Why Fellowships Are Necessary In Podiatric Foot And Ankle Surgery

Fellowship training is a bit controversial within podiatric surgery. Some see it as unnecessary and redundant. Others feel it marginalizes the role of residency training. I submit that both opinions are wrong and shortsighted. Let’s look outside of podiatry and review the role of fellowship training.

A one- or two-year fellowship is now standard in most allopathic and osteopathic surgical sub-specialty training. This additional year focuses and hones skills used in a specialty setting, often combining operative, research and practice management experiences. Typically, the operative volume and diversity is on par with what would take years of general training to gain. In addition, those at fellowship centers often are performing complex reconstructive and revision cases as well as developing new, cutting-edge techniques.

Foot and ankle surgery continues to evolve, encompassing more complex surgeries and reconstructions as well as more advanced technologies. Consider the breadth and complexity of what is now performed, from total ankle replacements (TARs) and circular external fixation with limb deformity correction to Charcot limb salvage surgery and cartilage replacement techniques. These require advanced training techniques with high volume exposure to achieve mastery. Specialized centers with areas of concentration allow the fellows to cater their training to specific interests.

If we look to the orthopedic model, the year of fellowship training is not merely an additional year of residency, but instead a specific focus on sub-specialization in the hand, foot and ankle, spine, total joint, etc. This year is structured with hands-on training, research and education and mentoring to advance the physician through this final stage in education. These fellowship-trained surgeons become active members in their respective specialty societies and carry forward and disseminate their training and expertise.

Fellowships have been available to DPMs for several years now but in limited numbers. In my opinion, these numbers are expanding in answer to an increasing demand for this level of specialized training from the general medical community.

If anyone has interest in completing a fellowship after residency training, I would encourage you to review the Web sites for the American Podiatric Medical Association and Council on Podiatric Medical Education (https://www.apma.org/Members/Education/CPMEAccreditation/Fellowships.aspx), and the American College of Foot and Ankle Surgeons (https://www.acfas.org/Students/content.aspx?id=493) for additional information.