User:Jeffersonswall/Podiatry in the United States

Podiatry in the United States ... Podiatry, or podiatric medicine and surgery, is a branch of medicine that deals with the diagnosis, prevention and treatment of disease of the human foot, ankle and associated structures of the leg. The scope of practice of podiatry is determined by each individual State, and as such, the medical and surgical intervention provided by a podiatrist will somewhat vary based on location (See Section: "Scope of Practice" below). The practice of podiatry in the United States is overseen by several organizations including the American Podiatric Medical Association, and its United States Department of Education designated educational arm the Council on Podiatric Medical Education.

Podiatric Medical Education
Podiatry school, or a school or college of podiatric medicine, is a term used to describe a graduate program at a university center or independent podiatry school that leads to the degree Doctor of Podiatric Medicine (D.P.M.). The D.P.M. is a 4 year long professional doctorate and second entry degree which means that several years of previous study is required for admission. The curricula at a podiatric medical school is largely dictated by the Council on Podiatric Medical Education (educational accrediting body) and American Association of Colleges of Podiatric Medicine (AACPM), however each podiatry school varies to some degree from another in terms of course content. Admissions criteria include 90 semester hours of undergraduate work (although most applicants have obtained a Bachelor Degree with course requirements in biology, general chemistry, organic chemistry, physics and English. Acceptable scores on the Medical College Admissions Test, and in some circumstances, GRE are required for admittance as well.  According to the AACPM, there were 991 applicants for just over 500 seats in 2009, making entrance into podiatry school less competitive than similar graduate programs such as allopathic, osteopathic and dental schools .  Average applicant MCAT composite scores are 22, and the average applicant GPA is 3.3.

Curriculum
The curriculum at the 9 podiatric medical schools consists of basic medical science courses and clinical sciences. The following are standard courses found at the Nation's 9 podiatry schools:

Basic Sciences

 * Gross Anatomy
 * Lower extremity anatomy
 * Histology/Cell biology
 * Biochemistry
 * Microbiology
 * Pathology
 * Physiology
 * Pharmacology
 * Immunology

Clinical Sciences

 * General Medicine
 * Radiology
 * Surgery
 * Traumatology
 * Podiatric Medicine
 * Women's health
 * Dermatology
 * Podopediatrics
 * Sports Medicine

Licensure
Podiatrists are licensed in all 50 states, the District of Columbia and Puerto Rico. Licensure is provided by the Podiatric Medical Board, or if applicable, subset of a State Medical Board in each state in the country and requirements generally include graduation from one of the nine accredited schools and colleges of podiatric medicine, passage of the National Licensing exams, postgraduate training and written and oral examinations. National Licensing exams are administered through the American Podiatric Medical Licensing Examination service (APMLE) and are taken in two parts while in a college or school of podiatric medicine. Part I covers basic science areas and is generally taken at the conclusion of the second year. Part II covers clinical areas and is taken in the winter of the fourth year, prior to graduation. Part III can either be taken immediately following graduation or during residency training.

Residency Training
After graduation, newly minted D.P.M.'s must complete a Podiatric Medicine and Surgery Residency (PMSR), which is a three year long hospital-based and competency driven surgical residency. The PMSR programs are located throughout the country, and are accredited by the CPME, the same accrediting body responsible for oversight of the colleges of podiatric medicine. Residency training has become longer and more standardized within the profession over the last few decades. Training allows the resident to medically manage their surgical patients, perform preoperative history and physicals, hone in on clinical skills, and understand how to become involved the multidisciplinary approach to patient care.

Surgical Requirements
The training model requires that resident physicians undergo extensive training in foot and ankle surgery. Minimum requirements include:
 * 80 digital procedures (i.e. hammertoe correction)
 * 60 first ray procedures (i.e. bunion correction, 1st metatarsophalangeal joint fusion)
 * 45 other soft tissue foot surgery (i.e. ganglionic cyst removal, neuroma excision)
 * 45 other osseous foot surgery (i.e. exostectomy, fifth metatarsal bunionectomy, transmetatarsal amputation)
 * 50 reconstructive rearfoot and ankle surgery (i.e. ankle arthroscopy, flatfoot reconstruction)
 * 50 trauma cases (i.e. open reduction internal fixation (ORIF) of calcaneal or ankle fractures, motor vehicle accidents, crush injuries)

Off Service Rotation
Residents are required to complete and show competency in rotations outside of podiatric medicine and surgery as well. Rotations are usually 4-8 weeks in duration, with the majority being completed during PGY-1 and PGY-2 years. Required rotations are as follows:
 * Internal medicine
 * Radiology
 * Behavioral Medicine/psychiatry
 * Infectious disease
 * General surgery
 * Anesthesiology
 * Emergency medicine
 * Two or more of the following medicine subspecialties: dermatology, pain management, endocrinology, neurology physical medicine and rehabilitation, rheumatology or wound care
 * One or more the following surgical subspecialties: orthopedic surgery, vascular surgery or plastic surgery.