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Appendix B

Responses to Open-Ended Questions

11. Is there any subject that could be covered in the primary educational setting that isnít currently being covered, or needs to be elaborated on in greater detail?
  • More realistic information regarding the "real world", ie. Performance expections and enthusiasm toward profession
  • Howto do research project. Documentation and its relationship to preventing loss or lawsuit.
  • More in-depth gait evaluation
  • Teach L-Codes
  • Technical skills are lacking. Most students are more interested in how much they are going to make per year and are more like sales people than orthotist / prosthetist.
  • Depends on the primary educatin setting, ie. Northwestern vs Texas vs Newington.
  • To stress the importance of the residents responsibility to the hosting facility not just simply the fact that the facility is responsibleto the resident.
  • Proper L-Coding for example have the L-Coding committee present to students.
  • Dear Mr. Ward- We are not utilizing our facility at this point for NCOPE residency training. Thank you!
  • Kessler Associates, inc. was sold on 03-31-1997. Now we are Hanger P&O inc.
  • Cost controls and containment and inveentory needs, ordering and using a catalog.
  • General business aspects
  • I have just trasferred to this office, and have not had any residents to date.
  • Basic material knowledge
  • Technical training and skills, interpersonal relationships.
  • Increased fabrication time/ better technical and hand skills!
  • AK socket variations and how to cast- more pathology-componentry- possible pay scale and job interviewing.
  • Observational gait analysis appears to be a weak point in the university training.
  • None that I can think of.
  • Integration of HCPCS coding language with various services / devices
  • Increase familiarization with L-code system- especialy since it is so outdated and not easy to understand at first encounter with d.
  • L-coding structure, insurance policies and billing vs what is needed.
  • More time evaluating patients and problem solving
  • The depth of knowledge graduates have in diagnose recognition and resulting biomechanical issues is disappointing. I could have educated my resident more completely in half the time he spent at school at a considerable savings. School should be comprehensive so residency can fine tune skills (clinical) and address professional issueawareness and R&D opportunities.
  • Documentation.
  • The students with little or no experience are useless in the lab because basic skills are not being taught. This lab skills are necessary to being an independent practitioner and supervisor / manager.
  • Improve future clinicians ability to interact with tech staff. Have solid understanding of materials and fabrication techniques.
  • Some of the programs could use more hands on time as far as fabrication is concerned.
  • Business practices and charting
  • A, E & L code billing overview
  • Professional human relations internally at practice level, ie, role modeling.
  • Prosthetics/ orthotics as it pertains to everyday life for the prosthetist/ orthotist servicing multiple hospitals and clinics. Demands by physicians have to be met which modifies the P/O practitioners decision making and time frame. P/O students should be better versed in structuring patients on a case by case basis, and how to adapt to different clinical situations.
  • The complexity of healthcare delivery systems. (Managed care organizations). Some knowledge of Medicare guidelines.
  • The need for demonstration of 3-D reasoning / thinking. L-code system. We had one poor resident with no 3-D skills- he struggles.
  • Basic fabrication skills
  • Actually too much paperwork and classes & not enough on hands. You do not use all the class room as detailed as they make it. I had one resident 10 years ago that had on hands only-very little classroom-boy she could manufacture any limb and had a perfect fit everytime. At the sametime I had a gentleman from another Pros. program that was mostly classroom with very little on hands. He had no knowledge of manufacturing a limb without supervision but he knew everything about ratios & muscles, etc. Without a good fit the classroom is wasted
  • L-coding and managed care.
  • Some schools have gotten to far away from hands on skills, their pushing the books and education but they are sending the wrong message to young practitioners. A lot of people coming out of school now feel the technition is responsible for everything after the cast is taken, until it goes back on the patient.
  • A little more depth of study in the psychological aspects of injury / disease or limb loss & strategies for coping with this patient population. O&P is 1/2 tx of body and 1/2 tx of mind. Your job is a practitioner not a tech. Techs need complete knowledge of fabrication process.
  • Business / finance.
  • I'd like to see the musculoskeletal diseases examined in greater depth in school.
  • Research Project
  • Patient practitioner interaction! Basic skills can be taught w/ supervision. Students are woefully short of knowledge of fabrication skills & technique.
  • Probably many, but no time or funding
  • Anatomy & Physiology
  • Ethics, Less common pathologies
  • More information on pathologies. Musculoskeletal in particular

12. What changes would you like to make to your residency program?
  • More supervision by certified practitioners.
  • Spend more time with resident
  • I would like to have one, (a resident).
  • Being in trasition from Novacare to hanger has been a major disruption. We are over coming the problems and feel we have recovered very well.
  • None at the moment. Lots of changes in the future but all relate to internal aspects.
  • Increase # to 2 or 3.
  • First yr not sure.
  • Everything
  • 1st year
  • That the student be responsible for fees paid to NCOPE. Especially if they leave after completing the residency.
  • None at this time
  • No changes at this point.
  • Be able to start new resident before exiting student leaves. Longer (overlapping) residency. Reduce wage by lowering initial salary with increases subject to
  • performance requirements.
  • Residents need a dose of humility, they are not as smart as they think they are.
  • Have been branch manager for 3.5 years- no residents since I came here.
  • Increase opportunities for resident to work with a variety of staff people.
  • More systematic. Would like resident to be efficient in one area before moving to the next segment.
  • I would like a more clearly defined rotation through the various orthotic and prosthetic specialties
  • I would like to add a rotation to an outside facility.
  • Being a small company, I would change nothing at this time, because the program is simple and runs smoothly.
  • Check out the new ABC practice analysis for answers to questions concerning what things should be taught- Kathy Carter at the national office
  • Increase diversity of clients / patients treated
  • Expand our use of CAD CAM
  • Are present ( and first) resident came to us with strong research skills, statistical analysis, etc, all of which he acquired before attending NW orthotics program. As the residency director, I need education in this area so I can help future residents who do not have adequate research skills.
  • More structure and more literature reading requirements.
  • More interaction between residents. I'd like to see the NCOPE provide monthly packets of material- case studies for discussion, etc.
  • Greater patient exposure
  • Develop program where residents visit different sites for a different perspective on O&P management.
  • Have a national match program similar to medicine.
  • Continue to build and structure more.
  • This is a new experience, so I expect a steep learning curve this year.
  • It is my program. I change it as I see fit.
  • Corporations expect a certain amount of revenue that should not be expected, therefore the residency does not work here. It's a shame.
  • None at this time
  • None at this time
  • I am only into my first year of the program.
  • More structured training
  • The changes necessary for our program are made as necessary.
  • Get Hanger to approve a resident.
  • Residents drive their own program with mgt interaction as necessary.
  • Increase the number of residents at our site.
  • More time to spend with resident.
  • access to U/E experience
  • The program like the field of study is about change.
  • none
  • none
  • less record keeping!
  • we just started and don't have a resident yet.
  • Improve the research experience available to the resident.
  • Just getting started
  • It would be nice to have a very brief, uncomplicated outline supplied by NCOPE to help guide us, recommendations on when to teach what, timelines, etc.
  • none
  • Very few. We've been evolving over a very long period of time (20 years).
  • I'm satisfied w/ our basic program at this time.
  • More 1 0n 1 time with each resident
  • none
  • Increase formal interaction among multiple residents
  • Increased structure (esp. Didactic vs. Clinical), Regularly scheduled testing, Rotations for short term observation of other O&P practices.
  • Better organized, more time
  • Provide opportunities for the resident to do self evals. More exposure to upper x management. More exposure to pediatric care.

13. What do you need or whose assistance would be beneficial in making those changes?
  • I need to direct personel.
  • I need to better develop resident teaching staff allowing me less time for details.
  • A resident.
  • In process
  • none
  • logistics / org ER- ?
  • NCOPE
  • NCOPE
  • NCOPE
  • I'd hire more of them
  • Internal company growth / expansion
  • NCOPE regional coordinators to assist in out sourcing residents for specialty clinics or facilities; ie. Scoliosis, CP, etc.
  • Involvment of other senior practitioners who could lead these areas in which the ?.
  • I need a bunch of free time and cooperation from administration to arrange this.
  • none
  • A change in the market place. A rule setting is not the best place for diversity.
  • Need a milling machine (carver) to complete the process (we have tracer cad and pdi thermoformer)
  • Any recommended literature / texts on research. Many of us "old timers" have topics we'd like to investigate and the residency research project has motivated
  • me to move forward in this area.
  • NCOPE
  • Educational facilities or other residency sites
  • Other residency sites willingness and a letter from NCOPE exlaining this.
  • NCOPE
  • NCOPE. Late announcement of residency seminar, too late to change plans for San Diego. Needs to go out with announcement.
  • Not applicable
  • Better teaching materials for residencies
  • We need no help identifying and implimentig changes.
  • Residents report directly to NCOPE.
  • More cash flow towards our company. As sometimes residents do not expect to and are not willing to hold an adequate patient load to cover salary.
  • More staff to take on work load. I do not believe a setting ( like any office who's primary objective it to produce financially) is set up for success as a residency site.
  • Working relationship with U/E resource.
  • Another 3 hours a day and 2 days a week.
  • Better sources of information on how to do research.
  • Maybe different timelines for larger and smaller facilities, ie. Rehab hospital vs small shops.

14. What changes to the NCOPE residency program would you suggest, if any?
  • Change to 18 months
  • Too new to me to say at this time.
  • none
  • No suggestions
  • Reduce the $1000 / resident payment, what the facility recieves and resident recieves are not worth the $1000.
  • student stuck in a poor program
  • Many
  • Less concern with the research paper.
  • Increase length of program to 18-24 months with automatic inclusion in the next CPM ( if successful completed residency)
  • Residency is not a dead end street. I hire residents in order to develop them into staff. I do not hire residents in order to train my competition.
  • More residency site and f/n
  • Not all facilities have or need CAD CAM.
  • Focus on patient management skills vs number of specific # of orthoses fit.
  • None
  • Better knowledge and communication skills to help them develop patient, doctor, and allied health team goals.
  • More guidance or structure regarding what is required of resident
  • I hate the new quarterly evaluation forms! NCOPE should either allow us to submit our own forms or provide forms on disk that allow me to fill them out at the computer. Requiring me to make evaluations out by hand is unprofessional, sloppy, and prone to errors ( such as the word I just messpelled!) !
  • The only thing I would question the cost incurred by the facility (especially a small co.) is rather high.
  • none
  • Specific dates when residents can be accepted.
  • None at this time.
  • None, I think the guidelines are comprehensive, yet flexible enough to allow variability (+ - to each program).
  • None at this time.
  • Many residents never have a residency. There has to be better communication between NCOPE and residents.
  • waive research project
  • none
  • Without education reform, NCOPE's hands are tied with respect to residency.
  • Better quarterly evaluation forms.
  • none
  • Unknown at this time.
  • Write the guidelines on stone tablets so there can be no whimsical changes.
  • Drop the $1000 charge to a facility. They are already putting in a large investment to the resident.
  • More information from NCOPE about goals and more resources for training.
  • Looks as if all bases covered, good program.
  • More options for students to explore in every day situations.
  • Less evals'- only 2 x year.
  • Consider extending program to 2 years 3800 hours.
  • Bring the cost down!
  • none
  • No research papers. You are here to manufacture artificial limbs not write papers. Leave the writing to those who want to go into inventing and research. A paper is not going to make you a better fitter.
  • To make it mandatory that residents receive hands on experience in fabication techniques.
  • Eliminate fee. This is the only profession where an employer has to pay an outside organization in order to have a resident.
  • wider selection of amputees - different levels & ages
  • No requirement for research which should be included in primary education. Residency is for hands on patient care.
  • Greater assessment of outcomes. Inservice exams etc.
  • A clear schedule from NCOPE as to when quarterly reports are due.
  • Motivate more facilities to establish residency programs.
  • A return to the 1900 hour requirement, with additional minimum activity requirements.
  • none


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