Objective: 
Many patients receive care from various health care providers and specialists.  Often patients visit these professionals without truly seeing a primary care provider.  It is imperative that all specialties understand the importance and have the tools to screen their patients for risk factors of disease.  The podiatrists, a surgical subspecialty should also be very detailed in their approach, evaluation and examination of their patients because they are performing operations on them, exposing them to risks of anesthesia and also may need to refer them for more comprehensive care.  At our University we have combined the teaching of clinical medicine with the podiatric and medical schools.  We felt the competency and standards should be the same. As a result of this, as well as the JACHO requirement for recertification of History and Physical skills, we set up a program to review these skills in the podiatric community by using standardized patients. 

Methods:
24 practicing podiatrists signed up for the review sessions.  On day one would attend lectures from 12-9 pm on the approach to history and physical examination, documentation and physical examination skills with an organ based approach.  On day two they were to experience the world of standardized patients.  The plan was as follows:  The podiatrists would examine a standardized patient with the complaint of heel pain.  The instruments that would be used to evaluate the DPMs performance would be 1) a complete history check list of 50 items;  2) a Patient Satisfaction Evaluation form of 19 items;  3) a modified head to toe (HTT)physical examination check list of 119 items, and,  4) a Physical Examination Finesse Scale of 19 items. Following the history-taking portion of the encounter, the DPMs would be required to view an X-ray of a heel spur and write up a list of their top five differential diagnoses.  They would then return to the examination room to perform the mo!

dified head to toe (HTT) exam. The final step in the process would be a 30 minute verbal feedback/teaching session where the patient would discuss the DPM’s history-taking skills, communication skills and physical examination skills.

Each participant would receive a DVD onto which would record the history-taking, physical exam and patient feedback.  The participants also would receive copies of the SP checklists and Patient Satisfaction Scales.

In addition to this standardized patient experience, the participants were also to be divided into small groups of four and given the opportunity to interview two additional standardized patient cases ­ 1) depression with suicidal ideation and  2) elder abuse.  Upon the conclusion of the group interview, the SP would discuss the case with the participants and give them feedback regarding their communication/interpersonal skills.

Results: 
After the lecture series on day one, we learned there was a high anxiety level among the DPM’s regarding having to perform a head to toe physical examination on the standardized patient.  We, therefore, changed the portion of the encounter session to a one hour head to toe (HTT) physical examination teaching session.  The standardized patient worked one-on-one with their DPM, going through the HTT checklist and teaching the techniques which are taught to our students.  This change was received positively.  The podiatric professionals learned a great deal and specifically were happy to slow down and go through a full history and physical.  They also were thrilled to have the opportunity to interview the depression and elder abuse cases, finding them to be extremely educational and “eye opening” experiences. The feedback both written and oral was overwhelmingly positive. 

Conclusion: 
The podiatrists felt that overall this would positively affect their practice and they would know best when to worry about other systemic manifestations of the disease they are treating in the foot.  Many felt they would return on a yearly basis to brush up and learn more. The standardized patient training is well received and will have a postive impact on allied health field and patient care.