Initiative Aims to Increase P&O Academic, Research Capacity

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Don Katz, CO, FAAOP
Don Katz, CO, FAAOP

Bold. Visionary. These words describe the American Academy of Orthotists and Prosthetists (the Academy) Advanced Education & Research Training Initiative (AERTI) which has the lofty goal of increasing the academic and research capacity of the O&P profession by tenfold.

Developing evidence-based practice protocols in prosthetics and orthotics is a crucial necessity that is increasingly being recognized by O&P clinicians, other healthcare professionals, consumers, payers, and the public.

It's like climbing a ladder. First, researchers are needed, then research projects must be conducted, then the O&P profession can move forward up the ladder in achieving evidence-based practice.

It takes sound research to establish evidence-based practice, but where will the qualified researchers come from?

Under the auspices of the Academys Project Quantum Leap (PQL), an umbrella program for several multi-year projects to advance the orthotic and prosthetic profession, the initiative aims to develop a wellspring of academic leaders and research scientists who are prosthetists and orthotists or are in fields with strong ties to P&O.

"It was quite apparent to the Academy that we need to advance evidence-based practice as much as possible, but we realized we were not going to successfully accomplish that unless we had more O&P professionals with advanced degrees to serve as primary investigators or at least participate in clinically based research," said Don Katz, CO, FAAOP, past Academy president, vice chair of the Academys Research Council, and previous chair of the Academys Research and Development Committee. "The genesis of the advanced degree initiative was, We need to get more of our own–more O&P clinicians or those with a relevant background or specific interest in orthotics and prosthetics to help move the whole concept of evidence-based practice forward."

Katz continued, "We kept looking at ourselves and asking, Why is this not really happening? We could just throw up our hands and say, Well, its always going to be a tough row to hoe because we are not trained as researchers–or we could change that!"

The Academy realized that the only avenues for earning a PhD related to P&O were outside the US–the University of Strathclyde, Glasgow, Scotland; the Hong Kong Polytechnic University in China; and LaTrobe University in Melbourne, Australia. "Now, however, advanced degree programs are really starting to gain momentum in the United States," Katz noted.

The initiative followed two conferences in 2004, one in March in Seattle, Washington, and one in July in Chicago, Illinois. The multidisciplinary meetings included orthopedic surgeons, physical and occupational therapists, engineers, and educators, as well as O&P clinicians. The insight of those in other disciplines was invaluable as to how to develop pathways for advanced degrees in O&P and developing a talent pool of research scientists and academic leaders, Katz observed.

Key Recommendations

The AERTI report summarizes four key recommendations as the cornerstone of the initiative:

  1. Institution or program grants should be made available to existing P&O educational programs for the development or enhancement of advanced research degrees relevant to P&O;
  2. Student training grants should be made available to individuals undertaking advanced research degrees relevant to P&O;
  3. Career development awards should be made available to enable current P&O faculty to pursue advanced research degrees; and
  4. Research education funds should be made available to improve the level of research education for entry-level clinicians, residency students, and experienced P&O practitioners.

Implementation of these recommendations will result in, according to the report:

  • Creation of an environment that fosters self-sustaining research efforts and produces peer-review P&O
    research that advances evidence-based practice;
  • A tenfold increase in the number of P&O faculty with scientific training at the master of science and PhD level;
  • A tenfold increase in the number of clinical providers with improved scientific/research training and knowledge; and
  • A tenfold increase in the number of certified practitioners with the skills to accurately evaluate the literature and understand the goals and role of evidence-based practice.

The summary concludes, "Fostering advanced education and research with the field of prosthetics and orthotics is an important undertaking because the infrastructure that this initiative creates will lead to higher quality, more effective healthcare that is of better value to society."

Types of Degrees

The report points out a distinction that often causes confusion: "To understand these recommendations, it is crucial to recognize the distinction between advanced academic degrees and advanced practice degrees. Advanced academic degrees, which are the focus of this strategic plan, prepare the graduate for scholarship and scientific research that will increase the knowledge base of the field. In contrast, advanced practice degrees provide vocational training that prepares the graduate to provide clinical services. This strategic plan and these recommendations do not address the question of whether or not advanced practice degrees are
appropriate, which is an independent consideration from the need to raise the academic level of the profession."

Needs, Barriers, Benefits

The report identifies the need, barriers, and benefits of training scientists and academic leaders in P&O. Seven primary factors contributing to the need are:

  1. Currently, there is limited evidence-based practice within P&O , stemming primarily from the small amount of high-quality P&O research now available. "Evidence-based practice" is defined as: "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients." The report sums it up succinctly: "The use of an evidence-based approach in clinical practice is intended to close the gap between what is known and what is done."
  2. The current small numbers of P&O faculty with advanced academic degrees teaching within US P&O programs presents a problem. The report states, "This affects the academic credibility of P&O programs, limits the career development and advancement of P&O faculty, and hinders the teaching and mentoring capabilities of P&O education programs, especially with respect to advanced academic degrees." The report notes, "There are currently 42 P&O faculty teaching in eight entry-level P&O education programs [accredited by the National Commission on Orthotic and Prosthetic Education (NCOPE) in cooperation with Commission on Accreditation of Allied Health Education Programs (CAAHEP)]. Of these, 50 percent have part-time appointments, 40 percent have a masters degree, and 10 percent have doctoral degrees."
  3. There currently are few clinically trained prosthetists or orthotists with advanced academic degrees such as the PhD, and many of those earned their PhD outside the US. The report adds, "Those few P&Os [prosthetists and orthotists] who have earned higher academic qualifications within the US have done so in programs that do not necessarily have a P&O focus or provide mentoring or resources for P&O research projects. These individuals face many challenges in charting their own individual path in the pursuit of an advanced academic degree relevant to the field of P&O."
  4. Contribution by prosthetists and orthotists to scientific investigations has been limited , the study observes, resulting in research that often is lacking in clinical relevance and applicability, thus limiting the transfer of knowledge into clinical practice.

Increasing the education and scientific foundations in P&O would provide vital benefits , the initiative points out :

  • Increased research capability. Among other benefits, having prosthetists and orthotists more actively involved in research would help ensure that the results are clinically applicable. There is an urgent need for outcomes research to establish evidence-based practice to ensure the efficacy of treatment, improve the quality of patient care, and to provide a sound rationale to healthcare providers and reimbursement agencies for the provision of particular treatment and care, the report points out. Research would enable the P&O profession to increase its knowledge base; thus advancements in technology can be effectively applied to clinical practice.
  • Ability to assume increasing professional responsibility . "Orthopedists, vascular surgeons, general surgeons, family physicians, pediatricians, and allied health professionals are increasing their reliance on prosthetists and orthotists for consultation and prescription recommendations, the initiative points out. "... A much higher level of professional responsibility will be expected of prosthetists and orthotists in the future as these trends continue. The educational foundation and science of P&O must increase to parallel the clinical responsibilities of P&O practitioners."
  • Establishing legitimacy and parity with other allied health professions. "It is interesting to note that other health professions, including physical therapy and occupational therapy, have developed entry-level vocational practice degrees at the masters and doctoral level... Advanced degrees (academic practice degrees, or both) would help in establishing parity with other allied health professions. Increased academic standing would help focus P&O professionals on comprehensive patient care, rather than the traditional device-oriented perspective of the P&O field," the report states.

The report continues, "Increasing the number of P&O professionals with advanced degrees would facilitate a paradigm shift within the field, emphasizing the importance of self-directed, lifelong learning and creating a culture that values advanced education and scientific research. Such a focus will lead to improved patient care within P&O and the resulting parity with other health professionals will improve the coordination of care with other disciplines." The report points out that advanced academic degrees would not be intended to replace entry-level practice degrees. "Since the focus of advanced academic degrees is to train individuals to be independent research scientists and educators, it will not create super clinicians or replace the role of experienced clinicians in patient care. ...In fact only a small cadre of individuals with advanced academic degrees will be needed to create academic synergy within the P&O profession, in view of the relatively small size of the profession and the limited number of academic institutions with P&O-focused programs."

The AERTI initiative does not only analyze and point out current problems, but also proposes positive solutions. Advanced-degree programs are becoming a reality. And the other side of the coin, clinical education, likewise is advancing as higher-degree programs develop and P&O school curricula are being revised and updated to reflect the changing realities of the last ten years in the prosthetic and orthotic profession in such areas as technology, clinical techniques, reimbursement, patient demographics, and legal and medical documentation.

The future indeed looks promising.

To view the complete AERTI report, go to www.oandp.org/pql/AERTI/

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