Q&A

Q1. What does public health mean to you?

Initially, public health to me was mostly about research design and biostatistics. At least, that was what drew me to public health as it was first introduced to me. However, after becoming involved in podiatric public health in the years since I was a student at the California School of Podiatric Medicine at Samuel Merritt University, my perspective on public health changed. I began to understand that public health was a lot more than research and p values. I didn’t have a full understanding of public health until I finished the American Podiatric Medical Association (APMA)/The Dartmouth Institute (TDI) podiatric public health fellowship. Public health to me now is about disease prevention, equity, and population health. There is much interconnectivity between prevention, equity, and population health; however, they each build upon evidence, which depends on rigorous research design and statistical analyses.

Q2. Why did you do a public health fellowship?

Pursuing a public health degree has long been one of my career goals. It was a subject that I thought could provide a solid foundation for research knowledge and patient care. I actually learned about public health even before I learned about podiatric medicine and surgery. While I intentionally decided to complete my DPM education, I was quite lucky to learn about the APMA/TDI podiatric public health fellowship during my third year at CSPM. I was pleased by the vision that the leaders of APMA foresaw in cultivating future podiatrists and was amazed by the training of Dr. Dyane Tower, the first APMA/TDI podiatric public health fellow. So naturally, after my residency, I applied for the fellowship and was very fortunate to be part of the program.

Q3. What was your experience for 1 year? How was it working with other specialties?

In a one year accelerated program at The Dartmouth Institute (TDI), I learned a variety of subjects. Courses ranged from biostatistics to health care management and qualitative research to policy development. The courses prepared me to cultivate my public health knowledge and to prepare me for the Capstone project. While the curriculum was definitely rigorous, I also got to meet many amazing individuals around the world as the class was composed of ⅓ pre-health students, ⅓ current residents, and fellows and ⅓ mid-career health care professionals. Through this unique class structure, I got to interact with:

a number of resident physicians at Dartmouth-Hitchcock Medical Center,
attending physicians from White River Junction Veteran Affair Medical Center,
faculty at Dartmouth’s Tuck business school,
providers from nearby healthcare systems,
CEOs at different healthcare organizations,
and New Hampshire state senators.

Through these invaluable experiences, I not only learned about many brilliant ideas but I also further sharpened my communication skills through a number of group projects. In addition to school work, our class was also actively involved in intramural sports and even won the intramural ice hockey championship, which I was proud to be part of.

Q4. What was your year project? Thesis about?

At TDI, there were a few major projects throughout the year. Individually, everyone was responsible for a Capstone project and an internship deliverable. For my Capstone project, I designed an NIH-grant level research proposal. The topic was to investigate the threshold level of toenail dust as an occupational respiratory disease in the podiatric clinic. I aimed to carry out this study in the next year or two as it was put on hold during my second fellowship in limb salvage at the University of Southern California with Dr. David Armstrong after the podiatric public health fellowship at TDI. The other major project that I was in the process of publishing involved a survey analysis on plain film utilization for a diabetic foot infection. This was a project that I collaborated with the wound care center at Dartmouth-Hitchcock Medical Center. The goal of the study was to explore the variation of plain film utilization among current practicing podiatric physicians and surgeons. This project could be a stepping stone to recommend future studies as well as potential algorithms for quality measures.

Q5. What part of public health are you interested in? Any sub-specialty or subtopic?

One particular part of public health that I realized during fellowship interested me was a quality improvement (QI). To me, QI seemed to connect evidence, quality of care, and improvement. The podiatric public health topics that I am interested in include non-traumatic major amputation prevention and toenail dust hazard prevention.

Q6. How does podiatry and public health go hand and hand?

Of numerous surgical specialties, podiatric medicine may be the most closely related to public health, particularly in secondary prevention. It is largely due to the population that we serve. Elderly, diabetic, and active populations all can benefit from some form of foot and ankle disease prevention. For the elderly, we assess their risk of falls and refer them to appropriate strengthening programs or to their primary physician for further workup. For diabetic patients with peripheral neuropathy, we educate them about the risk of limb loss, appropriate footwear, and signs of diabetic foot infections. For healthy active people, we recommend appropriate shoes to prevent foot and ankle injury so they can stay active and disease-free. We also identify any skin lesion in the foot and ankle that may be potentially malignant for anyone who comes through the door. I believe podiatrists are in a perfect position to prevent, treat, and maintain a healthy population.

Q7. What advice would you give to a resident interested in going for a public health fellowship?

Being involved with the American Public Health Association Podiatric Health Section is the first step in my opinion. The section is a great avenue to learn various current podiatric public health topics. It is also an excellent channel to share the podiatric public health research, works, and efforts completed by residents and students. Otherwise, any resident or student who is interested in the APMA podiatric public health can always reach out to previous fellows and/or the APMA website (www.apma.org/tdi) for more details about the fellowship.

Q8. If you can change one thing about how podiatry is portrayed in public health, what would it be?

Podiatry in the United States has been evolving drastically as podiatric education has changed in the past few decades. While many people have already noticed the changes from a 3-year mandatory surgical residency, the recognition of public health efforts and interest is still lacking even within the podiatric community. The extent of understanding public health often stops at the research when podiatric public health actually encompasses much more than research and biostatistics. Thus, if there is one thing I could change, I would like to see the expansion of our podiatric public health education and public health collaboration with various organizations. I am hoping that these efforts can help more providers see the value of podiatric public health and the health care communities will see the importance of podiatric contributions to public health.

Q9. What are we lacking in public health in the current times?

Podiatry plays an integral role in public health. I think what is lacking is the recognition of how much podiatric public health can contribute. To overcome this obstacle, rigorous studies and collaborative work will help demonstrate the value of podiatric medicine and surgery in both public health and in the health of communities in general.

Q10. How can we integrate public health into podiatry on an international level?

This is a complicated question, as many countries do not even know about podiatric medicine and surgery. Therefore, I believe a major component of the integration of public health and podiatric medicine will rely on education. Educating the health care communities about what US podiatry is capable of maybe one of the first and most important steps. Such education can be illustrated through actions and publications. For example, in the world of non-traumatic major amputation prevention, many podiatric physicians and surgeons like Dr. David Armstrong, Dr. James Wrobel, and Dr. Patrick Deheer have shown the world about our knowledge and efforts in major amputation prevention. Constant and transparent interactions with various international medical associations and organizations may be one of the channels to demonstrate the value and the role of US podiatry. From there, international collaboration can then be developed. This is obviously a very simplistic way of discussing a very large and complex issue; therefore, careful strategic planning is necessary and critical.

by Mariam Ebrihami

Podiatry & Public Health

Special Edition, Education

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Q&A

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