Temple University School of Podiatric Medicine

The journey that is the Temple University School of Podiatric Medicine (TUSPM) began as the Temple University School of Chiropody in 1915. The school was founded by a committee from the Chiropody Society of Pennsylvania, in conjunction with Temple's founding president, Russell H. Conwell. The initial dean was a medical doctor. The faculty included two full-time chiropodists, seven medical doctors, and 23 chiropodists as clinicians. The initial curriculum was 1 year, which expanded to a 2-year course in 1925 and a 3-year course in 1932. Students in the first 4-year program graduated in 1940. Dr. Charles E. Krausz became the dean in 1940. The enrollment dropped by two-thirds during World War II as a result of the draft. After the War, enrollment grew. In 1956, Temple University had an accreditation visit by the Middle Atlantic Association of Colleges and Secondary Schools, and as part of that visit the School of Chiropody was evaluated as well for the first time and received a satisfactory rating. Unfortunately, in 1958 the University was faced with a budget deficit due to the need to improve the University physical plant. As a result, the Board of Trustees elected to close two smaller schools, Theology and Podiatry.

The closure of the School was painful for the podiatric medical community, both in Philadelphia and nationally. On the third effort to start a new school, a group led by James E. Bates, DPM, William Ziegler, DPM, and four others met in Dr. Ziegler's home and committed to move forward. The first class of 24 students entered in 1963. Two years later, the College bought the previous Skin and Cancer Hospital, after acquiring a small bank loan by the commitment of 100 individual podiatric physicians personally securing the note. They refurbished it themselves and started foot clinics. The school went through several name changes: initially the Philadelphia College of Chiropody, then the College of Podiatry at St. Luke's and Children's Medical Center from 1960 to 1963, the Pennsylvania College of Podiatry in 1964, and, finally, the Pennsylvania College of Podiatric Medicine (PCPM) in 1967, the same year the first class graduated. Timing can be everything, and the urban redevelopment of an area in Philadelphia near Independence Mall created the availability of a building site. With funds from the Commonwealth of Pennsylvania and the Department of Health, Education, and Welfare, a new college building was constructed at Eighth and Race streets and was opened in 1973. A second building for student apartments and additional office space was opened in 1976. The college was successful, with a strong basic science faculty, a fast-growing clinic, and outstanding medical and podiatric medical faculty. Nonetheless, as a strong, independent college, the PCPM developed a strategic plan that was consistent with the profession's vision for a merger with an academic health science center.

Philadelphia has a large academic medical community, and the PCPM was fortunate to be approached by Temple University, a comprehensive public-aided institution with 17 schools and colleges and a comprehensive vertically integrated health system along with several health profession schools, including medicine, dentistry, pharmacy, nursing, public health, and others. Temple now has more than 28,000 undergraduates and almost 10,000 graduate students. In March of 1998, a merger agreement was effected between the PCPM and Temple University and the Health System. The agreement guaranteed independence for the School of Podiatric Medicine in the formulation of its curriculum; established a 4-year residency program at Temple University Hospital, a tertiary care hospital with a level I trauma center; established a Department of Podiatric Medicine and Surgery at Temple University Hospital; created access to medical rotations; and provided many integrated aspects with the University. Dr. John Mattiacci was chosen as the initial dean and has remained the dean since the merger. The TUSPM has been successful as part of the larger University community. Temple is a thriving urban university with a rapidly increasing number of applicants and a $1.6 billion health-care system.

Once again, timing is everything. The podiatric physicians who created the PCPM after closure of the Temple School of Chiropody allowed us to be in the position to be an attractive merger candidate. As a result, the merger has placed us where our alumni, faculty, and students have always known we should be: within the mainstream of education and health-care delivery in a growing and thriving institution, Temple University.

Lisabeth M. Holloway

A Fast Pace Forward: Chronicles American Podiatry. Philadelphia, PA, Pennsylvania College of Podiatric Medicine Center for the History of Foot Care and Footwear, 1987.

PCPM/TUSPM and the American Association of Colleges of Podiatric Medicine

The PCPM/TUSPM has been an active part of the American Association of Colleges of Podiatric Medicine (AACPM) through each of its years. In addition to the common student application service, the AACPM has served the students well with the development of a more orderly process for student externship selection and the residency interview and match process. The AACPM's Educational Enhancement Project provided additional evidence to support that the profession recognized the importance of the merger of its schools into academic health science centers. Most importantly, the AACPM provides a common voice for the academic community on educational issues important to the profession. It provides vehicles for faculty, residency directors, student affairs directors, and deans to work with their peers and work together for the benefit of the educational process. For a small profession, with a small educational community, having a common voice is critical.

A Curriculum Change Moving Forward

With the merger of the PCPM into Temple University in 1998, the TUSPM was born. With a strong faculty, a physical plant designed specifically for podiatric medicine, and a large patient base in a desirable location, the TUSPM has benefited by its merger with a large public research institution with its own health system. Some of the benefits from the merger have included investments in the physical plant, integration into the health system, the financial backing of the University during a downturn in applications and enrollment, teaching from medical school faculty, and integration into the University with its 16 other schools, all of which has been a momentous change for a small private institution. It is a change that has benefited our alumni and the profession by adding to the credibility of a degree from an outstanding university. Podiatric medical education is part of the medical mainstream in Philadelphia.

Despite a sea change in health-care delivery both nationally and in Philadelphia, the TUSPM has maintained the largest patient base among the colleges of podiatric medicine, with 40,000 patient visits at our own locations. Students are exposed to substantially greater numbers of patients at external sites as well. The advantage to the model of educating students with faculty who teach both in the didactic and clinical settings should be apparent: the opportunity to directly and immediately reinforce knowledge with patients who exemplify a broad range of conditions. Merger into Temple University and the Temple University Health System has increased the range of patients and pathologies that students experience. A close interaction with the Vascular Surgery Department at Temple University Hospital, including a collaborative Limb Salvage Center section staffed by both TUSPM Surgery Department faculty and medical school vascular faculty, has greatly increased the number of patients we see who require limb salvage or have Charcot's foot . Our wound care clinic at the TUSPM sees an extensive number of patients and has experienced rapid growth. It provides state-of-the-art care and education in this important field. Having a large of number of clinical trials allows the student to both participate in research and be exposed to cutting-edge wound therapies. The Department of Podiatric Medicine has nationally recognized experts in the field. Another important area has been foot and ankle trauma. The Department of Podiatric Surgery takes foot and ankle calls at Temple University Hospital. As a result, students see a large number of both simple and complex foot and ankle injuries, and the faculty have significant training and expertise in this and other surgical areas. A renewed focus on teaching biomechanics by the Department of Biomechanics and Orthopedics has been met with enthusiasm by students. An increased number of hands-on workshops and competency examinations have been developed to strengthen student biomechanical knowledge and the ability to apply that knowledge to clinical situations.

More physical plant changes have been made to update the building. Each of the three major classrooms has been remodeled and adapted for smart technology. Students take all examinations on iPads, enhancing examination security and preparing them for the many computer-based tests that they will take for licensure and board certification. The library has been remodeled, and students have online access through the University to a virtual world of publications at their fingertips from any location. One exciting development has been the state-of-the-art remodeling of the anatomy laboratory space with showers, locker storage, and computer learning facilities. Another simultaneous development is the construction of a dedicated standardized patient and simulation laboratory that also reflects state-of-the-art design. This is a result of revisions to the curriculum that incorporate more Standardized Patients for teaching purposes into the early years of the curriculum. With Standardized Patients, actors portray conditions to ensure that uniformity of exposure to specific conditions occurs. As an example, every student should know the clinical appearance and evaluation of a patient with gout. This can be simulated with the actor, and the student can receive instant feedback. An additional project is remodeling and expansion of the Ambulatory Surgery Center. This will allow us to expand the types of procedures performed there, including under general anesthesia.

Curriculum Change

Like every forward-thinking educational institution, the TUSPM undergoes constant curricular review and reform as needed. This occurs on both the departmental basis and by the faculty as a whole. During our most recent curriculum review, some of the specific objectives we identified as being critical for our future were 1) improving retention of didactic material, 2) using time more efficiently in the curriculum, 3) improving basic and clinical science integration, 4) reducing didactic material by 25% and using more small-group formats, 5) increasing use of technology, 6) expanding student patient exposures, and 7) improving student knowledge in biomechanics.

Academic administration (deans, chairs) met with the medical school faculty, students, TUSPM faculty, and the Curriculum Committee to get input into the revised curricular model. Achieving the proper balance is always difficult and requires a commitment to constant monitoring and change as needed. This was a large undertaking for the TUSPM, the most extensive curricular change in my memory of the institution. Attempting to integrate the basic and clinical sciences can be difficult, but a new Pathophysiology course was designed to do just that, immediately before the Part I American Podiatric Medical Licensing Examination Boards. Our underlying philosophy was to use our strengths and identify opportunities. The large patient population in TUSPM's Foot and Ankle Institute and the diversity of the population and the pathology is a major strength and unique aspect of our institution. One opportunity was underuse of the spring term of the second year. This created an opportunity to shift some third-year courses backward into the second year to free more time in the third year for even more patient experiences. Students learn best when they encounter real-life clinical situations. By shifting the courses backward to the second year it also created space to reduce the number of courses in the third year that the students would be simultaneously taking. One of our objectives was to improve retention of material. We recognized that a large number of courses and class hours in the third year resulted in students learning from test to test, greatly affecting retention. The actual number of courses has been reduced. A couple of shorter courses have been shifted to seminar formats over 1 day. Third-year courses have been shifted to earlier in the morning before clinic, for the first time opening up afternoon clinic as an experience for third-year students. Students will take fewer courses at any one time, allowing for better linkage between the courses they are taking and improved focus on the material at hand.

Implementation of the curriculum change began with the incoming first-year students. Course assessments, quarterly meetings with the academic dean, and meetings with the assistant dean for educational affairs provided ongoing communication and afforded the opportunity for course corrections as needed. As the curriculum revision expanded to the second year there was a focus on integrating material between courses. An example is the Pharmacology course and the Pathology course, where coordination exists to teach the same system at the same time. Standardized Patient teaching has also greatly expanded in the area of physical diagnosis.

The third year is also part of the new curriculum. With only two courses at one time, instead of five or six, the material will be more manageable for students. We believe that this will result in improved retention of material. Workshops, some longer examinations, and seminars will still take place in the afternoon, but third-year students will be freed up for greater patient care experiences. It enables us to take advantage of our unique strength in patient numbers and diversity. Additional workshops led by faculty will take place to assess clinical skills. An interprofessional education program exists with the other health profession schools. In addition, we use some of the medical school facilities. Our faculty work together with Temple University Medical School Emergency Department faculty to teach critical decision-making skills and techniques at the Temple University School of Medicine. Fourth-year students now have access to an additional month of externship before the CASPR (Centralized Application Service for Podiatric Residencies) match. Overall, as we have moved forward with implementation, we believe that we are accomplishing our objectives. Student feedback has been positive, and we will continue to modify the structure based on multiple feedback mechanisms.

Two other areas of focus have been integrating the teaching of professionalism and ethics into the curriculum and preparing students for the types of formats seen on board examinations. Professionalism education begins in the first year and includes peer evaluation of behavior.

Delivering a future-focused curriculum depends on having a faculty with true expertise in all of the areas of podiatric medicine and surgery. Our faculty are structured by departments to facilitate specialized expertise. Faculty are provided ongoing professional development, including opportunities to be engaged with the broader national community in their particular subdisciplines and opportunities to develop as educators. Our faculty have the support of resources through Temple University, including the Center for the Advancement of Teaching. Many of our faculty have participated in the yearlong Leadership Academy.

Finally, scholarship is vital to lead in the profession. All of our faculty are expected to contribute scholarly activity. At the most recent American Podiatric Medical Association national meeting, many of our faculty participated as lecturers, a large number of the posters were with TUSPM faculty, and nine of the posters received awards. Our faculty are well represented at regional and national meetings as lecturers and with posters.

Conclusion

The mission and vision of the TUSPM have been the cornerstone of our education of excellence since our beginning. For each podiatric physician we teach and send into the profession, we share and follow the mission and vision.

Mission: To educate highly qualified, ethical, and professional podiatric medical students who, on completion of the curriculum, are prepared for licensure and entry into postgraduate medical education and to advance the podiatric medical profession through research, quality patient care, and community service.

Vision: We will graduate doctors of podiatric medicine who are trained using the most innovative procedures and advanced technology. We will establish the Foot and Ankle Institute as the preeminent center of excellence for the diagnosis and treatment of maladies of the lower extremity. We will increase the body of knowledge of the lower extremity through research, scholarly publication, and presentation.

We have a bright, motivated, and dedicated student body; a talented faculty; proud and engaged alumni; and some unique resources to fulfill that mission. As part of Temple University, we have positioned ourselves for the future of medical education and health care.