Advancing O&P Education: How Are We Doing?
By Judith Philipps Otto Q: How are we doing?
A: The simple fact that more people are talking
about advanced educational programs in orthotics and prosthetics is
promising. The fact that there's enough interest and activity to
merit a feature story is progress in itself!
In talking with educational experts and O&P professionals
closest to the subject, one can't help realizing that there is
"buzz," enthusiasm, anticipation, positive energy--and above all,
there is real PROMISE in the record of what's been happening
recently and what's going forward already in 2004 with regard to
O&P education.
NAPOE, NCOPE Views
Bryan Malas, MHPE, CO, chair of the
National Association of Prosthetic-Orthotic Educators (NAPOE),
chair of the National Commission on Orthotic & Prosthetic
Education (NCOPE), and director of Orthotic Education at the
Northwestern University Feinberg School of Medicine, Chicago,
Illinois, cited O&P education's most important recent
accomplishment: the move toward outcomes-based
education.
"CAAHEP [Commission on Accreditation of Allied Health Education
Programs], which oversees NCOPE, essentially mandated that we move
toward outcomes-based education by the year 2007," Malas explained.
"NCOPE's intention is to try to have a working draft of the
standards for outcome-based education by 2005. So we at least have
a few years in which to iron out any potential problems with the
new changes."
More distance learning education is another
possible future trend Malas foresees. "As an example, we see that
Newington [Newington Certificate Program, Newington, Connecticut]
has already established a distance learning program, and early
signs seem to suggest positive student performance."
What's Ahead?
"The future emphasis will continue to be on outcomes-based
education," Malas said. "In addition, there has been some
discussion regarding a future consensus conference on education."
He added, "The things that come to mind as real needs for education
are usually issues of funding--just simply trying to keep the doors
open to the programs is at times a monumental task." Developing
more awareness about the profession as a career is another top
priority, Malas emphasized. About three years ago the schools saw a
28-percent decline in applicant numbers, Malas pointed out. "We're
starting to stabilize a little bit, but there are several programs
out there that are tuition-driven; and obviously, when you don't
have the applicants, it becomes even more of a challenge to keep
the doors open."
Commenting on the Academy of Orthotists & Prosthetists
(AAOP) Awareness Committee's efforts to promote the profession as a
career choice, Malas said, "They've worked on creating brochures
and CDs that people can use to give presentations about our
profession. We need to take this to junior college, high school,
and even junior high, and start raising people's awareness that
O&P is a viable professional option."
Malas notes that Northwestern is pursuing its own efforts to
raise visibility for O&P: "I recently met with representatives
from several different school districts in the greater Chicago
area. We brought in counselors and teachers for a tour of the
school, explained how the educational process works within our
profession, and what it takes to be accepted into a program. Each
participant indicated they would share this information with other
colleagues at their respective schools. Our hope is that this will
not only lead to an awareness of the profession, but that students
would desire this career pathway.
"For the moment," Malas adds, "it would be nice to just have
stability across all the schools, and know that those schools are
going to remain open. In the future, maybe we could have more
schools, but that's always the fine line that we walk: Do we add
more schools because we need to meet the needs of the ever-growing
patient population, or do we limit the number of schools in the
presence of an unstable applicant pool?"
Donald O. Shurr, CPO, PT, NCOPE chair
at the time this article was being researched (Bryan Malas, CO, is
the 2004 chair), also stressed the value of developing
outcomes-based standards, one of a set of ambitious goals and
objectives identified by NCOPE at its spring 2003 meeting.
"We're already accomplishing a number of things," said Shurr.
"The most important was to establish a first step at developing
outcomes-based standards for our orthotic and prosthetic schools.
That is not a finished product, but we got a very good start thanks
to a gentleman named Buddy Jeffcoat [then chair of NCOPE's Outcomes
Committee]. He really put forth a yeoman's effort to bring our
commission into step with CAAHEP."
The most pressing and significant need for change in the future
of O&P education pertains to "a couple of issues that are
obviously left unresolved," said Shurr. He cited the low number of
programs: "Those are a direct reflection of the lack of funding
from the federal government to provide scholarship and support for
our schools and our future students."
Shurr also would like to see programs moving toward a
masters-degree level. "The Negotiated Rulemaking Committee
experience demonstrated to us as a profession that it's very
important to be viewed--not only by ourselves but by the people we
work with in allied health and medicine--at a level equal to
occupational and physical therapists," Shurr said. "At the current
time, that's not the case. Hopefully, at some point we will convene
an education conference similar to the Ponte Vedra [Florida]
conference in the mid-70s that put us on a course establishing the
baccalaureate as the entry-level standard. With that consistency in
futuristic planning, hopefully we will develop masters-level
programs for our practitioners of the future."
What's Ahead?
NCOPE's defined goals for the coming year and the future
include, according to Shurr:
- Accrediting the first entry-level master's degree program in
O&P;
- A formal review of residency programs nationwide;
- Developing standards for O&P assistants;
- Writing standards for O&P education using an outcomes
format; and
- Creating a curriculum for practitioners' assistants (which is
complementary to the training NCOPE specifies for
technicians).
(Editor's Note: NCOPE adopted a new set of standards for the
Assistant and Technician level, effective January 1,
2004.)
"We're hoping the masters program will elevate the field and
ultimately provide a track for training O&P faculty," said
Shurr. "Now, it's mostly practitioners with a certificate and/or a
baccalaureate degree who teach. Really, this training will help
develop a new tier of instructors for future masters degree
programs."
Looking ahead to NCOPE's expectations for advanced O&P
education in 2004 and beyond, NCOPE Executive Director
Robin Seabrook commented: "I think that one of our
big pushes in 04 and into 05 should be to pull all our experts back
together for another consensus education conference. Let's see
where we are, where we are going, and how we can get there
educationally.
"The last consensus conference in education was in 1991, and I
think it's time for us to do another one, especially with regard to
all the issues that are hitting orthotics and prosthetics, such as
the Medicare legislation, the NRM [Negotiated Rulemaking] movement,
reimbursement, etc.," she continued. O&P needs to take a hard
look at its current body of knowledge, Seabrook said, to determine
whether it has expanded, based on services provided. If it has
expanded in some way, do the current educational process and
standards need to change, and if so, how? "If it hasn't changed,
and we're on the correct track, that's great," Seabrook said. "But
if we're not, then how do we get there and how do we make
changes?"
Academy Perspective
Don Katz, CO, FAAOP, AAOP president,
shared the Academy's perspective on accomplishments in the field of
O&P education:
"There have been a number of exciting initiatives within the
last year," Katz said. He cited the matriculation of new students
in the masters program at the Georgia Institute of Technology,
Atlanta, NCOPE's work in establishing a structure for O&P
assistant education programs, and the efforts underway to establish
a new school at St. Petersburg College in Florida. "I also feel
that during the past year NAPOE and the Academy have been
communicating effectively so we can have a stronger partnership for
education initiatives into the future.
"The Academy has been working diligently this past year,
investigating and trying to gain a better understanding as to how
we--as a professional association for prosthetists and
orthotists--can influence education funding throughout the
country," Katz continued. "We know the schools are working
incredibly hard to keep their doors open; and when you compare
where we are today to where we were the past decade or more, there
are a number of schools that no longer exist. It's frightening, and
it deserves the attention we're devoting to that very issue."
What's Ahead?
Katz detailed the efforts of the Project Quantum Leap (PQL)
initiative, including the convening of two conferences studying the
need for post-graduate degree education in prosthetics and
orthotics.
Katz pointed out that Georgia Tech currently has the only
masters degree P&O program in the country--and that there are
no PhD programs in the US.
"During my years on the Academy Board, the Board has come to
realize that there is a greater need for applied research than ever
before," Katz said. "It is essential for us to answer the many
clinical questions as to what is effective with regard to our
services." The reason why more research is not undertaken is
because "we are not trained as researchers," Katz said. "Why is
that? It's because we don't have post-graduate education."
He continued, "We need to convene a conclave of those from the
academic programs as well as other experts and study this. We need
to identify the problems and potential solutions, and then create a
long-term plan that hopefully will give us a realistic goal for
matriculating future P&O researchers."
CSOP Conferences
Another educational milestone was reached with the second
Clinical Standards of Practice (CSOP) consensus conference on
immediate post-operative care for the amputee, held in the spring
of 2003, Katz noted. The findings from that conference are in the
process of being documented. A summary of the first conference was
published as a supplement in the October 2003 JPO: "Orthotic
Treatment of Idiopathic Scoliosis and Scheuermann's Kyphosis."
"We intend to host two more Clinical Standards of Practice
consensus conferences in 2004, and then make opportunities
available to our schools to work with the Academy on creating
online education reflecting the CSOP findings," Katz said. "This
would be a great way to partner with our educators, who could then
review the material resulting from this enormous project&as a
tool for both primary and continuing education."
Katz continued, "This could be one of the first opportunities
for the Academy and our schools to partner in a project with
definitive goals, target lines, and online education benefits."
If, in a fantasy world, Katz were granted ultimate power to
fulfill O&P education's most significant need of the moment, he
admits that he would find it hard to limit his vision to just one
wave of the magic wand.
"I think the most significant need is for us to blaze a trail by
expanding the number of schools, increasing the awareness of our
field, and studying the initiative for offering post-graduate
degree education so orthotics and prosthetics can be a true and
meaningful player in clinical research."
Katz continued, "O&P awareness is really critical in this
equation. We have grave concerns about the number of practitioners
that need to be available to take care of our citizens in the years
ahead. Some of the NCOPE-published predictions are very troubling.
If we suddenly created more schools, we wouldn't have enough
students applying! There's a whole world of other glamorous
high-tech career opportunities out there--so many of these young,
vibrant minds are being drawn to careers other than
healthcare."
Is Advanced Education Really Necessary?
"I did a paper with some of my students at Shelby State--they
did most of the work--and presented it at the 1986 AOPA meeting,"
said Robert Rhodes, MPA, CO, chair of the
Education Committee at the University of Michigan O&P Center,
Ann Arbor. Rhodes is also a faculty member for the new graduate
certificate O&P program at Eastern Michigan University,
Ypsilanti. "We looked at reading level competencies in orthotics,
prosthetics, physical therapy, and orthopedic surgery, taking
averages based on seven studies of current textbooks in each
discipline. The averages demonstrated that to be able to read
orthotic literature and understand it, you needed 21 years of
education. (This would mean nine years past high school.)
Orthopedic surgery needed 19 years, prosthetics needed 17, and
physical therapy required 15. Definitely food for thought."
So How Are We Doing? An A or an F?
Rhodes' perspective inspires optimism: "I've been in the field
for more than 30 years, and when I entered the field, other people
that I knew who were getting into orthotics and prosthetics were
typically blacksmiths, saddlemakers, and shoemakers. People that we
see entering the field now have backgrounds in engineering,
physics, kinesiology, and other academic disciplines. The quality
of the students and the practitioners that we are producing today
is far, far better than I would ever have expected from looking at
it 30 years ago!"
Making changes quickly isn't easy, Rhodes warned. "We can always
look at things from hindsight and say that maybe ABC should have
done this or that differently, but I think that if we look at what
has actually happened, we've come a long way in a short time!
"When I started teaching at Northwestern in 76, I was one of the
few people in the field who had a bachelor's degree," Rhodes
continued, adding, "Now a baccalaureate degree is a minimum
requirement, and many practitioners have advanced degrees."
Don Shurr points to more fuel for
optimism: "I think the good news is that Ossur, for example, took
the opportunity to assist Cal State Dominguez Hills, which was on
the brink of closing its doors, and provided the program with
wonderful space in California, virtually salvaging a failing
program. Things like that don't normally happen. Ossur not only
gave them the bulk of a very large building in southern
California--which I'm sure is very expensive space--but underwrote
the costs of maintaining the building just for prosthetic and
orthotic education.
"That's the kind of generous support we need to make sure does
not go unacknowledged," Shurr added.
"I have been glad also to see what I think is a new focus on
education within the field of O&P," reflected Mark
Geil, PhD, Georgia Tech Master of Science Prosthetics
Orthotics (MSPO) Program, Atlanta. "The Academy's Project Quantum
Leap has made great strides in trying to restore federal funding
for education; the recent grant that the Department of Education
has bestowed for a couple of national conferences was focused
exclusively on education and educational standards in P&O. That
is a tremendous amount of progress."
Despite the current storm of who is a "qualified provider,"
possible changes in credentialing standards, and funding issues,
O&P education appears to making steady progress forward.
Current Programs
NCOPE Executive Director Robin
Seabrook provides a current scorecard of programs at
press time:
New Programs Applying for Accreditation in 2003
Georgia Institute of Technology,
Atlanta--Masters-level program in orthotics and prosthetics.
Applied in spring 2003; undergoing accreditation review in
December.
Eastern Michigan University,
Ypsilanti--Applying soon for a program to begin as a
post-baccalaureate certificate. The goal within the following year
is to turn it into a masters degree program in O&P, Seabrook
noted.
O&P Educational Programs Currently in Place
Schools with Baccalaureate Programs:
California State University Dominguez Hills
(CSUDH) -- Bachelors program, prosthetics only.
This beleaguered program relocated this past summer in an effort
to survive. Ossur donated one floor of its office building space in
Aliso Viejo, California, to allow the school to operate a
certificate program and then a bachelors program, but the program
is teaching prosthetics only at this time, said Seabrook.
University of Washington,
Seattle--Bachelors program.
University of Texas Southwestern Medical
Center, Dallas--Bachelors program.
Schools with Certificate Programs:
Newington College, Newington,
Connecticut--
In addition to the certificate-level program, the school now offers
its certificate via distance education for those pursuing their
second discipline, Seabrook explained. "If you've already done
either orthotics or prosthetics, and you want to extend your
credential, then you're eligible to participate in its distance
education program, if you meet all the other admissions
requirements."
Northwestern University, Chicago,
Illinois
Century College, White Bear Lake,
Minnesota
Rancho Los Amigos Medical Center,
Downey, California
"The program is inactive this year," Seabrook pointed out. "The
program is hoping to be able to reactivate next year, but did not
take in a class this past summer due to the shortage of healthcare
finance dollars in California."
Schools with Technician Programs:
Baker's College, Flint, Michigan
Century College, White Bear Lake,
Minnesota
Francis Tuttle Technology Center,
Oklahoma City, Oklahoma
Median School of Allied Health,
Pittsburgh, Pennsylvania
Spokane Falls Community College,
Spokane Falls, Washington
Schools with Assistant/Technician Programs:
This program is not really new, but revived and changed from a
previous 70s assistant credentialing program, Seabrook explained.
"ABC [American Board for Certification in Orthotics &
Prosthetics] has revived the program; NCOPE has drafted new
standards for the technician/assistants, and they were adopted
December 3, becoming effective January 1, 2004. There's currently
only one assistant-level program in operation."
Oklahoma State
University-Okmulgee--Assistant program.
Was accredited in December 2003. This program had already
applied for accreditation under an earlier and much tougher set of
"associate level" standards devised in 1995-96 and implemented
around 2000, Seabrook noted.
"Unfortunately, those standards were so high that most of the
[schools] didn't want to offer the program, especially at the
community-college level--because the course work being required was
so great that they were only a couple of credits off from a
bachelors degree!" Seabrook said. "This was part of the reason that
ABC/NCOPE reexamined the assistant level based on the practice
analysis survey results that ABC obtained three years ago. The
survey made it clear that there are a lot of technicians who are
performing some level of patient care. It was recognized that
perhaps there was a genuine need to credential these individuals at
the assistant level." 
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