Service-Oriented Care: Can It Be Taught?

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Neufeld

Neufeld

Burdett

Burdett

Kistenber

Kistenberg

Stark

Stark

Rhodes

Rhodes

Hovorka

Hovorka

Parente

Parente

Hornbeak

Hornbeak

Kapp

Kapp

Now, as never before, there appears to be increased humanitarian concern for those who are in urgent need of O&P products and care but are unable to acquire them. We see this compassion evidenced in the overwhelming response from the O&P community to major global disasters. But it is also true that there are people in need all around us, and their needs are not likely to lessen as disasters—natural, political, and economic—continue to occur.

Is there a better way to prepare the next generation of O&P practitioners to respond to the needs of underserved populations? Does that better way begin with our educators?

"I have definitely seen an uptick in the interest and participation in humanitarian efforts," notes Eric Neufeld, CPO, co-founder of the outreach-oriented Range of Motion Project (ROMP). Neufeld works for the Scheck and Siress patient care facility in Lincoln Park, Illinois. "This may have something to do with the situation in Haiti, where more opportunities for outreach presented themselves after the earthquake. It may have gotten people thinking about how to give back and do service work." (Editor's note: For more information about ROMP, read "ROMP: Growth of a Humanitarian Effort," The O&P EDGE, May 2006: www.oandp.com/articles/2006-11_10.asp)

Ray Burdett, PhD, PT, CO, CPed, director of the master of science in prosthetics and orthotics (MSPO) program at the University of Pittsburgh (Pitt), Pennsylvania, also observes that students are coming into the program with a strong interest in service, especially overseas, and agrees that the Haiti disaster may have influenced many. "Since we added master's programs," Burdett says, "we're getting students who have also had some previous service project experiences through their undergraduate programs."

"I've been teaching for almost 20 years," says Rob Kistenberg, MPH, CP, LP, FAAOP, co-director and prosthetics coordinator of the MSPO program at the Georgia Institute of Technology (Georgia Tech), Atlanta. "Students coming into the program now have a very strong desire or motivation to do humanitarian work. Before, that wasn't something that usually came out during the orientation or interviews. Now it's rare to find someone who doesn't bring that up at some point."

Is this fascination with service because the media have opened up a wider world of awareness to today's students, or is it a sign of the times?

"I think it's a generational thing," Kistenberg says. "Students coming into our profession seem to really want to find a way to give back now, where in previous generations the idea was that you would work really hard, be really successful, and give back more toward the end of your career, when you weren't spending so much time trying to build your ability to give back."

Gerald Stark, MSEM, CPO, LPO, FAAOP, vice president of product development and education at Fillauer Companies, Chattanooga, Tennessee, also notes a more service-oriented mindset in fresh graduates entering the O&P field. "The Millennial generation is not just worried about getting a job; they desire a greater spiritual connection or sense of purpose with their job. The prospective employees I interview say, 'It's not as important for me to make as much money as I can; it's more important that my job has meaning and that I can directly contribute in a meaningful way.'"That presents a new challenge for the employer. It's not about making the most salary; it's about making sure that they can contribute and make a difference."

Robert Rhodes, MPA, CO, FAAOP, director of the O&P program at Eastern Michigan University (EMU), Ypsilanti, also sees more students who arrive with the intent of pursuing some sort of service work. "I have not heard anybody in the last four to five years say that they wanted to get into the field to make money although when I was teaching at Northwestern [University, Chicago, Illinois,] 30 years ago, it was nothing for us to ask somebody why they were in the field and receive the reply, 'It's an easy way to get rich.'"

Can Conscience Be Created?

While heartening, these testaments by no means represent 100 percent of today's O&P students. Should they? If we can't legislate morality, can we compel or create conscience? Should that be one of the responsibilities of our educators?

Yes, Stark says, citing the tenets of Lev Vygotsky (1896–1934), a Russian constructivist educator whose social development theory stressed the need to create learning scenarios that involve a social environment where people learn by doing and sharing. "I try to create an environment, a sense of community in which we are essentially sharing different stories. I think we must evolve as educators, and learners should be encouraged to share their individual stories more and more instead of making it so teacher-focused. There is so much that can be learned through discourse. The instructor really serves as the facilitator or catalyst for the discussion."

Chris Hovorka, MS, CPO, FAAOP, co-director of the Georgia Tech MSPO program, says that the provision of service-oriented education depends, in part, on the educational institution itself. "Some institutions may have, as part of their mission, an outreach for human betterment factor, where other institutions may have a different agenda altogether. One of Georgia Tech's missions is to advance technology to a level that can better society and the people living in it, whether that's through some kind of engineered product or how we function as a society. When Georgia Tech decided to launch the entry-level graduate program (i.e., MSPO program), part of the reason was that the institute wanted to provide another degree offering for students so that students would be empowered to enter the world with a new knowledge and skill targeted toward bettering the lives of people through wearable technology in healthcare…. Orthotics and prosthetics work very well to meet that goal."

Perhaps a number of educators have already influenced a personal predilection to service. Rhodes notes, "Even when I was in school at Northwestern back in the '70s, Jim Russ, CO, used to tell us, 'You take care of the patient—that's your number one priority—and the money will take care of itself.'"

Good Intentions, Idealism May Not Be Enough

MProject Hope Belize

At the Project Hope Belize, Orange Walk Town clinic, Chris Hovorka instructs a Georgia Tech MSPO student while evaluating a child who needs a lower-limb orthosis. Photographs courtesy of Chris Hovorka.

For service-oriented care to take hold, "it truly takes a behavioral change," says Matt Parente, MS, PT, CPO, curriculum coordinator of The Newington Certificate Program (NCP) in Orthotics & Prosthetics, Connecticut, and clinical program director of the University of Hartford, Connecticut, MSPO program. "A change in the environment cues students to think of others. During their entire academic career, it's always been about them getting the grades, doing well, being the best, and driving for themselves, but in this field, we seldom put ourselves first. Sometimes idealism isn't enough; sometimes it takes a true change in mindset…."

There seems to be a certain romance associated with students' commitment to international service in disaster-ridden areas and third-world countries, but our own country has underserved populations as well. Are these populations being overlooked?

"Absolutely," Kistenberg says. "That's one of the reasons for starting the P&O community clinic in Atlanta. I felt distraught by the fact that I could run a charitable prosthetics-orthotics clinic in Belize for the past 15 years, but I couldn't do that in the United States. That was really the motivation for getting the clinic started; a lot of groups can get a team together and take it to a foreign country and provide services. Why can't we take care of people in our own back yard?"

The Good Samaritan Health Center, or Good Sam as Kistenberg calls it, is a clinic in Atlanta where the working poor or indigent can access adult and pediatric health and dental care, as well as P&O services that are "mostly driven by our second-year students but overseen by certified practitioners," Kistenberg says.

The collaborative project between Good Sam, the Georgia Tech MSPO program, and Prosthetic Hope International began in October 2011, and funding was available through a grant from a local charity. "We're doing it as a pilot," Kistenberg explains. "It gives the students good hands-on, start-to-finish clinical experiences while serving the community. It provides a mechanism for local facilities to refer those patients they are unable to assist due to lack of funding, and it also provides Georgia Tech with a patient population for education or research projects. It's a win-win situation for everyone."

Similar initiatives are in the works through other O&P education programs as well. Rhodes notes that EMU's program is waiting for space. Scott Hornbeak, MBA, CPO, FAAOP, coordinator of the California State University, Dominguez Hill (CSUDH) O&P program, reveals that as CSUDH transitions to a master's degree, coming in June, the university is looking forward to students being more involved in pro bono work, especially with the doctor of physical therapy (DPT) school next door at California State University, Long Beach (CSULB), with its pro bono clinic already in existence.

left: Matt Parente.

From left: Matt Parente instructs University of Hartford MSPO student Taber Hammond in prosthetic fabrication. (Photographs courtesy of Matt Parente.)

The need for domestic service emphasis is definitely there, agrees Susan Kapp, MEd, CPO, LPO, associate professor and director of the University of Texas, Southwestern (UT Southwestern), Dallas, School of Health Professions master of prosthetics-orthotics program, which graduated its first group of master's students in December. "Our clinic serves the county hospital with many uninsured. Medicaid in Texas does not cover prostheses, so we are always looking for assistance. I've tried for decades to convince the hospital to help support a program where our students can provide basic prostheses. We refer some of the patients to vocational rehab if returning to work is a possibility for them. There just are not any resources for prosthetic care if one doesn't have insurance."

Neufeld agrees that a domestic humanitarian focus is needed. "There is indeed a certain population that falls into a coverage gap—they make too much money to be qualified under public aid benefits, yet not enough to afford private insurance; those people get stuck in between," he explains. "One of our major initiatives is to increase the development of ROMP USA—extending the student outreach program to those without resources in the United States. It's still in the early stages, but we're hoping to roll it out later in 2012 here in Chicago under my supervision. Once the model is established and the kinks are worked out, it will be something we can roll out on a city-by-city basis."

For those educational institutions that have, as part of their mission, a goal of increasing the number of service-oriented practitioners, how should the O&P education programs impart these ideals?

Georgia Tech's general-education program and standard teaching approach evolved as it expanded its faculty, Hovorka recalls. "We felt we needed to not only teach students to provide care as they render services to others in the United States, but also to offer students an expanded perspective outside the United States; hence, we engaged students in clinics created by Robert Kistenberg in Belize, and more recently, the Good Samaritan partnership."

Joseph Kersch (left) and Hammond (right)

Board-eligible prosthetist Joseph Kersch (left) and Hammond (right) evaluate a patient.

As chairperson for the United States National Member Society of the International Society for Prosthetics and Orthotics (USISPO), Kistenberg also recalls past efforts that resulted in scholarship grants that covered the cost of student ISPO memberships to each O&P school. "We hope to be able to award such scholarships again soon," he hints.

"Every graduating class at the University of Hartford is challenged to take on a charity," Parente says. "This year's MSPO students have decided to support disabled sports by raising awareness, raising money, and donating their time. This also nurtures a service-oriented mindset."

Burdett describes a course in professional issues that's part of the Pitt program. "Service is one of the areas that we talk about; we also discuss ISPO and its mission. Students are required to report on service opportunities in the profession as a group assignment so they are aware of what's out there."

As part of his course, one of Pitt's faculty members takes orthotic students in small groups to interact with people who are homeless, Burdett says, so that they can experience service learning in the form of interaction with patients during foot inspections.

"We're trying to see if we can help some of these people through Feet for Life—a pedorthic association program that provides shoes at low cost for individuals who may need them," he explains.

Neufeld's ROMP program offers the opportunity each year for a limited group of Northwestern University Prosthetics-Orthotics Center (NUPOC) students to participate in its program, providing humanitarian O&P services out of country. "It has become almost competitive to get into that group," Neufeld explains, "so I definitely appreciate that Northwestern is promoting it as a valuable experience and valuing it within the program."

The students benefit, he points out, by being exposed to a broad variety of prosthetic cases and solutions within a single week during their ROMP commitment and through their exposure to the need that exists in a world previously unknown to them—an exposure that hopefully leaves a lasting impression.

Hovorka says that Georgia Tech tries to "integrate service concepts into our students' capstone research…."

Learning by example is a method cited by nearly every educator interviewed for this article. "Every one of our clinical instructors has done outreach clinics throughout the Caribbean, Haiti, China, or elsewhere," Parente says. "We're all able to speak to this point and bring our personal experiences to our students. It's easy to read about, but when you're sitting there with students, they can truly get a better appreciation and ask the questions that they want to know.

"The same applies to the Ivan R. Sabel Foundation, established by Hanger Orthopedic Group [Austin, Texas]," he continues. "Students see that no matter how big or small a company you have, you can always give to the patient. Capturing their interest early helps to foster that long-term commitment to helping others."

And while service may very well be its own reward, Rhodes offers students practical incentives for humanitarian pursuits—and practical solutions to help achieve those goals: "I tell students that one of the best ways to get free advertising is by doing humanitarian things, and we discuss examples of an O&P practice that made the news by bringing in a pediatric amputee from Iraq and providing his prosthesis. There's nothing wrong with getting kudos for doing something good. I also tell them not to do it just for the kudos!" (Editor's note: Check out the related article in this month's issue, "Doing Good Is Good for Business.")

Rhodes also advises students to research patient-funding options and, if a patient doesn't have insurance coverage, to have a plan in place so the patient does not just get written off. Rhodes tells his students that one possibility is to consider fitting the patient with an experimental option to serve his or her needs and to write it off as research. "More than one road leads to serving the underserved," he says.

The Educator's Role: What Should It Be?

Neufeld believes that if educational institutions value experience like the ROMP style of international outreach, "incorporating it into the curriculum and allowing it to count toward their [students'] clinical hours and their residency would be a really nice way for [educators] to promote this kind of service within the field."

Parente feels that the role of the educator is to educate and expose students to as many situations as possible to prepare them for their professional career. "The role that we have taken at the Newington program and the University of Hartford is to [lead] by example; that way, the students notice it."

The educator's true role, Kistenberg believes, is to provide an environment that opens students' eyes to a multitude of possibilities.

"If your students spend all of their clinical hours in U.S. private practices or in institutional settings, they have a somewhat narrow focus," Kistenberg says. "We serve them best by opening up experiences, demonstrations, or even lectures to the students on the varied means whereby prosthetic and orthotic services are provided throughout the world and the impact those could have in the developing world.

"Even if you're just planting a seed, it can open up the world to them and engender a determination to change the world through service."

Judith Philipps Otto is a freelance writer who has assisted with marketing and public relations for various clients in the O&P profession. She has been a newspaper writer and editor and has won national and international awards as a broadcast writer-producer.

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