Is O&P Education Doing Its Job?
September 2006 Issue
Prove it! Show me! These words sum up the paradigm shift sweeping through US healthcare, including the educational field. Orthotics and prosthetics too is running with the tide, and is in fact, ahead of the wave, according to Robin Seabrook, executive director of the National Commission on Orthotic and Prosthetic Education (NCOPE)
The educational programs accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) in cooperation with NCOPE, are being required to change to outcomes-based education. So, not only is there increasing emphasis in healthcare on outcomes measurements and evidence-based practice (EBP), there also is a shift toward outcomes in healthcare education--looking more at the end result than the educational process itself.
"On global scale, there has been a shift in medical education in this direction for some time; we're being consistent with that paradigm shift," explained Bryan Malas, CO, NCOPE chair. "Also, we have been mandated by CAAHEP to move to outcomes-based education; CAAHEP works with Committees on Accreditation (CoAs) for outcomes-based standards." NCOPE began drafting new standards in the CAAHEP-required outcomes-based format, with innovations and tweaks being added to the standards before CAAHEP adopted them.
CAAHEP has required that all of its CoAs move to outcomes-based education standards by 2007, Seabrook said. "About three or four years ago, we started looking at what this means, how other professional disciplines are doing this, etc. So we are actually a year ahead!"
CAAHEP approved O&P practitioner outcomes-based education standards January 28, 2006, after the American Academy of Orthotists and Prosthetists (the Academy) and the American Board for Certification in Orthotics and Prosthetics (ABC), also member organizations of CAAHEP, endorsed the standards late in 2005. An open hearing was held before adoption by the CAAHEP board. (See box for more information on CAAHEP's structure and accreditation procedures.)
New O&P programs seeking accreditation must meet these new standards, and currently accredited programs will be required to be in compliance with the outcome standards when their accreditation comes up for review.
What Is Outcomes-Based Education?
Just what is outcomes-based education? One definition, cited by California State University-Monterey Bay, is: "Outcomes-based education is an educational model where the desired end results are identified first, followed by the identification and development of the means to achieve those results. This means that students (as well as future employers, the parents of students, service learning partners, etc.) know what is going to be learned in advance and that there will be proof that the student actually knows the information and can apply it."
"There are two basic types of outcomes from any educational system," Roy Killen, associate professor of education, University of Newcastle, Australia, wrote in 2001. "The first type includes performance indicators such as standardized test results, completion rates, post-course employment rates, etc. The second type of outcome is less tangible and is usually expressed in terms of what students know, are able to do, or are like as a result of their education. It is this second type of outcome that is normally implied when outcomes-based education (OBE) is being discussed&"
In fact, an Internet search reveals that outcomes-based education is increasingly being used throughout the world, as is evidence-based practice.
Elaborating on the definition relative to O&P education, Malas explained, "We look less at the process and more on the question: Are the objectives being met? Show us how the objectives are being met.'"
The educators explained that the core curriculum is not changing much. The change is in how the students are evaluated during the process--making sure that the evaluation process is able to show that the student has met the objectives of the curriculum, explained Daniel Abrahamson, CPO, Division of Prosthetics Orthotics, Department of Rehabilitation Medicine, University of Washington School of Medicine. "It's not, You need to teach this specific material to your students'; it's You must show your students have learned this.'"
In the past, students at Northwestern University Prosthetics Orthotics Center (NUPOC) would be evaluated on such aspects as very specific fabrication and fitting criteria, explained Mike Brncick, MEd, CPO, administrative director. "Now, with outcomes-based assessment, we are looking at the overall function of the patient that a student has managed&Can the patient walk and use the prosthesis for his or her needs and be functional in it? Did the students use the knowledge and skills they learned throughout the lecture and laboratory sessions to reach the outcome we expected?"
Bob Lin, CPO, FAAOP, program director of the Newington Certificate Program, Newington, Connecticut, pointed out that there is a cultural shift to outcomes both in education and clinical care. "The O&P profession needs to shift to the concept of "We provide patient care," rather than "We provide this or that knee orthosis." Lin noted that one of Newington's most popular courses is healthcare management. "There is more emphasis on patient assessment, such as being able to do observational motion analysis, consult with the physician on the prescription and being able to say, This is what the patient needs biomechanically.' We don't just say, The patient came in for a brace; he now has a brace,' but rather, we need to be able to show data on the patient's improved gait and other outcomes."
Outcomes Assessment Tools
Just how are outcomes evaluated? What benchmarks or tools are needed?
Developing ways to evaluate outcomes is difficult, Brncick acknowledged, adding that two basic questions must be answered: 1) Is the program accomplishing its objectives? and 2) What standards or baseline indicators do we use to see if we are accomplishing the goals of the program?
"Another very important part of the overall process is determining if we are using the correct standards or baselines to determine the outcomes," he added.
In its Standards and Guidelines for O&P program accreditation, CAAHEP includes outcomes assessment and reporting. (The complete document can be accessed at www.caahep.org ). According to the Standards and Guidelines, "Outcomes assessments include but are not limited to: programmatic summative measures, positive placement, employer satisfaction, graduate satisfaction, NCOPE Resident Survey, performance on national certification examinations, and student retention. Programs must meet the outcomes assessments thresholds."
The measuring tools and procedures will be standardized, Malas said. For instance, a postgraduate survey would be standardized for reporting purposes to NCOPE, although the program could include additional questions for its own use.
Outcomes-based education will be more data-driven than past standards, but the tools and procedures are still being developed. Other measures might include an exit exam as students complete the programs, tracking employment rates of graduates, employer satisfaction surveys, graduate satisfaction surveys, and others. The educators noted that the schools are already using many of these tools, but now the data will be reported to NCOPE.
Seabrook observed that many allied health professions outcomes assessments rely heavily on students' success in obtaining licenses and/or passing board exams, which they can do right after graduation. But since ABC currently requires a year of residency before sitting for the ABC exam, at this point certification would not weigh as heavily. However, NCOPE has discussed the possibility with ABC that, when all the programs are under the new outcomes standards, graduates could take the written part of the ABC exam immediately after graduation, with the written simulation exam and the clinical patient management exam being taken after completion of the residency requirement, she said, adding, "The written exam is probably the most closely aligned didactically with what is learned in school."
Increasing Curriculum Flexibility
CAAHEP at a Glance
For more information on CAAHEP, visit www.caahep.org
For more information on CHEA, visit www.chea.org
One innovation making life easier for all involved has been to move specific curriculum courses and requirements from the Standards to a Curriculum Guide. The Standards are basically "set in stone" and thus involve a detailed, difficult process to change, whereas a guide can much more easily be changed, providing much more speed and flexibility to adapt to the changing needs of the profession, patients, and the healthcare environment.
Currently, the Curriculum Guide, updated in 2006, is largely based on the ABC Practice Analysis, published in 2000; ABC is currently developing a new Practice Analysis, with the survey now underway. Explained Steven R. Whiteside, CO, FAAOP, chairman of the Practice Analysis Task Force, quoted on ABC's website ( www.abcop.org ), "[This] detailed survey...will allow us to build the practice profile of the contemporary O&P practitioner, and thus identify the knowledge and skills they need to provide proper patient care. After the survey is analyzed, it will serve as a blueprint for developing O&P education and residency programs, as well as certification exams."
Benefits of New Approach
What are some of the benefits to this new approach to O&P education?
"The new standards will affect the quality of education in numerous ways," said Brncick. "One way is the effect they have on how schools approach teaching. In my opinion, this will open the door for much more creativity in delivering the curriculum and structuring the educational experience. The whole process will be less prescriptive; the emphasis will be on whether the students are successfully trained as entry-level orthotists and prosthetists, rather than on how they got there. I believe students will have more choices in the type of program they would like to attend. Each school is unique in its emphasis on its curriculum. This will enable each school to determine how they want to develop and deliver their curriculum. This diversity is a good thing for the schools, students, and the profession."
"We will probably see a greater variety of delivery systems," said Malas. "The transition to an entry-level masters degree is probably the biggest change on the horizon. The scope of knowledge has grown beyond the current baccalaureate level."
He added, "O&P education is being proactive rather than reactive."
Fast-moving changes are taking place in O&P education, including the move to outcomes-based education, emergence of new schools, new masters programs, and even a new O&P-related doctorate program, which is likely to be announced soon.
In light of these exciting developments, is O&P education doing its job? In a word, yes!