Podiatry

I. Rationale

Diseases and disorders of the foot affect the quality of life and mobility of millions of Americans. Foot ailments can be the first sign of a more serious medical problem, such as arthritis, diabetes, and nerve and circulatory disorders. As such, it is important for family medicine physicians to be able to diagnose and manage many of these conditions, so that timely and effective care can be delivered to these patients.

II. Competencies

Medical Knowledge/Patient Care

Goal: Provide Evidence Based Care and medically competent care to patients with common podiatric conditions.

Objectives:

A. Learn to diagnose and manage

  1. Corns and calluses
  2. TineaPedis
  3. Hallux Valgus
  4. Hallux Limitus
  5. Tailor's Bunion (5th Metatarasal)
  6. Subungual hematoma & contusion
  7. Hammertoe
  8. Bone Spurs
  9. Verruca
  10. Arteriosclerosis Obliterans (ASO)
  11. Raynaud's Syndrome
  12. Ankle Osteoarthritis
  13. Ankle Sprain
  14. Rupture, Tendon, Foot
  15. Plantar Fasciitis
  16. Tendonitis, Achilles
  17. Abcess Toe
  18. Abcess, Cellulitis Foot
  19. Ulcer, Neurogenic
  20. Ulcer, Decubitious
  21. Osteomyelitis Foot
  22. Onychocryptosis
  23. Onychomycosis
  24. Metatarsolphalangeal Jt. Deformity
  25. Sesamoiditis
  26. Foreign Body
  27. Fracture, Phalanx
  28. Fracture, Metatarsal or Tarsal
  29. Fracture, Ankle
  30. Ganglionic Cyst
  31. Morton's Neuroma
  32. Tarsal Tunnel or Sinus Tarsitis

B. Learn a few basic podiatric procedural skills essential to the practice of family medicine.

  1. Callus/corn removal
  2. Toe nail removal
  3. Digital nerve block
  4. Cryotherapy

Learning Activities
Attending Rounds / Research Conference / X / Outpatient Clinics
Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / X / Faculty Supervision / X / Readings
Didactics / X / Procedures
Other
Evaluation Methods
X / Attending Evaluation / X / Directly Supervised Procedures / X / Morning Report
X / Program Dir
Review / X / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / Videotape Review / X / Quarterly Review
Other

Practice Based Learning and Improvement

Goal:The resident should develop skills in evaluating their own patient care, appraising and assimilation of scientific evidence to improve patientcare.

Objectives:

  1. Identify resources for personal education.
  2. Develops a plan for ongoing education.
  3. Identify Point of Care learning resources.
  4. Utilize Electronic Medical Records Decision aid tools and templates for patient care.
  5. Recognizes strengths and weaknesses of knowledge and skills in self and others.

Learning Activities
Attending Rounds / Research Conference / X / Outpatient Clinics
Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / X / Faculty Supervision / X / Readings
Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / X / Directly Supervised Procedures / Morning Report
X / Program Dir
Review / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / Videotape Review / Quarterly Review
Other

Interpersonal and Communication Skills

Goal: Residents will develop and demonstrate effective information exchange and teaming with patients, their families and other health professionals.

Objectives:

  1. Develop patient sensitive skills for interviewing that allow accurate, and complete collection of information regarding symptoms, the family and the community that affect the patient's health and care.
  2. Develop skills in communicating results to patients, their families, other health care providers.
  3. Develop skills in educating patients and their families, in dealing with sensitive issues

for patients and families, and in negotiating a plan of investigation and treatment with

the patient and family.

  1. Develop professional relationships with co-workers, consultants, ancillary staff and other professionals to enable assembling of health care teams and mobilization of community resources to optimize care of the patient.
  2. Develop an understanding of the role of the family medicine consultant, and is able to support the patient through the process of consultation, medical evaluation, treatment, rehabilitation and long-term care.
  3. Use professional language and demeanor when communicating with other residents, with Family Medicine attending physicians, with physicians from other services, with non-physician clinical staff, with non-physician non-clinical staff, and with patients and their families.
  4. Create and sustain a therapeutic and ethically sound relationship with patients.
  5. Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills.
  6. Work effectively with others as a member or leader of a health care team or other professional group.

Learning Activities
Attending Rounds / Research Conference / X / Outpatient Clinics
Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / X / Faculty Supervision / Readings
Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / X / Directly Supervised Procedures / X / Morning Report
X / Program Dir
Review / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / X / Videotape Review / X / Quarterly Review
Other

Professionalism

Goal: Residents will demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

Objectives:

  1. Demonstrate integrity, honesty, respect and a commitment to excellence in all activities
  2. Demonstrate sensitivity, respect and adapt appropriately to the social and cultural issues of each patient.
  3. Display initiative and resourcefulness in patient care and in solving problems.
  4. Be timely in attendance of activities and completion of tasks.

Learning Activities
Attending Rounds / Research Conference / X / Outpatient Clinics
Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / X / Faculty Supervision / Readings
Didactics / Procedures
Other:
Evaluation Methods
X / Attending Evaluation / X / Directly Supervised Procedures / X / Morning Report
X / Program Dir
Review / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / Videotape Review / X / Quarterly Review
Other

Systems Based Practice

Goal: Demonstrate an awareness of and responsiveness to the larger context and system for health care and the ability to effectively call on system resources to provide care that is of optimal value.

Objectives:

  1. Utilize and understand the importance of appropriate referral or consultation with podiatrists.
  2. Support of the individual and family through consultation, evaluation, treatment, and rehabilitation.
  3. Understand the psychosocial and economic impact of podiatric conditions on the individual and family and use of the health care system to assist as needed.
  4. Learns most cost effective ways to manage patients with podiatric conditions.

Learning Activities
Attending Rounds / Research Conference / X / Outpatient Clinics
Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / X / Faculty Supervision / X / Readings
Didactics / X / Procedures
Other
Evaluation Methods
X / Attending Evaluation / Directly Supervised Procedures / Morning Report
X / Program Dir
Review / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / Videotape Review / Quarterly Review
Other

IV.Instructional Strategies (see above)

This is a four-week elective and should be attended by the resident for a minimum of 5-6 half days per week. The other 4-5 half days per week will be spent in the resident’s continuity clinic and in didactics. Readings can be obtained from Section VI and should also be solicited from the Clinic Medical Director and team.

V.Evaluation Strategies (see above)

  1. Observation and end of rotation evaluation from the Podiatry faculty.
  2. Procedure documentationby the resident
  3. Conference attendance
  4. In-training exam profiles
  5. Resident evaluation of rotation and faculty

H. Completion of required readings and scoring >90% on open book Monograph quizzes

VI.Implementation Methods

This medical elective consists of 6 ½ day sessions per week of Podiatry in a clinical setting of the, for a total of 4 weeks.

Location: Robert Schwartz, DPM

Foot & Ankle Center

1711 Mt. Vernon Road, Suite 2

Dunwoody, GA 30338

Contact: Charlotte: 770-963-5161 office

678-638-7779 fax

Family Practice Center: 5 ½ days per week in the Family Medicine Clinic, 4 ½ days in the Podiatry Clinic.

Call/Vacation: Call will be with the Family Medicine Service at Emory University Midtown Hospital. Vacation is permitted.

Supervision: Residents will be supervised by Dr. Robert Schwartz.

Conferences: The resident is expected to attend Thursday morning Family Medicine Didactics Conferences.

VII.Suggested Readings/Resources

1.AFP Monograph:FP Essentials 307: Common Foot Problems

2.JOAN M. BEDINGHAUS, MARK W. NIEDFELDT. Over-the-Counter Foot

Remedies.Am Fam Physician. 2001 Sep 1;64(5):791-797.

3.JOONG MO AHN, GEORGES Y. EL-KHOURY. Radiologic Evaluation of Chronic Foot Pain.Am Fam Physician. 2007 Oct 1;76(7):975-983.

4.MICHAEL R. SIMPSON, THOMAS M. HOWARD.Tendinopathies of the Foot and Ankle.Am Fam Physician. 2009 Nov 15;80(10):1107-1114.

5.ROBERT G. FRYKBERG.Diabetic Foot Ulcers: Pathogenesis and Management. Am Fam Physician. 2002 Nov 1;66(9):1655-1663.

6.JOEL J. HEIDELBAUGH, HOBART LEE.Management of the Ingrown Toenail.Am Fam Physician. 2009 Feb 15;79(4):303-308.

7.JEFFREY D. TIEMSTRA. Update on Acute Ankle Sprains. Am Fam Physician. 2012 Jun 15;85(12):1170-1176.

8.Barrett M. Schroeder. American College of Foot and Ankle Surgeons: Diagnosis and Treatment of Heel Pain. Am Fam Physician. 2002 Apr 15;65(8):1686-1688.

9.DENISE B. FREEMAN. Corns and Calluses Resulting from Mechanical Hyperkeratosis.Am Fam Physician. 2002 Jun 1;65(11):2277-2280.

10. ROBERT G. FRYKBERG. Diabetic Foot Ulcers: Pathogenesis and Management. Am Fam Physician. 2002 Nov 1;66(9):1655-1663

11. TODD C. SOMMER, THOMAS H. LEE. Charcot Foot: The Diagnostic Dilemma.

Am Fam Physician. 2001 Nov 1;64(9):1591-1598.

12.ALFRED F. TALLIA, DENNIS A. CARDONE.Diagnostic and Therapeutic Injection of the Ankle and Foot.Am Fam Physician. 2003 Oct 1;68(7):1356-1363.

13.DANIEL B. JUDD, DAVID H. KIM. Foot Fractures Frequently Misdiagnosed as Ankle Sprains. Am Fam Physician. 2002 Sep 1;66(5):785-795.

Last Updated April 19, 2013