Report from the Academy Meeting in Orlando: Part Three
Symposium on Education and Professional Practice
I chaired these sessions, which highlighted some of the recent work by the Academy as part of Project Quantum Leap . Doug Smith MD started off the program by summarizing the goals of the Academy Grant Projects, which are being supported by funding from the United States Department of Education. The vision for this series of activities is that:
Strengthening the academic sector within P&O will address a number of key contemporary problems and position the field to face anticipated future challenges more effectively
Dr. Smith has long been an advocate for coordinated amputee rehabilitation, championing the most effective application of both surgical and prosthetic science to enable each individual to accomplish as much as they possible can. In addition to being the co-Principle Investigator on this grant, he serves as the medical director for the Amputee Coalition of America and the Director of the Prosthetics Research Study, and is a full-time orthopaedic surgeon and professor at the University of Washington and Harborview Medical Center in Seattle, Washington. Doug has proven to be an invaluable contributor to all of these projects, not only by providing managerial oversight but also by clarifying and strengthening the vision and how it applies to each individual effort.
My presentation, which followed, was a concise review of the specific projects that comprise Grant Year One, highlighting how they dovetailed with Year Two activities, and could be extended into a Year Three initiative. Collectively, these inter-related projects are designed to have a positive short, medium, and long term impact on the academic level of the field.
The first project, which is a major emphasis, is an Awareness Campaign to increase the number of qualified applicants to NCOPE accredited practitioner programs. The premise is that there is a large pool of high quality, qualified candidates to become practitioners who aren't aware of the field. Julie Hayes of the Academy and her team have done literally scores of career awareness programs across the country with a broad range of collaborating educational institutions. Although the primary focus is to encourage application to practitioner programs, to address the growing shortage of qualified clinicians, there is also a "pull through" effect encouraging related training as a technician, fitter, and so on. Each year, the number of sites visited and the level of students targeted will be expanded-to ultimately include high school, community college, and university settings. The enthusiastic response from the local CPOs, who serve as the on-site experts in these programs, and the number of institutions that have requested return visits and expanded information for their students, suggest this will prove an effective approach to meeting manpower demands without lowering educational standards. If short term results are any indication, the substantial increase in the number of hits to the O&P Careers web site by people interested in more information about a career in P&O is also a favorable sign.
The second project is a scientific comparison of the ratio of ABC Certified practitioners to potential P&O patients who are Medicare beneficiaries. This Geographic Mapping project involves analysis of millions of Medicare claims, in collaboration with data experts at Reden and Anders, Ltd., to determine the number of persons with an O&P-related diagnosis across the country versus the number of ABC Certifees available to provide care. Year One looks at state-level data; subsequent research will look at smaller geographic areas. Potentially, this data-driven project can help identify areas of greatest need for more practitioners so the Academy and other organizations can target these areas with various programs to improve beneficiary access to qualified caregivers.
The third project, titled Advanced Degree Strategic Plan , is intended to facilitate training of scientists and academic leaders who will influence the future of P&O by:
- Creating a blueprint for the development of academic degrees focused on P&O science
- Identifying methods to attract P&O clinicians to pursue advance academic studies
- Encouraging researchers to conduct investigations relevant to clinical P&O practice
The premise of this multifaceted project is that, although the field will always have a primary need for clinically educated graduates, we must also have a cadre of graduates who possess advanced academic degrees and the resulting skills and expertise to conduct original research that will define and shape the future of the profession.
Using a strategy similar to that of the Awareness Campaign , the primary focus of this effort is to facilitate the development of clinically-savvy individuals who have earned academic doctoral degrees. In today's highly competitive world, the PhD is the minimum standard to succeed in securing external funding for research projects. Creating a limited percentage of PhD CPOs will enable the field to exert more control over our future by conducting relevant scientific research, providing the staff for educating tomorrow's clinicians, and becoming mentors to encourage others to follow the path of advanced education.
In collaboration with a broad range of academic institutions that already have entry-level clinician programs, Year One has resulted in a strategic plan to accomplish these outcomes. Future work will involve identifying agencies and organizations willing to assist in achieving the goals by providing funding and mentoring. The hope is that, within the next few years, clinicians interested in obtaining a PhD will no longer have to enroll in overseas programs but will have a number of high quality domestic choices as well.
The "pull through" effect will also encourage more Masters level options as well, and some clinicians will find that this level of education is sufficient for their goals and aspirations. Those with a strong commitment and talent for scientific research and teaching will be able to go on to earn a doctoral degree here in the U.S. that permits a focus on P&O-related topics.
The Master Agenda project has two primary goals:
- To develop a formal structure for State-of-the-Science conferences based on literature review and expert opinion
- To develop and prioritize a list of topics for ongoing SSC conferences
After consultation with scientists from the National Institutes of Health, the Academy has developed a comprehensive plan to conduct ongoing conferences to document the state of current practice and the scientific evidence, or lack thereof, in support of clinical decisions and beliefs. This protocol is based on the decades of successful experience by the NIH in conducting rigorous consensus conferences in various medical fields. The list of prioritized clinical topics developed in Year One is being used to conduct objective rankings of the literature on key clinical questions and to identify topics for future SSCs.
The sixth project is another major effort: conducting the actual State-of-the-Science Conferences . In addition to the original two consensus conferences conducted by the Academy prior to the awarding of this grant, two additional SSCs were held in Year One and two more will be completed in Year Two.
Some topics, such as the orthotic management of plagiocephaly, are emerging subsets of practice that have not yet been studied systematically, in which case one major contribution of the State-of-the-Science attendees is to identify key research questions that need to be answered. Publishing these results as Supplements to the Journal of Prosthetics & Orthotics and posting them online will encourage the allocation of research dollars to these important clinical questions, helping to drive the gradual development of evidence-based practice in our field.
Other topics, such as post-operative amputee management, have been studied for many decades. In that circumstance, the SSC serves to identify the scientific level of our current knowledge, which forms the basis for clinical standards for care. The identification of important but unanswered clinical questions will then help drive knowledge forward. In either case, the beneficiaries are the patients who will receive care that is up-to-date, scientifically based, and derived from the collective thinking of a diverse group of leading clinicians and scientists.
Year One SSCs were on orthotic topics: management of plagiocephaly and the neuropathic foot. Year Two will focus on lower limb prostheses, on ankle-foot components and outcome measurement instruments. The first two have been accepted by the JPO and the balance will be submitted in Year Two.
Last, but certainly not least, the sixth project is to develop and implement Online Courses that are available 24/7 at very low cost, based on the findings of the Academy expert conferences. The inaugural courses, for Year One, on the orthotic management of idiopathic scoliosis and post-operative amputee management are now available on the Academy web site. These multimedia modules offer today's busy clinician, for the first time, an in-depth academic course on current practices in these key areas of clinical responsibility.
Each course is developed by the faculty at one of the institutions offering CAAHEP-accredited practitioner training, based on a competitive Request for Proposals. This insures that the content is structured by experts with experience in the education of clinical professionals. Because the developing institution is able to freely use the module they created in their program, this also helps insure that students are exposed to this information sooner rather than later. Finally, the many hours it takes to convert a Supplement on a specific topic into interactive education may pique the interest of the faculty who tackle these projects, leading to further research into related topics.
Collectively, the Academy Grant Projects represent the most concerted effort to strengthen the academic foundation of our profession ever undertaken by the field. The past decade's never-ending string of financial and governmental compliance challenges have demanded our collective attention and appropriately so. But we must not be distracted from also building the scientific future of our profession. This aspect of the Academy's Project Quantum Leap initiatives is a long-overdue effort to build the foundation to advance daily patient care to the level of evidence-based practice with strong scientific justification based on controlled research.
The third and final speaker in this session was Jean Deitz, PhD, OTR/L . Dr. Dietz is Professor and Graduate Program Coordinator at the University of Washington's Department of Rehabilitation Medicine, and one of the prime movers of their doctoral program in Rehabilitation Sciences. The title of her talk was "Graduate Education in O&P: Lessons Learned from OT" and she presented a droll summary of the successes and struggles that the Occupational Therapy profession went through over the past 40 years to raise their entry level standards. Using her own experience as an illustration, Dr. Dietz emphasized the importance of having a mentor who provided ongoing encouragement and help with problem solving, and sufficient financial support to focus on studies and the thesis rather than working three jobs to survive.
In the 1970s, the OT landscape was much like P&O today: the entry level credential was a baccalaureate degree and there were no domestic opportunities for an advanced academic degree. Currently, there are three post-professional doctoral programs specific to Occupational Therapy or OT Science in the United States, and more are under development. The OTs will be moving to an entry-level masters degree in 2007 as their minimum academic standard.
Dr. Deitz emphasized the importance of comprehensive planning so that no unexpected barriers arise that prevent interested students from completing graduate studies, and offered practical advice on how to build momentum from the initially small core of doctoral level graduates in the field. There were numerous direct parallels between the OT experience and the challenges facing P&O in achieving this goal.
One unique problem facing P&O is the very small numbers in our profession. The limited pool of potential candidates makes it almost impossible to sustain a program offering an advanced academic degree in P&O per se. Dr. Dietz suggested that we look closely at the Rehabilitation Sciences programs currently in existence because they could be modified to meet the needs of the CPO. Most current Rehab Science students are OTs or PTs, so the core curriculum already includes a full range of clinical topics as well as a strong clinical research component. It should be feasible to substitute core P&O science courses for some of the more therapy-specific classes resulting in a program that is directly relevant to our profession.
Dr. Dietz cautioned, however, that although the Rehab Science approach eliminates the almost insurmountable barrier of creating a critical mass of P&O students and faculty sufficient to sustain a full-time program, it also carries some risks. At least initially, many of the senior faculty will likely come from other related fields such as engineering, and many will not have any prior experience supervising P&O-related research. So, recruiting open-minded faculty and supporting them with clinical experts will be a critical element if this is to succeed.
It may be that the timing for such an initiative is very favorable because health policy experts are increasingly recognizing the value of a focus on rehabilitation science principles. For example, a 1997 Institute of Medicine Report: Enabling America: Assessing the Role of Rehabilitation and Engineering stated that "Rehabilitation science and engineering should be more widely recognized and accepted as an academic and scientific field of study...and should serve as the basis for developing new opportunities in multidisciplinary research and education".
Dr. Dietz concluded her presentation by noting that there are already a number of Rehab Science programs in the United States and Canada, so it would seem practical to approach selected program directors to see what would be required to add a P&O track. The end result would be a new track to develop future leaders in P&O who are advanced clinicians, educators, clinical researchers, and high level administrators within health care and academic institutions.