The four-year podiatric medical school is followed by a surgical based residency, which is hands-on post-doctoral training. As of July 2013, all residency programs in podiatry were required to transition to a minimum three-years of post-doctoral training. Podiatric residents rotate through core areas of medicine and surgery. They work under MD supervision in such rotations as emergency medicine, internal medicine, infectious disease, behavioral medicine, physical medicine & rehabilitation, vascular surgery, general surgery, orthopedic surgery, plastic surgery, dermatology and of course podiatric surgery and medicine. Fellowship training is available after residency in such fields such as geriatrics, foot and ankle traumatology, infectious disease etc. In reality though, the residency training of most podiatry residencies today are already highly inclusive of these medical areas. In most states, their scope is limited to areas at or below the ankle joint, however, some states include the leg, as well as the hand as within the scope of podiatry.