Residency Insight

THE RULES THE GOVERN HOW PODIATRIC RESIDENCY PROGRAMS ARE RUN HAVE BEEN SUBSTANTIALLY CHANGED:
HERE ARE THE HIGHLIGHTS OF CPME 320

By Jay Lieberman, DPM

The Council of Podiatric Medicine recently updated its 320 guidelines. Residency directors should certainly review these new guidelines and become very familiar with its contents. Today’s discussion will be just a glimpse of the many changes with which a Director of Podiatric Medicine should become familiar.

CHANGES THAT AFFECT THE LOCATION OF THE PROGRAM

Surgery centers must be co-sponsored by a hospital or academic health center support a residency training program. A surgical center simply does not provide the academic experiences needed for a well rounded residency program.

An affiliation agreement must exist with all offsite training facilities. These agreements must be signed and dated by the chief administrative officer of each site location and forwarded to the Director of Podiatric Medical Education.

An affiliation agreement is an acknowledgement that the offsite hospital or surgery center is participating in a residency program based at the home hospital. These agreements are often difficult to obtain, because organizations within a community may be competing for health care dollars and consumers. It may be seen as a conflict of interest to align with a competing organization. The residents are caught in the middle, because without such an agreement, their malpractice insurance may not extend coverage to the off site location.

A maximum of 20% of residency education is allowed to be conducted in a podiatric private practice setting.

Office based residency programs are a thing of the past.

CHANGES AFFECTING THE RESIDENCY SELECTION PROCESS

The institution that sponsors the residency program must participate in the National Resident Application Service (CASPER). The facility cannot obtain a binding commitment from the prospective resident prior to the date established by the matching service.

This policy will have a very positive impact on prospective residents nationally. The process will be fair and financially feasible for podiatry students

CHANGES THAT AFFECT THE EDUCATION PROCESS

The resident should have sufficient office and study space. The resident must have access to adequate library resources including electronic retrieval of information from medical databases, informational technologies, computer hardware/software and related resources. Didactic activities should take place at least weekly. Instruction in research methodology must be included and practice management should be part of the curriculum as well. A monthly journal club should be in place.

Generally, the goal here is to have all of the attendings participate in the didactic component of residency training. Unfortunately, managed care has made many physicians apathetic. They are required to work harder for lower reimbursements. As a result, many residency programs are unable to fulfill the didactic requirements of CPME320 secondary to time constraints on all physicians affiliated with the program. The new CPME document also stipulates that Residents must have formal education in practice management.

Practice Management Education was severely overlooked in the past. It is now recognized as an integral part of the educational process for residents. An excellent surgeon cannot practice appropriately unless he/she can relate to patients properly and run an efficient practice that is profitable.

NEW RESIDENCY MODELS

The goal here is the standardization of Post Graduate Podiatric Medical Education. Well defined competencies for each level of podiatric residency are being established. When a podiatrist applies for staff privileges at a hospital in the future, the nature of his residency training will be clear to the credentialing committee. These types of standards have existed for many years in other medical disciplines.

The following residency designations will be PHASED OUT:

• POR (podiatric orthopedic residency)

• PPMR (primary podiatric medical residency)

• RPR (rotating podiatric residency)

• PSR-12 (12 month podiatric surgical residency)

• PSR-24 (24 month podiatric residency)

They will eventually be REPLACED by these designations:

• PM&S-24 (podiatric medicine and surgery 24)

• PM&S-36 (podiatric medicine and surgery-36)

YOUR RIGHT TO KNOW

The sponsoring institution should inform the Director of Podiatric Medical Education of current amounts of direct and indirect GME funding received.

Don't be afraid to ask!! It is your right to know. Your residents deserve the best education we can offer them.