A Conversation with Peter Crisologo, DPM

Dr. Peter Crisologo

RESEARCH FELLOW AT UT SOUTHWESTERN DIABETIC LIMB SALVAGE FELLOWSHIP IN DALLAS, TEXAS

Q&A

Q1: Where did you go to podiatry school and where did you train during residency?
A: I went to school at Des Moines University and completed my residency training at Ohio State University in Columbus, Ohio
Q2: At what point in your education or training did you begin thinking about pursuing a fellowship, was it during school or residency?
A: When I started my residency, I kind of knew that I wanted to do a fellowship. My interests at that point were elective reconstruction. I was interested in something like Dr. Hyer’s program in Columbus, a big reconstructive one. I wanted to pick some facet in podiatry and really delve into it and become an expert in that area. That was appealing to me as opposed to practicing general podiatry. There is nothing wrong with general podiatry but doing just that was not as appealing to me. One way I could meet my goal of being an expert was to further specialize with fellowship training. My goals in what I was interested in started to change halfway through residency (2nd year).

“One way I could meet my goal of being an expert was to further specialize with fellowship training”

Q3: What is the application process like for fellowships?
A: Even from when I applied just a few years ago to now, the application process has become different and is now becoming more advantageous to the applicant. It used to be heavily favored towards the institution. There was no centralized application or process. You just kind of contacted programs individually and they had their own deadlines and interview dates. There were about 1/4th of the programs back then on ACFAS than they are now. There was a lot of guesswork involved. Starting last year maybe, ACFAS started implementing a centralized process, which includes a 2-page general application to go along with whatever supplementary information specific programs wanted. They are trying to make it a narrower timeframe as well. They haven’t specifically said this, but I believe it is going in the direction of CRIP, in which applications will be due and interviews will be conducted on a certain date and it will be a match process.
Q4: What sparked your interest in pursuing this specific fellowship at UT Southwestern?
A: Wanting to do a fellowship is a good thing you should really ask yourself what you want to do with your career. Fellowships got started with people who may not have had good residency training and they wanted more training, sort of like the 4th year of residency. The vast majority of programs now are offering more specialized training. I applied solely based off of my clinical interests. By the middle of the 2nd year, I decided that diabetic wounds were my interest as well as academic medicine. There were only 2 programs that met those interests: UT Southwestern and Georgetown. UT is more clinical heavy (80% clinical, 20% research), Georgetown from what I heard is more research heavy (80% research, 20% clinical). I interviewed and liked both programs and ultimately offered the position at UT and decided to take it. I caution people on shot-gunning programs since most are specialized. If you apply across different sub-specialty areas, programs may get apprehensive that you may not know what you’re interested in. They want someone to come in and be fully invested in what the program is offering. Therefore, you should really examine what your interests are, not what other people are doing.

“Wanting to do a fellowship is a good thing you should really ask yourself what you want to do with your career”

Q5: Is your specific position a research position? I noticed on the website that there are 2 clinical fellows and 1 research fellow at the program.
A: Residencies are very much defined by CPME, while fellowship is largely elective. You don’t HAVE to have it to practice. It really is for you to get what you want out of your experience. I was interested in research and academics so I asked the program if they had anyone do both. Since I showed interest, my position was essentially created for me as a clinical research track over 2 years. Last year, I completed the clinical portion. This year, my responsibilities are 80% research and 20% clinical.

“Fellowships got started with people who may not have had good residency training and they wanted more training, sort of like the 4th year of residency. The vast majority of programs now are offering more specialized training”

Q6: In terms of research that you are involved in, are you expected to publish a certain amount of projects the completion of the fellowship?
A: There is generally 1 publication expected by the end of the clinical year, publishing during that year is difficult due to the large clinical responsibilities. For the research portion, there is not a real requirement as that is why I am doing it. Currently, we are on track for ~16 article submissions by the end of the year.
Q7: Along with the application process, are you expected to visit programs beforehand in person?
A: Fellowships are not as cut-throat of a process as applying to residencies are. It is more laid back as you are trying to get into something that you WANT to do instead of something you HAVE to do. It depends on the program whether visits are required, it certainly helps both sides get to know each other better.
“If you apply across different sub-specialty areas, programs may get apprehensive that you may not know what you’re interested in. They want someone to come in and be fully invested in what the program is offering”
Q8: Did you also apply to jobs at the same time, while applying to fellowship?
A: Yes. You can always say no but you can’t turn around and say I wish I would’ve done that. I got offered a hospital system-based job in a smaller town in Ohio. However, they didn’t have any residency teaching or research, it was strictly clinical. I was conservative in that I applied to fellowships but also applied to jobs as well as you aren’t guaranteed to be accepted to a fellowship and need a plan in case you don’t.
Q9: Looking forward to after you complete the fellowship, are you looking to apply to a specific job setting in which you can be involved in teaching as well?
A: Yes. My goal is academic medicine, ideally at a large major medical institution with involved academics. When you apply to positions at places where there is a medical school or residency program, you are not the only faculty but you can also request to be given an academic appointment.
Q10: At Ohio State, was fellowship training common amongst graduates from that program or is that something you mostly sought out yourself?
A: I would say it’s relatively common, maybe 30%. My program was 2 residents per year. I’m doing a fellowship, my co-resident had no interest. The year before me, 1 did and 1 did not. The year prior to that, neither did.
Q11: Were your attendings at the program encouraging of your desire to go into fellowship?
A: They were supportive in whatever we wanted to do with our careers after residency. Whether it be fellowship, private practice, hospital group, etc. They were interested in hearing what our plans were and were supportive in guiding us whenever they could.
Q12: Did you have a mentor that you went to for advice regarding your pursuit of a fellowship and the application process?
A: None of the attendings at Ohio State did a fellowship, I did have someone that I talked to more than the others, but no specific mentor throughout the process. I had a very specific interest so not many others sought out this track that I went into.

About the Program

Q1: Were there any benchmarks that you had to meet for the clinical portion of your fellowship?
A: Not really. Our institution is a large 1000 bed county hospital (Parkland Hospital), which is incredibly busy. It is primarily a hospital-based service, which is 75% inpatient. We usually have 2 fellows that switch week to week: 1 on the floor, the other in the OR. We generally do 1200-1500 cases per year between the 2 fellows as we are an extremely busy hospital.
Q2: Were/are you involved with teaching responsibilities at the medical school or with students/residents as a fellow?
A: Not directly. There are a lot of students rotating with different services. I enjoy talking with other teams, it gives us a great opportunity to show them what we know. We have a very unique skill set in properly being able to manage the diabetic foot better than any other profession. It’s a good way to share knowledge with other services being in a well-integrated hospital. The residents from the Hunt Regional program come rotate with us for 12 weeks in the year.

Q3: Did you have research publications in school/residency prior to going into fellowship?
A: Not during school. I submitted one project in residency to JFAS but it didn’t get accepted until I already started the fellowship.
Q4: In terms of the future for someone looking to settle down in a career at an academic institution or hospital setting, do you think fellowship training will become more of the norm for the profession?
A: Absolutely. Most of the other medical specialties are fellowship trained. In these large medical academic centers, you are held towards the standards that all other medical specialties have set as opposed to just podiatry. Being fellowship trained showed that you can be considered an expert in your field. Some places actually will only consider fellowship trained podiatrists when hiring.

“Most of the other medical specialties are fellowship trained. In these large medical academic centers, you are held towards the standards that all other medical specialties have set as opposed to just podiatry”

Q5: How many podiatry faculty are at the program?
A: There are 2 main faculties involved with the program (Dr. Lavery and Dr. LaFontaine) and are part of the plastics department. UT supplies all the doctors and they also supply doctors for Parkland. Parkland has 1 podiatrist that they hire but his main interest is in outpatient cases (Dr. Lewis). There are also podiatrists in the orthopedic department who deal with the general bone and joint pathology.
Q6: Is there anything unique about the clinical portion of the fellowship?
A: It’s a good way to transition from a resident mindset to being an attending. You are a fully licensed physician and you can do a lot on your own. We do a lot of complex diabetic limb salvage and it definitely builds confidence in dealing with such cases. You become an expert in managing the most complex, train wreck, nightmare complication patients. We have a saying: “If it’s going to go wrong with a patient, it’s going to happen at Parkland.”
Q7: How closely to you work with other departments such as plastics and vascular?
A: We have an excellent relationship with those two departments. We do a lot of cases with plastics as we part of their department and they will do free flaps for our patients. We are very well-integrated, frequently calling fellows on each service. We work closely with vascular as a lot of our diabetic patients have vascular pathology.
Q8: At UT, do they plan on keeping the 3 positions moving forward?
A: They actually want to expand further, especially the research arm of this program, Dr. Lavery wants to get more fellows funded. He likes the idea of a 2-year position that is a hybrid of clinical/research, like the position I am in. Since we are recently ACFAS-recognized, we have been getting more interest in our program.
Q9: Are research projects that you work on more prospective/retrospective/case series?
A: By nature, a retrospective is much easier. However, there are a fair amount of prospective studies as well. Things from retrospective to phase III clinical trials for non-reconstructible vascular disease.

“If you get into a fellowship that you’re actually not interested in, the dropout rate is actually pretty high”

Q10: Do you have any general advice to students/residents who may be looking to go into fellowships?
A: The main thing is to examine what your interests are. During the first part of the residency, if people want to do fellowships, everyone wants to do the reconstructive fellowships, putting frames/nails/etc, which I wanted to as well. Later on, I decided I didn’t really want to focus too much on that and decided I wanted to specialize in diabetic limb salvage. You have to make sure that you enjoy the area that you choose to go into. Don’t do a fellowship just to do a fellowship. If you get into a fellowship that you’re actually not interested in, the dropout rate is actually pretty high as you don’t HAVE to have a fellowship to practice.

By Rafay Qureshi

Temple University School of Podiatric Medicine

the fellows

Special edition
Vol 1.

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