Residency Insight -- A PRESENT Podiatry eZine

– Scholarship –

Robert Frykberg,
DPM, MPH
PRESENT Editor,
Diabetic Limb Salvage

There was very little scholarly mentorship exhibited by my faculty when I was going through Podiatry School in the early 70’s. Attention to the pinball machine in the lounge or sports scores seemed to be the areas of greatest interest to both faculty and students, when outside of class. At one point, we even joked that DPM was the acronym for “Doctor of Pinball Machines”. I honestly cannot remember ever being encouraged to write, engage in research, or to pursue any scholarly activities outside of our required coursework. To be fair, however, several of the faculty had edited a text or chapters therein and a few had published a paper or two. We knew this because they referred to these works in their class notes and lectures. But is that really as far as it should go? Frankly, I expected much more of an academic environment than I witnessed – especially since we were to receive doctoral degrees.

Fortunately, things changed somewhat for the better in my Residency. Although I had already published a paper with a private Podiatrist and role model by that time, there was really no emphasis on such activities by my Podiatry attendings. Perhaps they were just too busy to worry about such matters, or more likely, they were also products of the same type of education that I had received. However, I was surrounded otherwise by very accomplished physicians and surgeons from the Harvard system and Joslin Clinic. They were truly icons in their day – and we would shiver in our boots if they were displeased with our work or if we had missed some aspect of patient evaluation that should have been obvious. We frequently went to their conferences and lectures. Each week there was a multidisciplinary “Foot Rounds” conference conducted by the Vascular surgeons in concert with other specialties involved in the care of patients with diabetic foot problems – the Podiatrists were expected to attend as well. This is where I first experienced true scholarship. Noted physicians and surgeons from well known Boston hospitals discussing and debating aspects of care for each patient – most based on the relevant literature as well as their collective experience.

One key event that I believe sold me on the necessity for academic scholarship in our “practice” was when I attended the weekly Orthopaedic Grand Rounds at the old (and famous) Peter Bent Brigham Hospital, home to the Harvard Orthopaedic Residency program. I remember sitting in the amphitheater lecture hall, listening to the Chief of Orthopaedics (Clement Sledge, MD) present a case of interest for that week. He was a very auspicious guy who was held in great esteem by his colleagues. When questions were posed to him by the physicians, residents, and students in the audience, I was in awe of his knowledge. With every reply came a quote, citation, study, or paper as a reference for his remarks – truly an evidenced based discussion, long before EBM became our buzzword some 30 years later. This had a profound effect on me – because I had never really experienced genuine erudition before – all off the top of his head, ingrained in his memory bank. This was magnified by the lecture my old Chief of Podiatry gave weeks later. Contemporaneous mumbo jumbo – I do this, I do that, it seems to work for me somehow – the typical fare of the day in our profession back then (all while he was wearing galoshes!). I was embarrassed for him. The contrast between the two Chiefs and Professions was remarkable back in 1976 and I still vividly remember it to this day.

Nonetheless, and as I discussed in a previous RI, our small profession has made dramatic strides in education, residency training, and the value that it places on scholarly activity – especially noted by all the great papers and studies generated from our residency programs. Unfortunately, in my humble opinion, only a small percentage comes from our schools themselves – the very institutions that should be driving our progress in this regard. I can’t answer why this is so – perhaps it is not in their culture as it was not in the culture, of my school so many years ago.

"...the credibility of our profession will be determined by the credibility of our literature." —E. Dalton McGlamry, DPM

Inasmuch as the aforementioned events shaped my philosophy about such things, there is another very important contribution made by a former Editor of the Journal of the American Podiatry Association (as it was called back then). In 1976 or 1977, I clearly remember an editorial that E. Dalton McGlamry, DPM (a true giant in our profession in that decade) wrote that made a very great impression upon me. Since I no longer have a copy of that opinion piece I will have to paraphrase. He said that the key to making a difference in our world (i.e., Podiatry) was authorship. Leaving a record in the medical literature of your writings, cases, reviews, and studies. Making a difference (he also might have used the word notoriety) required the discipline to write; going above and beyond the day to day care of patients and running a practice. He argued that the credibility of our profession would be determined by the credibility of our literature, as well as to the contributions we make to the larger body of medical literature. How many editorials do you remember from your readings (other than “Wither Podiatry” written by a sour orthopaedist of the same time period)? I continue to remember this editorial because I have embraced it all these years- as have so many others who have had the same mind set over the last thirty years or so.

"If a little knowledge is dangerous, where is the man with so much knowledge as to be out of danger?" —Thomas Huxley

Scholarship is critically important to your development as an educated consumer of the medical literature. It is critically important for optimal patient care. It is important in your interactions with other medical specialties. Remember that credibility is defined not just by what you can do, but also by what you know and how you speak. Learn the literature, at least develop an area of interest or expertise and master its literature. Become conversant with it, quote it, and refer to it when you are discussing such things with your colleagues. It takes a great deal of discipline and mental exercise to accomplish this, but it is all worth it in the end. Challenge others (and most importantly, students) to do the same. You might just be surprised as to what it can do for your career!

GET IN ON THE DISCUSSION

We at PRESENT love hearing from you, and look forward to learning from you. Please post your interesting cases, thoughts, or questions in the eTalk section of PRESENT podiatry to promote our collective knowledge.

Best regards,