My one-month internship at East Coast Podiatry Centre (ECPC) has been a very valuable learning experience. The team of podiatrists at ECPC have been incredibly helpful in taking time out of their busy schedules to teach me many practical skills that will no doubt benefit me in my future practice as a podiatrist. This experience has also provided me with a greater understanding of podiatry in private practice as well as within a very multicultural society. Getting the opportunity to shadow all eight podiatrists on the team allowed me to learn a lot as each podiatrist had different educational backgrounds from different countries across the world. Each podiatrist had their own approach to patients and ways to communicate information effectively to patients. I have learnt about the effectiveness of using support tools such as anatomical foot models and other visual aids (e.g. iPad Pro anatomy apps) to explain to patients about their specific conditions. I have obtained many useful tips which will help me in my future patient interactions. Moreover, the podiatrists have been very patient in discussing patient cases, conditions, and treatment plans with me, and answering all of the questions I had.
Throughout this internship, I have been exposed to many diagnostic and treatment modalities that I previously had little or no experience with. These include diagnostic ultrasound, extracorporeal shock wave therapy (ESWT), and PACT therapy, just to name a few. The staff at ECPC were kind enough to let me practice these skills on them while experienced podiatrists supervised and guided me, ensuring that I adopted the correct technique. The hands-on experience I had with these modalities expanded my theoretical and practical knowledge of their use and application.
In my own experience, when treating patients, I have always started with the more conservative treatments such as taping before proceeding on to treatments such as custom foot orthoses. However, I have learnt that treatment results are very important in private practice as patients are paying for a higher level of service and therefore have greater expectations with regards to treatment outcome. This internship has taught me about managing patient expectations, a skill that will help me in my future practice. It is important to keep the patient’s expectations in consideration when prescribing a treatment plan. Sometimes, patients may have unrealistic expectations, it is therefore imperative to clearly explain the potential treatment outcomes and tailor the treatment plan to best accommodate the patient. For example, when prescribing custom foot orthoses, the patient’s lifestyle is an important consideration as factors such as sports activities may affect the prescription. This internship has also taught me about managing patient compliance through prepaid treatment packages to optimise treatment success.
The staff training days conducted at ECPC were incredibly unique as I do not know of any other practice that dedicates a whole day to staff training every week. This commitment to ensuring that the staff were up-to-date with the most current knowledge and skill set was very inspiring. These training days also incorporated cases presentations, whereby each podiatrist would present either a topic or an interesting case that was seen in the clinic from the week before. This was very useful for me as it helped consolidate my understanding about various conditions or treatment modalities, especially within the context of cases that were not straightforward. Also, the role-playing activities conducted during these training days allowed me to practice my patient interaction skills in a controlled environment and gain professional feedback on any areas I need to improve on. This will most definitely help me in my future patient consultations.
The patient demographics that present in podiatry clinics in Perth, Australia, are very much skewed towards an elderly Caucasian population. Many of the patients I have treated in my university student clinic have been elderly Caucasian routine care patients, with a few exceptions involving biomechanical or chronic conditions. However, during my internship at ECPC, I was very surprised to see so few routine care patients, instead, there was a vast range of conditions that I had never encountered before. These included idiopathic toe walking, plantar fibromas, and many more. Moreover, the patient demographics were incredibly diverse with patients of all ages, nationality, and ethnicity presenting to the clinic. The exposure to so many different patient presentations has definitely expanded my knowledge on podiatric conditions, with regards to their diagnosis and appropriate treatment plans. Furthermore, the diverse patient demographics has encouraged me to reflect on cultural and/or age-related sensitivities in order to best accommodate the patient. This exposure has made my approach to patients more holistic, especially when it comes to interacting with a diverse population.
My experience with private practice has been very limited thus far during my studies as most of my student placements have been in public hospitals in Perth. This internship has not only shown me what private practice is like in Singapore, but has also shown me how a higher standard of podiatric care is conducted. Prior to this internship, my impression of private podiatric practice was that most of the patients would be routine care patients and that each consult would be very short (around 20 minutes). However, I was pleasantly surprised to observe so many different conditions and in-depth consultations, which has expanded my knowledge on podiatric medicine. In particular, as I have had little experience with biomechanics and custom foot orthoses prescription in practice, I used to find this topic quite intimidating. However, after observing and getting the opportunity to have hands-on experience under expert supervision, I am more confident in my ability to conduct a full musculoskeletal assessment on patients and write an appropriate prescription.
Another aspect about East Coast Podiatry that I noticed during my internship was the attention to detail when it came to patient comfort and podiatric care. I was fortunate enough to start my internship when ECPC was moving their Orchard branch to a brand new space within the same building as well as launching their new diabetic high risk wound service, Singapore Diabetic Foot Centre (SDFC). I witnessed the amount of thought and detail that went into every aspect of these clinics, from the individual room setups to the height of the glass frosting in each room. This produced a calming atmosphere for patients who visit ECPC, ensuring that they get the best possible experience and not feel claustrophobic during the consultation and treatment. This was a stark contrast to my own experience during student placements in public hospitals, whereby podiatry clinics would often be in the basement or at the back of hospitals without any windows or wide-open spaces. In some public hospital clinics, patients were treated in cubicles as opposed to their own private treatment room. This can make patients who are already suffering from a podiatric condition feel even worse about the state of their health.
Overall, I would like the thank the team at ECPC for making this internship such a valuable learning experience and for teaching me practical skills that I will most definitely apply in my future practice as a podiatrist. Also, I hope that future podiatry students will take full advantage of this great opportunity to experience podiatric practice at such a high standard and gain a greater understanding of podiatry in a very multicultural society.
Grace Wan Final Year Doctor of Podiatric Medicine Student (University of Western Australia) 17 January 2018
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