The Evolution of Pedorthic Education

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By Maria St. Louis-Sanchez

New educational standards planned for future pedorthists would help them better serve their patients and, some pedorthists hope, help them remain credible in the medical community.

The requirements will likely mean that the process required to obtain certification will cost future pedorthists more time and money but will better prepare them for the challenges of their careers, experts say. Many changes have been proposed in the new standards, but the biggest one is that pedorthists will have to have a minimum of an associate degree to become certified, says Robin Seabrook, executive director of the National Commission on Orthotic and Prosthetic Education (NCOPE), headquartered in Alexandria, Virginia.

"Certainly, the former education process based on coursework and content was shorter," she says. "Now you are talking about at least a two-year commitment at the community college level. That's an obvious increase, but we believe that education is the foundation from which patient care excels. So it will be an investment in their future and the patients they serve."

The new standards have been endorsed by NCOPE and their sponsors, the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) and the American Academy of Orthotists and Prosthetists (the Academy). The standards have been submitted to the Commission on Accreditation and Allied Health Education Programs (CAAHEP). As of this writing, CAAHEP was reviewing the standards and asking for public comment. After the comment period, CAAHEP planned to schedule an open hearing in October. If the standards pass, as they are expected to, Seabrook says they may be in place within the next few months.

Pedorthists who are currently certified will be grandfathered in and will not have to meet the new standards, Seabrook says. Overall, she says, the new standards will be better for patients and the profession as a whole.

"These standards benefit the profession in several areas. One is validity for the services they provide for a vulnerable population," she says. "It creates better patient care. Also, it can help increase the workforce for this profession by making it more well known. When you can point to it in a college catalog, individuals looking into it as a prospective profession might be more willing to consider it."

The standards submitted to CAAHEP for review are the result of about three years of work, with input and feedback from pedorthists, ABC, and the Academy. The standards were created with the same overall CAAHEP framework that is already being used by other O&P education programs.

"When we transition to the new standards, it's not going to be overly taxing for these programs that are already accredited by NCOPE to become CAAHEP accredited and meet the standards," Seabrook says. 

A Necessary Change

Looking back at the start of some pedorthic careers can be a little cringe-worthy, says Dennis Janisse, CPed, assistant professor in the Department of Physical Medicine and Rehabilitation at the Medical College of Wisconsin and CEO of National Pedorthic Services, headquartered in Brookfield, Wisconsin. A former shoe repairman, he got his pedorthic start in the 1980s by taking a ten-day course and later using the course instructor as a mentor. After Janisse and his wife became certified, they started their business and soon had a referral for their first patient with a diabetic ulcer. He knew the importance of the task but was nervous about his own ability to do it.

"I was like, ‘Oh my gosh, all I did was see pictures of that in a course,'" he says. He called his mentor who walked him through the process. Thankfully everything turned out fine, and he is now knowledgeable enough to be a mentor to others. But he acknowledges that more training would have been better for him and his patient.

"It would have been better if I had come out of a better course and knew truly what to do and what to expect," he says.

While certification standards have increased since he was first trained—and pedorthists are now required to have 1,000 hours of clinical experience before certification—Janisse doesn't think the current baseline training is enough.

"Some of those people coming out of pedorthic courses, if a doctor tried to talk to them about serious medical issues, I have a hunch they would be in trouble," he says, adding that the clinical experience is loosely structured and some pedorthists may not get the experience they need with it. With these new standards, he hopes future pedorthists will know exactly what to do when they see their first patients with serious medical conditions.

While historically many pedorthists gained a lot of their skills on the job, elevating education grants the next generation of pedorthist a sound foundation to build upon, says Chris Robinson, MS, MBA, CPO, ATC, FAAOP(D), clinical research director for NCOPE.

"The seasoned pedorthists have been dynamic in developing their skills, tapping colleagues, collaborators, and via their own unique clinical experiences," he says. "But as an accreditor, it is NCOPE's job to ensure that anyone who graduates from a CAAHEP/NCOPE-accredited pedorthic program is prepared to succeed, and the burden of becoming a competent pedorthist doesn't overly rely upon the experiences that occur in a clinic for them to learn independently what they need…. Regardless of where they elect to work, they will have the baseline information they need to succeed in any typical pedorthic setting."

The newer standards are so vital that it was the pedorthists themselves who requested them, Seabrook says. In the past, most pedorthic programs were presented by manufacturing companies and had no formal education requirements tied to them, she says. The programs were two to four weeks long with no formalized admission process.

"There was no criteria established that you need a minimum of a high school diploma and no identification of the education and curriculum needed to graduate," says Seabrook.

Janisse says the new standards are needed for pedorthists to be seen as the healthcare professionals they are.

"These standards are long, long overdue," Janisse says. "We're assuming a lot of responsibility, especially with our diabetic population. We need the right education and qualifications to back us up on that."

He pointed out that O&P clinicians now need to have a master's degree to be certified.

"And we were still sitting around with the same education requirements we have had since our existence," he says. "We have to do this to remain credible." 

Expected Changes

Overall, Robinson says, future pedorthists will be better trained and have a broader education than what was previously required of the profession.

"These new standards ensure that everyone has a stronger foundation before entering into patient care," he says. Along with requiring a baseline associate degree, the CAAHEP/NCOPE standards make pedorthic education more patient-centered while recognizing the challenges of the current healthcare environment, he says.

"Historically, pedorthic education had a tendency to overly focus on the device versus focusing on the fact that orthoses are the treatment for a specific biomechanical condition or pathology," he says. For example, rather than just learning about orthotic design to treat a patient with a diabetic ulcer, the standards require the pedorthist to know more about how the disease process affects healing as well.

"The standards focus on understanding the needs of the patient and their caregivers. Beyond needing an orthosis, comprehensive care may require more education and follow-up than a condition with a less complex disease process. People with diabetes often have sensory issues and familiarity with diminished sensation provides a more comprehensive clinical picture for the pedorthist…. Given that the diabetic population has frequent complications with ulcerations and foot deformity, the pedorthists become the first line of defense and treatment to ensure that these individuals have their feet taken care of, so hopefully they won't have complications of neuropathic foot."

Along with centering on patients, the standards will help cement the pedorthist's role in the interdisciplinary healthcare team by providing value to patient care and hopefully improving outcomes such as quality of life and participation within the community.

"It's a function of depth of education while recognizing that the pedorthists have the skills and knowledge to provide measurable value to that healthcare team," Robinson says. The contemporary pedorthic curriculum will feature more in-depth material science to better determine the best materials for the patient to meet their biomechanical and therapeutic goals. A working knowledge of regulatory issues and practice management is also integrated to ensure that care is provided in a manner consistent with contemporary practice and rules defined by the payer. 

Putting the Standards Into Place

The experts expect the new standards to be adopted by CAAHEP, but the details about how exactly they will be implemented are still being worked out. Currently, four schools have expressed an interest in adding a program for future pedorthists to obtain an associate degree. Those schools already have O&P programs or classes and adding on a program for pedorthics wouldn't be a big stretch, Janisse says.

One of those schools is Joliet Junior College in Illinois, which offers an associate degree in orthotics and prosthetics technology as well as a variety of certificates for specializations, including lower-limb orthotics or spinal and upper-limb orthotics. Many of the standards that NCOPE has outlined for pedorthists have crossover with classes that are already in the program, says Desmond Masterton, MC, CO, CPed, associate professor of orthotic prosthetic technology at the college.

"We already have classes like practice management that cover the coding, billing, and financial aspects and O&P-related medical classes," Masterton says.

How exactly those schools will handle the shift will probably vary from school to school, Seabrook says. Though the programs will have to meet the standards, the name of the degree awarded and the exact classes will probably differ, she says.

Masterton says that if and when the standards pass, it will just be the first step to building out a new pedorthic program. At Joliet Junior College, the department would first need to perform a needs assessment and prove to its advisory board with market research that there is a need for a pedorthic program. The department would also need to submit a new program proposal to the curriculum committee that would have to be approved both
by Joliet Junior College and the Illinois Community College Board and then passed onto the Higher Learning Commission, a regional accreditor of post-secondary institutions.

"It will take at least a year or two for everyone to check off on our paperwork," he says. "I think some more conclusive research would have to be performed to get a yes or no answer, but right now, just anecdotally, it's looking favorable." 

Looking Toward the Future

While the new standards are expected to increase the depth and breadth of pedorthic education, Robinson hopes that they will also help change the face of the profession as a whole and add more diversity to its ranks. A 2017 study of ABC-certified pedorthists, which can be viewed at https://bit.ly/2oGBx8M, found that the respondents were predominantly male (65 percent) and Caucasian (77 percent). Just 4 percent were Hispanic, and 2 percent were African American. "I'd like to see the pedorthic profession attract individuals who are representative of the patient populations that require their services," Masterton says.

He says that other health sciences programs have seen an increase in female candidates when they transitioned to a higher level of education, including the prosthetist/orthotist. Also, he says, escalation of the educational stances will potentially improve exposure to the pedorthic profession and may attract interest from additional academic institutions looking to expand their degree offerings. Historically, people have been introduced to the profession either from personal experience or a family friend.

"The student bodies of these schools will be larger, more diverse, and academic counselors can hopefully help to identify students with aptitudes well-suited to succeed in a contemporary pedorthic curriculum," he says.

These new standards also mean that some people who might have considered the profession now will go another way, Masterton says. But that's not necessarily a bad thing, he adds.

"Some potential future pedorthists may look at the time and money investment and choose a different career," he says. "But if somebody is not committed to entering a profession then they shouldn't. We work with patients, and if [pedorthists] aren't adequately educated and trained, then patients could be hurt."

Overall, a better education for future pedorthists can only be a good thing for the profession and the patients we serve, says Robinson.

"I think a profession is always judged by its lowest common denominator," he says. "Seeing pedorthists transition to a higher expectation in combination with increased professionalism can shed some well-deserved public awareness and give more credence to value pedorthists can offer." 

Maria St. Louis-Sanchez can be contacted at msantray@yahoo.com.