Many have lamented and seek answers on the lack of high quality peer-reviewed published podiatric research. Some blame the colleges, others blame APMA.I take a different view. Why does there have to be blame on any level? The importance of original academic research in medicine is self- evident. However, it is still a minority in all fields who churn out the research.
Be that as it may, since 1977, when I started podiatry school, there was NEVER a milieu for research in any of our colleges. Original research is much more complicated than one might think, and very costly. Since working in a very research oriented academic institution, I can tell you that “research” is done on weekends and nights, with armies of coordinators, assistants, graduate fellows, and ancillary personnel. The procurement of funds and the assemblage of these teams is a business in itself.
In my institution, appointed faculty are on two separate tracks, 90% research/10% clinical or 90% clinical/10% research. There are those who fall in between these ranges depending on circumstances. Those on clinical tracks engage mostly in patient care activities and are not mandated to produce original research.
Still, that does not in any way invalidate their contribution to the academic mission of the institution. Podiatric medicine is largely and always has been a predominantly clinical pursuit, and as such, does not in any way invalidate us as a healing art. We join the tens of thousands of MD/DO practitioners who see patients day in and day out and never publish original research.
My own alma mater, NYCPM, has a joint program with the Icahn School of Medicine at Mount Sinai, where I work, where students attain the dual DPM/MPH degree. There have been many who have availed themselves of this opportunity and have achieved here with distinction. In that environment, they become well trained in research methodology. Where that takes them in the research environment ultimately is up to them. Whatever our pursuits ultimately are, neither clinical work or research work invalidates the other as a lesser choice.
Bryan C. Markinson, DPM, NY, NY
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02/28/2018 Amol Saxena, DPM
Lack of Podiatric Authors in Our Journals (Joseph Borreggine, DPM)
There are many reasons for the lack of DPM produced research and more non-DPMs publishing in our journals.
Most podiatric students and residents are not required to actually complete written and publishable research during their training. There may be less "perceived value or need". As I interview Fellowship candidates, I am able to see how much research they are actually required to complete. Most are case studies. There was a time where podiatrists were trying to document their cases and show the pathology they were capable of seeing. Publishing was the only way to "see" it. I wrote an editorial about the need to go beyond this in a 2012 JFAS editorial.(1) Now the bar has been raised, which I will relate further.
A generation ago, when Dr. Borregine and I went to school, our biomechanics professor Dr. Oleg Petrov required us to write a paper and a few of us published our work. Some residency directors would not give a certificate unless the required research was completed. This is still my policy for my Fellowship. In fact, approved ACFAS & AAPSM Fellowships require it, though I seldom see it enforced.
Non-DPMs from around the world like to publish in American journals. As an Honorary Member of the German Association of Foot & Ankle Surgery, I see they want to practice American-style podiatry & foot surgery, so they read our journals. Publishing in our journals is beneficial to US DPMs and foreign foot and ankle specialists. More of our work gets read and cited, raising our journals impact factors and the foreign researchers get a "notch in their cap" for publishing in an American journal.
Another aspect of non-DPM and foreign DPM research is that many come from socialized medical systems. They have to use evidenced-based medicine practices and their findings and outcomes can influence practice patterns around the world. This is helpful to all foot and ankle practitioners who read the research. Those who don't, may be missing out. Unfortunately, in the current society, many don't read the journal articles, but rather search on "Google", etc. This may sometimes be efficient and easier, though not often accurate nor reliable.
As I mentioned, the bar for research in all aspects of medicine has been raised, as "high- level" studies are required to change practice patterns and policy. Though it is difficult to do level 1 or even 2 studies on some aspects of podiatric treatments we should be able to do level 3 studies. George Tye Liu, DPM recently ran for the ACFAS board (and won) on the platform that DPMs need to do more research and start maintaining registries. One weakness the podiatry community has is that research funding primarily goes to research institutions, where few DPMs work. Therefore, if most of the foot & ankle work is done by non-DPMs in academic centers receiving funding, it makes sense that the research produced would be by non-DPMs.
Another aspect of the current medical environment is that various agencies and groups are evaluating outcomes. It won't be long before they start evaluating the outcomes of common podiatric procedures, compare to others, costs etc. Many DPMs have already started to do this, including in the most recent issue of JFAS.(2)
I do see many of our colleagues are still pushing and publishing high-quality research that is often cited in non-podiatric journals as well: Larry DiDomenico, John Grady, Chris Hyer, and Scot Malay to name a few residency directors. They are mostly from "my generation." Our diabetic foot colleagues like David Armstrong have been demonstrating a DPM's value. I realize IRBs can be onerous, taking CITI on-line may seem like a waste of time, and it can take years to accumulate data and finally get to see it in publication etc. If it was easy, everyone would be doing it!
If you are a podiatry student or resident, I encourage you to take up the research challenge and make the profession better for you and your colleagues. If you are a currently practicing DPM, I encourage to continue to read our journals and others pertaining to your interests, along with mentoring the next generation of potential podiatric researchers. We owe it to show them how to make things better for themselves and the profession.
Amol Saxena, DPM, Palo Alto, CA
1. Saxena A. Stand up and start counting.J Foot Ankle Surg. 2012 Jan-Feb;51(1):1-2. doi: 10.1053/j.jfas.2011.10.025. Epub 2011 Oct 14.
2. Albright RH1, Haller S2, Klein E3, Baker JR4, Weil L Jr5, Weil LS Sr6, Fleischer AE7.Cost- Effectiveness Analysis of Primary Arthrodesis Versus Open Reduction Internal Fixation for Primarily Ligamentous Lisfranc Injuries. J Foot Ankle Surg. 2017 Dec 20. pii: S1067- 2516(17)30617-8. doi: 10.1053/j.jfas.2017.10.016. [Epub ahead of print]
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