P&O Education: How Did We Get Here - Where Are We Going?

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By Sidney Fishman, PhD

To help the reader better understand the current complex state of entry-level education, we need to consider a series of pertinent historical facts from the past 50 years. To our knowledge, this information has not been widely disseminated to P&O before. These past events play a major role in understanding some of the roots of today's educational issues.

The Artificial Limb Research Program

In the early post-World War II period, the US government urgently needed to upgrade prosthetic services in order to improve the quality of care available to returning veterans. Essentially, the tiny "artificial limb industry" was in no position to attack and solve this problem by itself. This concern resulted in the federal government allocating $1 million annually to improve prosthetic-and later, orthotic-services nationwide.

The inauguration and organization of this unique undertaking involved several government departments, notably the Veterans Administration and subsequently, Health, Education, and Welfare, as well as extraordinary technical, financial, and political complexities which cannot be detailed here. The decision was made in 1947 to place the responsibility for this effort with the National Academy of Sciences-National Research Council (NAS-NRC), unquestionably the most respected and prestigious scientific organization in the nation. The NAS-NRC activated the Artificial Limb Program (ALP), which continued for more than 25 years.

The first university centers invited to participate in the research phases of the ALP were the University of California at both Berkeley and Los Angeles. They were joined by New York University (NYU) shortly thereafter. 1

From the very beginning, it was clear that progress in this specialized research and development depended on substantial input from, and close collaboration with, the fields of engineering, medicine and surgery, and psychology, as well as physical and occupational therapy, to supplement prosthetics (limb-making and limb-fitting as it was known then) per se. As the research progressed, the scope of these interdisciplinary activities grew substantially, studying innumerable issues important to P&O.

From 1947 to 1959, revolutionary scientific and technical advances were made by the ALP. Prime examples include new components, the quadrilateral and PTB socket designs, principles of lower limb fit and alignment, as well as a completely new technology for upper-limb prostheses. It is fair to say that the major contributing science was engineering; however, the contributions of all the groups were required to account for ALP's remarkable successes, which revolutionized prosthetic-orthotic practices through the world. 2

Short-Term Upgrading Instruction

The director of the ALP, General F.S. Strong Jr., an engineer by training, considered it absolutely necessary to transmit these significant improvements as quickly as possible to the clinical teams then responsible for amputee care. To accomplish this objective, the University of California-Los Angeles (UCLA), the NYU post-graduate Medical School, and Northwestern University (NWU) initiated the first formal university-based prosthetic instruction in the world during the 1950s, funded by government grants. These short-term, specifically upgrading courses were not designed for novices, but rather for practicing prosthetists (and later, orthotists), physicians, surgeons, occupational and physical therapists and other rehabilitation professionals. These courses were enormously valuable and popular, changing the entire technical nature of P&O practice over the decades from the 1950s through the 1980s.

However, these courses were not designed to-nor was it possible-to include the extended academic and technical educational background required to develop professional practitioners in P&O. At that time, relatively few of the limb and brace fitters being trained had any post-secondary school education.

Long-Term Entry Level Education

As time went on, however, it became clear that these short courses did not and could not meet the needs of newcomers preparing for careers in P&O. They needed far more lengthy and broad-based training. Responding to this need, in 1963 NYU offered the first O&P degree program in the world, concurrent with its ALP short-term course training.

Strongly influenced and supported by NYU's extended 12-year multidisciplinary P&O research and educational experiences, a four-year professionally oriented training program was developed. It provided a total specialized experience of 1,800 hours of didactic and laboratory classes, plus more than 1,000 hours of clinical experience in cooperating facilities. The content of this curriculum unquestionably is academically equivalent to the masters degree curricula currently being offered in allied health.

For details of courses included in the NYU bachelors degree program, an expanded bibliography, and related information, read Long-Term Entry Level Education . (Exclusively Online)

Recommendations and Conclusions

The essential elements of a first-class masters degree curriculum, including the necessary professional education and clinical experience, are not at issue.(3) However, a program would be much more efficient, with total time requirements substantially reduced, if the two complementary but different aspects of P&O services-patient care and technical fabrication activities-were separated. If this could be accomplished, a five-year masters program for the professional practitioner should serve P&O very well.

Such a program would provide appropriate exposure to the liberal arts, sciences, and technical and communications skills, as well as most-if not all-the necessary clinical experience. Separate vocational training would be offered to technicians to assure the production of quality appliances fabricated according to the specifications of the professional practitioner.

Without changes, P&O cannot successfully meet the challenges of the present circumstances, i.e., recruitment of students, relationships with other medical professionals, as well as accreditation, legislative, and licensure issues.

Bibliography

  1. Furman, B., Progress in Prosthetics, US Department of Education, Health and Welfare, Washington, DC, 1962 161 pp
  2. Wilson, A. B., "History of Amputation Surgery and Prosthetics," Chapter 1 in Atlas of Limb Prosthetics, American Academy of Orthopaedic Surgeons 1992 13 pp
  3. Fishman, S., "The Professionalization of Prosthetics and Orthotics," article in O&P Business News, June 1, 2001