It’s not surprising when your personal life overlaps with your professional life. My wife home schools our two children, who are 12 and five-years old. She has been doing this for about five years and has been very successful thus far. Recently, my wife showed me a short lecture by the founder of an online educational company for gifted children called G3. One of this company’s advantages is the ability to personalize children’s education. The founder mentioned that this was a primary disadvantage to public school education. Essentially, public school has a one-size-fits-all method which might work for a large number of students but fails miserably for students on either extreme of the intellectual spectrum.

Here is where personal life and professional life overlap. The public school model sounds suspiciously like our current podiatric residency model. The current Podiatric Medicine and Surgery residency model is highly standardized across the country with some obvious variation based on available rotations and hospital structure.

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“The current Podiatric Medicine and Surgery residency model is highly standardized across the country, making it easier for those outside of podiatry to understand our skills”

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In many ways, this is very positive. A standard structure across the profession makes it easier for those outside of podiatry to understand our skills. It is also easier for our profession to demonstrate and easily translate our knowledge and skills across state lines. These are very important characteristics to demonstrate to the general medical community. The ability to create standardized tests and board exams follows naturally from this model. But is this really the best way to educate our residents?

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“But is this really the best way to educate our residents?”

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When I compare this model to the customized homeschool model, it seems to be incomplete. The most significant disadvantage that jumps out immediately from our current one-size-fits-all model is that not everyone wants to be a podiatric surgeon.

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“Podiatry’s dirty little secret – not every resident wants to be a podiatric surgeon”

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There is a lot to podiatry, and surgery is only one part. Many podiatrists have satisfying and lucrative practices outside of the surgical realm. Yet our current residency model moves inexorably toward a fully surgical practice. We are essentially mimicking orthopedic surgery.

Despite the benefits of a standardized residency, we are in the process of swinging the pendulum too far in this direction. Many of you will recall the recent past in which there was an alphabet soup of residency programs. Names such as Primary Podiatric Medicine Residency (PPMR), Podiatric Orthopedic Residency (POR), and Podiatric Medicine and Surgery 24, 36, and 36+ (PM&S 24, 36, 36+) were the common designations for the variety of residencies that existed in recent history. Obviously, this created problems for the profession, which led us to combining these into the current Podiatric Medicine and Surgery 3-year model. The only variation now is whether or not a program obtains the Rearfoot Reconstruction and Ankle (RRA) certificate. The ramifications of this change continue to play out as noted by the loss of many of our two-year programs, which is part of the reason for the current recent residency shortage.

Now, if a podiatric medical student does not want to become a surgeon, they must still complete surgical training. As I’m sure everyone would agree, not all students who graduate from podiatry school should be surgeons. Unfortunately, our programs, as they continue to move further surgically, supply less and less nonsurgical podiatry. They also spend very little time in other pursuits such as research, academia, or podiatric subspecialties such as dermatology, biomechanics, or radiology.

If the one-size-fits-all model of education does not work well for our public schools, then why should it work for our residencies? I would like to see an adjustment to our current model.

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“I would like to see an adjustment to our current residency training model, WITHOUT scrapping the current model.”

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What I do NOT want to do is scrap the current model. It remains important that podiatrists demonstrate to the public and the medical community our knowledge and skills in a clear way. What I would like to see is our community better utilizing our current resources and working together to create new resources to train our young colleagues.

Here are a few suggestions:

Not convinced that one-size-fits-all is not best? I’ll provide one highly anecdotal example: my homeschooled children.

As a previously untrained teacher, my wife looked for guidance from the Massachusetts state standards (the best in the country). Within these standards (the equivalent of our competencies), my wife provided a customized education based on our children’s interests and our resources (very different from public school). For example, when my son was younger, he was very interested in paleontology. My wife had the leeway to allow him to explore this field. She was also able to sneak in other important scientific concepts, such as the scientific method. She seeks out others to provide education for which she is not comfortable. For example, my daughter takes an acting class and my son takes a special English class. As a result, my son, at 12-years old, has completed his freshman high school year and is on track to complete high school by the time he’s 15-years old. My 5-year old daughter has almost completed 1st grade and is able to read and do early second grade math (she should be in pre-K or kindergarten based on age). They both took special tests with our charter school to assess their levels, rather than arbitrarily placing them in more advanced years. They have proven their knowledge and skills to function at advanced levels beyond their young years.

Now apply this example to our podiatric residents. If my children can do it, why wouldn’t this method work for our trainees? Clearly, what I’m suggesting would be a highly ambitious and far-reaching set of goals, but if done right would be beneficial to our residents, the profession, and our patients.