Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St, Pomona, CA

Should We Bring Back
the Preceptorship?

Much discussion has occurred on the PRESENT blogs and podiatry.com about the educational process of our students and residents. Whether it's about fellowships, residency placement, or education standardization, we've had several vibrant discussions online. One issue that I see brought up only intermittently, and by a few unique individuals, is about practicing physician education. Now, I'm not talking about regular CME, online CME, or conferences — PRESENT Courseware has already made this an art. I'm wondering about those podiatrists in practice for many years who would benefit from learning new theories, techniques, and technologies that require more time to learn. I've heard the question before, “What will you do for those doctors in practice for 30 years who weren't trained like our current residents? How will you make them current?”

Tonight's Premier Lecture is
Use of Topical Wound Oxygen in Complex Diabetic Wound Care
by Francis Derk, DPM

It goes unsaid that podiatric medicine, like all other medical fields, requires an attitude of lifelong learning. Medical care in 2011 is not the same as it was in 1971 or 1981 or even 2001. As such, each of us must make the effort to continually update ourselves with the most recent research, practice methods, technologies, and procedures. Without doing so, stagnation is the result. I can recall various physicians I've worked with in training and early practice that had become comfortable and ended up doing the same procedures they did many years ago, despite an evolution in our field. They justified their complacency with the statement, “It works well in my hands.” Well, medicine is moving away from this attitude.

So, how do we stay current? We've already made mention of a few options – those in which PRESENT Courseware is cornering the market. But what about that small subset of skills that is not so easily taught during a weekend conference or CME course? For these skills, I wonder if it would be beneficial to bring back the preceptorship. Years ago, when podiatric residencies were few, those who could not obtain a residency might opt to do a preceptorship before beginning active practice. What if we brought back focused preceptorships that taught one particular skill?

This actually already exists, though it's called something different: the mini-fellowship. Take, for example, the AO/ASIF mini-fellowship which runs from 1 to 3 months. Another example is the Ilizarov mini-fellowship. Both of these educational experiences expose attendees to high yield, high quality, hands-on, high volume, focused training on specific skills, namely advanced fixation methods and external fixation, respectively. I've never spoken to a graduate of either one of these programs who didn't feel they benefited from attending. I have to say, I find it interesting that both of them occur mostly outside of the United States.

I think it's time we expand and formalize preceptorships or mini-fellowships (call it what you want) and make them available to practicing podiatrists who are willing to pay for them. Let's say, for example, I want to improve or update my Ponseti clubfoot casting technique as a way to expand my practice. I might enroll in Dr. Podopeds' 2 week long clubfoot mini-fellowship. Dr. Podopeds is an expert in Ponseti clubfoot casting and sees a high volume of talipes equinovarus patients.

The structure of this mini-fellowship might include a one day didactic session with focused lectures and practice casting on clubfoot dolls. The next 12 days would be spent with Dr. Podopeds in clinic, seeing clubfoot patients at various stages of treatment, performing hands-on Ponseti casting, performing percutaneous TALs, anterior tibial transfers, reconstructions, and possibly newborn surgery (posteromedial releases) for the rare patient. Additionally, you'd learn about bracing, shoeing, and patient education methods, besides the “bleed-over” patients that you see together that don't have clubfoot. On day 14, you'd be given some type of assessment examination and then receive a completion certificate. Incidentally, Dr. Ponseti did almost exactly this training method as a one week course before he died. I believe the course is still in existence.

I can see similar types of courses for a variety of other topics: practice management, diabetic limb preservation, focused fixation methods, biomechanics methods, and various surgical techniques for starters. Say, for example, I want to spend 2 weeks with a certain nationally known physician to learn his surgical methods. Here's another opportunity for a mini-fellowship.

Clearly, there are benefits to this idea. For the preceptorship physicians, this is a revenue positive business model that will provide extra income, while increasing personal reputation for the preceptor. At the same time, the attendee has improved his skills and knowledge. Additionally, if academic institutions – say, our podiatric medical schools – oversaw these programs (for a small administrative fee that improves their bottom line) they could provide high numbers of CME credit because of the time-intensive nature of the preceptorship. It would provide the added benefit of standardizing the mini-fellowships and prevent attendees from taking advantage of the time away to vacation.

With some discussion, organization, and working out the details (there are many) this could be a fantastic educational opportunity to further educate the interested. What do you think? Would you participate? Would you be a trainer? Would this educational method supplement our current methods or would it turn into a gimmick with no value?