. Following graduation, Dr. Rogers completed a PM&S-24 residency at Saint Vincent Catholic Medical Centers in New York in 2006, and a fellowship in diabetic limb salvage and wound care at Scholl College of Podiatric Medicine in 2007.  Since then, he has focused much of his practice and research on the diabetic foot and currently sits on several committees for many organizations around the world that promote podiatry or diabetic foot care.  He has authored over 150 papers or book chapters and delivered almost 500 lectures in all 50 states and more than 40 countries.

ABPM Spotlight! Meet Director, Mitchell Shikoff, DPM

Mitchell Shikoff, DPM

Dr. Mitchell Shikoff has been a Diplomate of the ABPM since 1989 and has served on the board since 2009. Dr. Shikoff has several roles as a Diplomate of ABPM; he is currently the Vice President, Chair of the Case Document Review Committee, Chair of the Credentials Committee, serves on the Speakers Bureau, and formed the Marketing Committee on which he is extensively involved. Dr. Shikoff is also the ABPM representative to the American Podiatric Medical Association (APMA), the American Board of Foot and Ankle Surgery (ABFAS) and the Joint Committee on the Recognition of Specialty Boards (JCRSB), where he has served as the Chair. He represents both the ABPM and the ABFAS as a residency program reviewer for the Council on Podiatric Medical Education (CPME).

“My time serving as a Director of the ABPM for the past ten years has been challenging and rewarding. I’ve been able to be part of a transformational process of the ABPM and witness astounding growth in membership and Diplomate value. I am proud of the significant changes and encourage all residents to attain certification promptly. Finally, get involved with the Board on one of the many committees and run for a position as a Director. It will keep you at the forefront of your chosen profession.”

Originally from Northeast Philadelphia, Pennsylvania, he completed his Bachelor of Science and Bachelor of Arts undergraduate degrees at the Pennsylvania State University in 1979. Dr. Shikoff received his Doctor of Podiatric Medicine in 1983 from the Dr. William M. Scholl College of Podiatric Medicine in the Rosalind Franklin University of Medicine and Science. He completed his post graduate surgical training in St. Louis, Missouri. Dr. Shikoff has offices in Bensalem, PA and Feasterville, PA since 1985 and continues to take advanced training in various aspects of Podiatric Medicine, Surgery, and Wound Care which most recently includes new biologic wound dressings and Hyperbaric Oxygen Therapy. Dr. Shikoff has served as a residency director of a three year PMSR program, and thoroughly enjoys training residents at the hospitals where he is an attending.

As a dedicated husband and father of two, Dr. Shikoff has many interests outside of Podiatry. He enjoys bicycling, skiing, scuba diving, fishing, traveling, and spending quality time with the family.

Outpatient vs. Inpatient Workup of Diabetic Foot Infections

By: Marisse Lardizabal, DPM,

Diabetic foot infections (DFI) are both challenging and common amongst all podiatrists. Treatment of DFI’s require a level of comfort and training as well as resources available to clinicians. ABPM has traditionally been a great source of information for podiatrists which makes the board certification by ABPM paramount.  Like many podiatrists, you may encounter these types of patients initially in the clinic/outpatient setting, where you can catch the potential signs and symptoms of a diabetic foot infection waiting to happen.

First, nothing can substitute a thorough History and Physical Exam on a patient.  A complete NLDOCAT will give one a lot of information as well as develop a story as to why the patient is presenting with a diabetic foot infection.  For example, time frame of the ulceration, how well the patient’s diabetes is controlled, and any prior and/or current ulcerations will help you formulate a treatment plan. This may also foreshadow how compliant a patient will be with their recovery.  A thorough physical exam is of significant value when looking for classic clinical signs of infection, as well as the status of the neurovascular structures. Does the patient have enough circulation to heal an ulcer? Is a referral to a vascular surgeon necessary? Obtaining radiographs and necessary labs (CBC, CMP, ESR, CRP) should be obtained for a complete work up.

The Infectious Disease Society of America Diagnosis and Treatment of DFI, also known as IDSA Classification, is one of the most helpful guidelines that should be utilized by clinicians who treat DFI routinely. This guideline classifies DFI based on severity of the infection, clinical signs, and constitutional symptoms presented. IDSA also makes recommendations of what the appropriate treatment course should be.  For example, consider a patient who presents with erythema <2 cm around the ulcer with 2+ signs of infection. According to the IDSA guidelines, the patient’s infection is classified as “uncomplicated soft tissue infection” or Mild DFI. Therefore one may feel comfortable sending the patient home with oral antibiotics, local wound care and offloading as well as a 3-5 day follow up to see if the signs of infection have resolved.

Moderate DFIs (erythema > 2cm with 2+ signs of infection present) are the most challenging to classify and treat. Without close observation, these patients can potentially get worse and can be very much considered as admitting criteria depending on presentation of the infection.  At times, these patients can benefit from a decompression of the infected foot in the clinic setting, while making sure wound cultures are obtained prior to discharge. If patients are discharged home, close follow up and monitoring is essential. If symptoms do not improve, the safest course of treatment may be hospital admission for IV antibiotics and possible surgical interventions.

 

Lastly, severe DFIs are complicated local infections in conjunction with the patient endorsing constitutional symptoms as well as presence of SIRS criteria. These are the patients that will be admitted to the hospital for surgical management of the infection due failure of conservative treatment.  The IDSA guidelines are key elements to be familiar with as they will guide your treatment and tell you which patient will need a higher level of care.

Once the patient is admitted to the hospital, inpatient work up of DFI is very much similar to the outpatient setting.  If admitting the patient under Internal Medicine, it is important to communicate necessary labs, imaging, choice of IV antibiotics, NPO status as well as plan for surgical intervention to the service for an efficient and effective hospital course.  One may consider advanced imaging, such as an MRI (preferably prior to surgical intervention), whether there is concern for osteomyelitis or abscess in the foot.  The advanced imaging should by no means delay surgical intervention if it is considered emergent.

This brief overview of triaging DFIs can hopefully streamline how DFIs are treated in one’s practice.  Effective treatment of DFIs is our expertise and it will benefit our patients to have a standard of how it is treated.  Being board certified by ABPM, I feel confident in treating DFIs with the knowledge and background that I continually use in my daily career as a Podiatrist.

 

References:

Clinical Infectious Diseases, Volume 54, Issue 12, 15 June 2012, Pages e132–e173, https://doi.org/10.1093/cid/cis346

ABPM Spotlight! Meet ABPM Director, Coleen Napolitano, DPM

Coleen Napolitano, DPM

Coleen Napolitano, DPM

The ABPM welcomes Dr. Coleen Napolitano as the newest member of the ABPM Board of Directors. Dr. Napolitano has been a Diplomate since 1994 and has been active with the ABPM for the past 15 years, primarily with the Examination Committee, where she is the current Chair of the certification exam (Part 2) sub-section.

“I am quite familiar with the ABPM’s past and present and have witnessed first-hand the significant strides it has made in the medical community, said Dr. Napolitano.  “I look forward to contributing to the future of ABPM and believe that ABPM certifies specialty skills that represent the majority and the best of podiatric care, witha focus on medicine and podiatric orthopedics.”

Dr. Napolitano did her undergraduate at Florida International University on a running scholarship.  She obtained her doctorate and Bachelor of Science from Dr. William Scholl College of Podiatric Medicine and completed her residency training at Hines Veterans Administration Hospital in Illinois.  Dr. Napolitano followed her certification with the ABPM by becoming ABFAS certified and encourages podiatry residents to recognize the benefits of dual certification.

She is currently an Associate Professor in the Department of Orthopaedic Surgery & Rehabilitation in the Section of Podiatry at Loyola University Medical Center and is the Program Director for the podiatry residency training.

Clinical Presentation Skills: Communication with your Patients

Faith A. Schick, DPM

Faith A. Schick, DPM

By: Faith A. Schick, DPM

The ability to communicate with your patients is integral to successful outcomes.   This is an important practice skill that should be developed and mastered prior to graduating residency.

As a resident, I recall spending time shadowing multiple physicians.  After a period of time, I was able to know what the physician was going to say before the words came out of his/her mouth.  This wasn’t because I was getting smarter at understanding how I was supposed to treat a specific condition,  but because I became familiar with the conversation the attending was going to have with the patient.  As time went by, and after many experiences, I was able to synthesize different versions of what I was hearing, and have specific treatment plans I would share with my patients when the time came.

Developing this organized thought process helped to ease the transition from resident to attending.  When the time came I was ready.  I knew how I wanted to treat my patients and what supplies I needed to perform an appropriate physical examination and render care.  Being board certified with ABPM and though my experiences I knew I could handle any situation. I was able to walk into the treatment room with confidence and explain to my patients what I thought their condition was, and how we were going to manage it without faltering.  I knew what I wanted to say before I said it, similar to the physicians I had observed.    This confidence reassured my patients.

Realize that just because what you are saying makes sense to you, it doesn’t necessarily mean that it is going to make sense to your patients.  During residency you are surrounded by peers who easily communicate using medical terminology.  Once in practice this changes, and your audience becomes your patient population.  Language needs to become more simple; you need to still speak intelligently, but use words that your patient will understand.  For example, instead of saying “calcaneus”, explain by saying “heel bone”.  While it may make sense to you that a patient should sleep in their CAM boot, you need to very clear with patients giving them instructions.  Make sure to ask if your patient has any questions before leaving the room.

Think about the message you are trying to convey.  How do you sound?  What does your posture look like?  Are you making good eye contact?  As time has gone by, I have come to appreciate the value this has on my office workflow.  I am able to review my chart notes with ease knowing that there is an organized thought process as to how I treated my patient during their last visit, and depending upon their outcome how I plan to proceed with care.  My staff is able to anticipate my needs and the needs of my patients.  Appointments are scheduled in an organized fashion based upon the diagnosis.  With the advent of electronic health records, I have been able to develop templates that facilitate my documentation process.  Patients are able to leave the office with organized instructions explaining their diagnosis and plan of care.

This level of organization assures that I do not miss any step in my patient’s treatment.  By the time the patient has completed their visit to the office they have an established diagnosis with plan of care, all questions have been answered, necessary studies having been ordered, medical supplies have been dispensed, and a follow up appointment has been made as needed.  This limits my liability and the chance that something gets overlooked or forgotten.  All too often physicians are multi-tasking throughout the day and a simple distraction can lead to error.  Having an organized treatment algorithm keeps things on track to make sure nothing gets missed, and communication with your patients is of utmost importance.

 

 

 

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