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Proposed CPME 320 Changes May Dramatically Reduce Required Biomechanics Cases In Residency Training
Podiatrists in the United States should be aware of the proposal of substantive changes to the requirements for approval of podiatric medicine and surgery residencies. These changes to the Council on Podiatric Medical Education (CPME) 320 Standards and Requirements for Approval of Podiatric Medicine and Surgery Residencies are available for review at:
https://www.cpme.org/residencies/content.cfm?ItemNumber=29729&navItemNumber=15094 .
Among the proposed changes is a reduction of the number of biomechanics cases required to meet the Minimum Activity Volume (MAV) during the three-year residency training program. If this change is enacted, the current requirement of 75 biomechanics cases will reduce to 50 cases. Although the CPME website has no explanation as to the rationale for such a reduction, there appears to be a trade-off with the addition of 50 wound care cases to the Volume and Diversity requirements listed in Appendix A of the 320 document.1
The current CPME 320 document defines biomechanical cases as: “direct participation of the resident in the diagnosis, evaluation, and treatment of diseases, disorders, and injuries of the foot, ankle, and their governing and related structures by biomechanical means. These experiences include, but are not limited to, performing comprehensive lower extremity biomechanical examinations and gait analyses, comprehending the processes related to these examinations, and understanding the techniques and interpretations of gait evaluations of neurologic and pathomechanical disorders.”2
While the resident must participate in the treatment of disorders by “biomechanical means,” this section of the document does not provide the specifics of the type of treatment(s). In the proposed draft of the changes to the CPME 320 document, requirement 6.0 designates a competency in biomechanics, which does outline some forms of treatment: “Perform biomechanical examination and manage patients with lower extremity disorders utilizing a variety of prosthetics, orthotics, and footwear.”1
Neither the current CPME 320 document nor the proposed draft of changes provides a description of the required elements of a biomechanical examination.1,2 However, a page on the CPME website shows links to templates and a sample biomechanical evaluation form developed by the American Board of Podiatric Medicine (ABPM) that are also available on the ABPM website.3,4
Where Does Biomechanics Rank In Importance In Podiatric Medical And Surgical Residency Training?
In Appendix A of the proposed changes to the current CPME 320 document, the case volume requirements are listed as follows:1
• Podiatric foot and ankle surgical cases (PMSR/RRA) 300;
• Foot and ankle surgical cases (PMSR only) 250;
• Trauma cases 50;
• Podopediatric cases 25;
• Practice-based procedures 100; and
• Wound care 50.1
Thus, the requirement of 50 biomechanics cases is identical to the number of cases required for trauma and wound care, and represents only 16 percent of the required number of cases for foot and ankle surgery.
In my opinion, the current requirement for 75 biomechanics cases during a three-year podiatric residency training program is inadequate to prepare the resident for the full scope of podiatric practice. Reducing the required biomechanics case volume to only 50 cases only adds to a serious and troubling trend in our profession.
A Significant Decline Of Biomechanics Emphasis At Podiatric Medical Colleges
Over the past 30 years, it is my observation that the schools of podiatric medicine have gradually eliminated training and experience in implementing non-surgical, biomechanically-based treatment interventions for lower extremity pathologies.
For decades, podiatric surgeons have boasted that they have superior skills to their orthopedic counterparts based upon the fact that podiatrists have a better understanding of the biomechanics and pathomechanics of disorders affecting the foot and ankle. While that claim had strong validation 30 years ago, the argument is no longer valid based upon the significant reduction in formal training of students and residents in all areas of biomechanics during podiatric medical school and residency.
For example, at the California School of Podiatric Medicine at Samuel Merritt University (CSPM), the total units of biomechanics and sports medicine offered today is 8.75 units in comparison to 15 units in my experience in the 1970s and 1980s. Currently, of the total 125.5 total units offered at CSPM in the first three years of training, only these 8.75 units are devoted to biomechanics and sports medicine.5
Another example is Kent State University College of Podiatric Medicine (KSUCPM), which offers only two didactic courses in biomechanics and sports medicine, comprising seven credits out of 134 for the first three years in the classroom.6
Of the total time spent in training, biomechanics and sports medicine comprise just under seven percent of the total at CSPM and five percent at Kent State University.5,6
In my own encounters with hundreds of graduates of all the schools of podiatric medicine during the past 20 years, I am appalled by the lack of experience that most of them report in implementing biomechanical treatments on live patients during their four years of training. Most of them express a desire to expand their training and knowledge in biomechanics, sports medicine and non-operative interventions for foot and ankle pathlologies. A reduction in the minimum activity volume (MAV) for biomechanics cases from 75 to 50 cases will diminish the only remaining opportunity for residents to gain critical knowledge and experience in implementing non-operative, biomechanically-oriented interventions for the treatment of foot and ankle disorders. In my opinion, there is no justification for this reduction in training, which is already lacking with the current standards and requirements for completing an accredited podiatric medicine and surgery residency training program.
In Conclusion
There are a number of important links on the webpage for the proposed changes to the CPME 320 Standards and Requirements. An open call for comments will extend through January 2021 and interested parties may make their opinions known.7 Also, there are two town hall meetings scheduled for December 2020 (Thursday, December 3rd at 8:00 p.m. EST/5:00 p.m. PST and Tuesday, December 15th at 3:00 p.m. EST/12:00 p.m. PST). To participate, you must register in advance at https://register.gotowebinar.com/rt/2966918189367769872 .
I encourage all of my colleagues to review the proposed changes to the current CPME 320 document and submit comments as well as attend the offered town hall meetings. The future of our profession, and certainly the preservation of critical training in biomechanics, is at stake.
Dr. Richie is an Adjunct Associate Professor within the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University in Oakland, Calif. He is a Fellow and Past President of the American Academy of Podiatric Sports Medicine. Dr. Richie is a Fellow of the American College of Foot and Ankle Surgeons, and the American Academy of Podiatric Sports Medicine. Dr. Richie is the author of a new book titled "Pathomechanics of Common Foot Disorders" available from Springer at https://www.springer.com/us/book/9783030542009 .
References
1. Council on Podiatric Medical Education. CPME 320 and 330 revision in progress. Available at: https://www.cpme.org/residencies/content.cfm?ItemNumber=29729&navItemNumber=15094 . Accessed December 1, 2020.
2. Council on Podiatric Medical Education. Standards and requirements for approval of podiatric medicine and surgery residencies. Available at: https://www.cpme.org/files/CPME/CPME%20320%20Updated%20May%202020.pdf . Published July 2018. Accessed December 1, 2020.
3. Council on Podiatric Medical Education. Resources, samples and how-to documents. Available at: https://www.cpme.org/residencies/content.cfm?ItemNumber=32527&navItemNumber=32584 . Accessed December 1, 2020.
4. American Board of Podiatric Medicine. Pathology specific biomechanical examination templates. Available at: https://www.abpmed.org/pages/residents/biomechanical . Accessed December 1, 2020.
5. Samuel Merritt University. Doctor of podiatric medicine. Available at: https://www.samuelmerritt.edu/programs/doctor-podiatric-medicine . Accessed December 1, 2020.
6. Kent State University. Podiatric medicine – D.P.M. Available at: https://catalog.kent.edu/colleges/pm/podiatric-medicine-dpm/#roadmaptext . Accessed December 1, 2020.
7. Call for comment: feedback concerning CPME publications 320 and 330. Available at: https://www.surveymonkey.com/r/LFNRLHQ . Accessed December 1, 2020.
