Addressing The Challenges Podiatry Students Are Facing Due To COVID-19

Developing, grooming and investing in podiatric medical students is essential for the profession's future. The COVID-19 pandemic has certainly brought forth unprecedented challenges for the education and training of podiatric medical students. The American Podiatric Medical Association (APMA) stands alongside the American Podiatric Medical Students Association (APMSA) in putting students interests first. Unfortunately, other key stakeholders within the profession seem unwilling or unable to make the adjustments to our students’ educational processes that are necessary for our new normal. 

Several challenging educational issues have transpired over the past few months with little or no consideration given to student feedback. The inability to find balanced solutions to emerging issues affecting podiatric medical students is disappointing. 

The 2020 American Podiatric Medical Licensing Examination (APMLE) Part II Clinical Skills Patient Encounter (CSPE) exam, governed by the National Board of Podiatric Medical Examiners (NBPME) and administered by the National Board of Osteopathic Medical Examiners (NBOME) is scheduled to take place August 18 through November 10 in Conshohocken, Pa. The APMSA, with support from the APMA and numerous other key stakeholders, requested that NBPME cancel the exam for the Class of 2021. 

The APMSA surveyed the Class of 2021 on this issue and 517 student students responded. This survey provides robust data for consideration such as: concerns for student physical and mental well-being during a pandemic; the impact on clerkship rotations that are already tenuous at best; the additional financial burden of travel; and test expense during a time when many are struggling financially due to the economic impact of the pandemic. 

The NBPME cancelled this exam in 2016 for logistical reasons so the precedent exists for canceling the exam. Issuing a decision letter on July 15, 2020, the NBPME announced that it will modify the process but will proceed with testing, disregarding the requests from APMSA, APMA, and other key stakeholders. 

What About The Unresolved Issues With Fourth-Year Clerkship Rotations?

Fourth-year clerkship rotation challenges for the Class of 2021 remain unresolved. Clerkships continue to be cancelled due to surging outbreaks of the COVID-19 pandemic around the country. Fourth-year students are missing out on critical hands-on patient care under direct supervision of an attending podiatric physician and the didactic educational process that accompanies clerkship rotations. Facility rules regarding clerkship rotations are another piece of the clerkship puzzle. 

The American Association of Colleges of Podiatric Medicine (AACPM) and the Council on Podiatric Medical Education (CPME) issued a recommendation letter on June 15, 2020. Upon review of this letter, it was difficult to identify any tangible steps to resolve the issue. Fourth-year rotations are indispensable in the residency matching process for both programs and students. The rotations are also vital in the preparation of students to succeed in residency. Collectively shrugging our shoulders at an unparalleled unprecedented difficulty is not a solution. 

The APMSA subsequently surveyed the Class of 2021 after the AACPM and CPME recommendation letter. Key findings include: 

1. Almost 90 percent of respondents believe that losing the ability to clerk at a program (because of COVID-19-related canceled rotations) will impact their residency selection/ranking during the 2021 match. 
2. Over 50 percent of respondents support shortening clerkship rotations from four or five weeks to two or three weeks. 
3. Almost 60 percent of students favor moving the January 20, 2021 ranking to February with 22 percent being neutral on the issue and only 19 percent opposed. 
4. There is strong support for delaying the Centralized Residency Interview Process (CRIP) to allow for an extra clerkship cycle. Specifically, 43 percent of respondents support the idea and 32 percent are neutral. Only 24 percent expressed opposition to this idea. 

Based on sentiments collected from the Class of 2021, the APMSA requested that AACPM: 

1. Move the January 20, 2021 ranking to a later date. AACPM did move the ranking date to February 23, 2021 in response to APMSA’s request. Kudos to AACPM for making this change. This allows most of the month of February to serve as an additional clerkship month prior to submission of rankings for both students and programs. 
2. Delay CRIP to allow students to attend an extra clerkship, especially if the interviews transition from in-person to virtual. The Accreditation Council for Graduate Medical Education (ACGME) changed the interview process immediately for allopathic and osteopathic residencies. AACPM set October 1, 2020 as a deadline for changing CRIP from in-person to either a hybrid or complete virtual interview process. 
3. Seriously consider shortening clerkship rotations. 

Another potential solution is to copy the concept that the DPM Mentors Network used for student recruitment. Maintaining mentor and mentee safety by following state and local guidelines must govern the process. In order to simplify the clerkship process, perhaps there could be a repository of volunteers whom students could contact directly. Hurdles to this solution would be schools enabling students to rotate at more than one office-based rotation and modification of the approval process for clerkships allowing office-based rotations to count as official rotations. Virtual rotations are approved clerkship rotations, despite varying widely in what the rotations entail (some involving as little as one hour per week for journal club). The lack of direct patient interaction under the guidance of an attending podiatric physician is an experience that cannot be replaced by a journal club. 

Final Notes

Every day of inaction is a lost day of learning. The Class of 2021 is paying for an education they are not receiving. How can the profession stand by and accept this? The APMSA and APMA continue to advocate on behalf of the students while other key stakeholders seem paralyzed by bureaucracy, indecision, inaction and a lack of foresight and vision. 

The time for boldness is now. The time to stand by our students is now. The time to protect the profession's future is now. We must raise our collective voices in support of the students to those sitting on the sidelines, watching the hourglass empty on the Class of 2021's final year of education.

"The failure to invest in youth reflects a lack of compassion and a colossal failure of common sense."

• Coretta Scott King

"Leaders are like gardeners... As leaders, we are not only responsible for harvesting our own success but for cultivating the success of the next generation." 

• Susan Collins

Dr. DeHeer is the Residency Director of the St. Vincent Hospital Podiatry Program in Indianapolis. He is a Fellow of the American College of Foot and Ankle Surgeons, a Fellow of the American Society of Podiatric Surgeons, and a Fellow of the American College of Foot and Ankle Pediatrics. Dr DeHeer is also a Fellow of the Royal College of Physicians and Surgeons of Glasgow, and a Diplomate of the American Board of Podiatric Surgery.