Advancing O&P Education: How Are We Doing?

Q: How are we doing?

A: The simple fact that more people are talking about advanced educational programs in orthotics and prosthetics is promising. The fact that there's enough interest and activity to merit a feature story is progress in itself!

In talking with educational experts and O&P professionals closest to the subject, one can't help realizing that there is "buzz," enthusiasm, anticipation, positive energy--and above all, there is real PROMISE in the record of what's been happening recently and what's going forward already in 2004 with regard to O&P education.

NAPOE, NCOPE Views Bryan Malas, MHPE, CO, chair of the National Association of Prosthetic-Orthotic Educators (NAPOE), chair of the National Commission on Orthotic & Prosthetic Education (NCOPE), and director of Orthotic Education at the Northwestern University Feinberg School of Medicine, Chicago, Illinois, cited O&P education's most important recent accomplishment: the move toward outcomes-based education .

"CAAHEP [Commission on Accreditation of Allied Health Education Programs], which oversees NCOPE, essentially mandated that we move toward outcomes-based education by the year 2007," Malas explained. "NCOPE's intention is to try to have a working draft of the standards for outcome-based education by 2005. So we at least have a few years in which to iron out any potential problems with the new changes."

More distance learning education is another possible future trend Malas foresees. "As an example, we see that Newington [Newington Certificate Program, Newington, Connecticut] has already established a distance learning program, and early signs seem to suggest positive student performance."

What's Ahead? "The future emphasis will continue to be on outcomes-based education," Malas said. "In addition, there has been some discussion regarding a future consensus conference on education." He added, "The things that come to mind as real needs for education are usually issues of funding--just simply trying to keep the doors open to the programs is at times a monumental task." Developing more awareness about the profession as a career is another top priority, Malas emphasized. About three years ago the schools saw a 28-percent decline in applicant numbers, Malas pointed out. "We're starting to stabilize a little bit, but there are several programs out there that are tuition-driven; and obviously, when you don't have the applicants, it becomes even more of a challenge to keep the doors open."

Commenting on the Academy of Orthotists & Prosthetists (AAOP) Awareness Committee's efforts to promote the profession as a career choice, Malas said, "They've worked on creating brochures and CDs that people can use to give presentations about our profession. We need to take this to junior college, high school, and even junior high, and start raising people's awareness that O&P is a viable professional option."

Malas notes that Northwestern is pursuing its own efforts to raise visibility for O&P: "I recently met with representatives from several different school districts in the greater Chicago area. We brought in counselors and teachers for a tour of the school, explained how the educational process works within our profession, and what it takes to be accepted into a program. Each participant indicated they would share this information with other colleagues at their respective schools. Our hope is that this will not only lead to an awareness of the profession, but that students would desire this career pathway.

"For the moment," Malas adds, "it would be nice to just have stability across all the schools, and know that those schools are going to remain open. In the future, maybe we could have more schools, but that's always the fine line that we walk: Do we add more schools because we need to meet the needs of the ever-growing patient population, or do we limit the number of schools in the presence of an unstable applicant pool?"

Donald O. Shurr, CPO, PT, NCOPE chair at the time this article was being researched (Bryan Malas, CO, is the 2004 chair), also stressed the value of developing outcomes-based standards, one of a set of ambitious goals and objectives identified by NCOPE at its spring 2003 meeting.

"We're already accomplishing a number of things," said Shurr. "The most important was to establish a first step at developing outcomes-based standards for our orthotic and prosthetic schools. That is not a finished product, but we got a very good start thanks to a gentleman named Buddy Jeffcoat [then chair of NCOPE's Outcomes Committee]. He really put forth a yeoman's effort to bring our commission into step with CAAHEP."

The most pressing and significant need for change in the future of O&P education pertains to "a couple of issues that are obviously left unresolved," said Shurr. He cited the low number of programs: "Those are a direct reflection of the lack of funding from the federal government to provide scholarship and support for our schools and our future students."

Shurr also would like to see programs moving toward a masters-degree level. "The Negotiated Rulemaking Committee experience demonstrated to us as a profession that it's very important to be viewed--not only by ourselves but by the people we work with in allied health and medicine--at a level equal to occupational and physical therapists," Shurr said. "At the current time, that's not the case. Hopefully, at some point we will convene an education conference similar to the Ponte Vedra [Florida] conference in the mid-70s that put us on a course establishing the baccalaureate as the entry-level standard. With that consistency in futuristic planning, hopefully we will develop masters-level programs for our practitioners of the future."

What's Ahead? NCOPE's defined goals for the coming year and the future include, according to Shurr:

Accrediting the first entry-level master's degree program in O&P; A formal review of residency programs nationwide; Developing standards for O&P assistants; Writing standards for O&P education using an outcomes format; and Creating a curriculum for practitioners' assistants (which is complementary to the training NCOPE specifies for technicians). (Editor's Note: NCOPE adopted a new set of standards for the Assistant and Technician level, effective January 1, 2004.)

"We're hoping the masters program will elevate the field and ultimately provide a track for training O&P faculty," said Shurr. "Now, it's mostly practitioners with a certificate and/or a baccalaureate degree who teach. Really, this training will help develop a new tier of instructors for future masters degree programs."

Looking ahead to NCOPE's expectations for advanced O&P education in 2004 and beyond, NCOPE Executive Director Robin Seabrook commented: "I think that one of our big pushes in 04 and into 05 should be to pull all our experts back together for another consensus education conference. Let's see where we are, where we are going, and how we can get there educationally.

"The last consensus conference in education was in 1991, and I think it's time for us to do another one, especially with regard to all the issues that are hitting orthotics and prosthetics, such as the Medicare legislation, the NRM [Negotiated Rulemaking] movement, reimbursement, etc.," she continued. O&P needs to take a hard look at its current body of knowledge, Seabrook said, to determine whether it has expanded, based on services provided. If it has expanded in some way, do the current educational process and standards need to change, and if so, how? "If it hasn't changed, and we're on the correct track, that's great," Seabrook said. "But if we're not, then how do we get there and how do we make changes?"

Academy Perspective Don Katz, CO, FAAOP , AAOP president, shared the Academy's perspective on accomplishments in the field of O&P education:

"There have been a number of exciting initiatives within the last year," Katz said. He cited the matriculation of new students in the masters program at the Georgia Institute of Technology, Atlanta, NCOPE's work in establishing a structure for O&P assistant education programs, and the efforts underway to establish a new school at St. Petersburg College in Florida. "I also feel that during the past year NAPOE and the Academy have been communicating effectively so we can have a stronger partnership for education initiatives into the future.

"The Academy has been working diligently this past year, investigating and trying to gain a better understanding as to how we--as a professional association for prosthetists and orthotists--can influence education funding throughout the country," Katz continued. "We know the schools are working incredibly hard to keep their doors open; and when you compare where we are today to where we were the past decade or more, there are a number of schools that no longer exist. It's frightening, and it deserves the attention we're devoting to that very issue."

What's Ahead? Katz detailed the efforts of the Project Quantum Leap (PQL) initiative, including the convening of two conferences studying the need for post-graduate degree education in prosthetics and orthotics.

Katz pointed out that Georgia Tech currently has the only masters degree P&O program in the country--and that there are no PhD programs in the US.

"During my years on the Academy Board, the Board has come to realize that there is a greater need for applied research than ever before," Katz said. "It is essential for us to answer the many clinical questions as to what is effective with regard to our services." The reason why more research is not undertaken is because "we are not trained as researchers," Katz said. "Why is that? It's because we don't have post-graduate education."

He continued, "We need to convene a conclave of those from the academic programs as well as other experts and study this. We need to identify the problems and potential solutions, and then create a long-term plan that hopefully will give us a realistic goal for matriculating future P&O researchers."

CSOP Conferences Another educational milestone was reached with the second Clinical Standards of Practice (CSOP) consensus conference on immediate post-operative care for the amputee, held in the spring of 2003, Katz noted. The findings from that conference are in the process of being documented. A summary of the first conference was published as a supplement in the October 2003 JPO: "Orthotic Treatment of Idiopathic Scoliosis and Scheuermann's Kyphosis."

"We intend to host two more Clinical Standards of Practice consensus conferences in 2004, and then make opportunities available to our schools to work with the Academy on creating online education reflecting the CSOP findings," Katz said. "This would be a great way to partner with our educators, who could then review the material resulting from this enormous project&as a tool for both primary and continuing education."

Katz continued, "This could be one of the first opportunities for the Academy and our schools to partner in a project with definitive goals, target lines, and online education benefits."

If, in a fantasy world, Katz were granted ultimate power to fulfill O&P education's most significant need of the moment, he admits that he would find it hard to limit his vision to just one wave of the magic wand.

"I think the most significant need is for us to blaze a trail by expanding the number of schools, increasing the awareness of our field, and studying the initiative for offering post-graduate degree education so orthotics and prosthetics can be a true and meaningful player in clinical research."

Katz continued, "O&P awareness is really critical in this equation. We have grave concerns about the number of practitioners that need to be available to take care of our citizens in the years ahead. Some of the NCOPE-published predictions are very troubling. If we suddenly created more schools, we wouldn't have enough students applying! There's a whole world of other glamorous high-tech career opportunities out there--so many of these young, vibrant minds are being drawn to careers other than healthcare."

Is Advanced Education Really Necessary? "I did a paper with some of my students at Shelby State--they did most of the work--and presented it at the 1986 AOPA meeting," said Robert Rhodes, MPA, CO , chair of the Education Committee at the University of Michigan O&P Center, Ann Arbor. Rhodes is also a faculty member for the new graduate certificate O&P program at Eastern Michigan University, Ypsilanti. "We looked at reading level competencies in orthotics, prosthetics, physical therapy, and orthopedic surgery, taking averages based on seven studies of current textbooks in each discipline. The averages demonstrated that to be able to read orthotic literature and understand it, you needed 21 years of education. (This would mean nine years past high school.) Orthopedic surgery needed 19 years, prosthetics needed 17, and physical therapy required 15. Definitely food for thought."

So How Are We Doing? An A or an F? Rhodes' perspective inspires optimism: "I've been in the field for more than 30 years, and when I entered the field, other people that I knew who were getting into orthotics and prosthetics were typically blacksmiths, saddlemakers, and shoemakers. People that we see entering the field now have backgrounds in engineering, physics, kinesiology, and other academic disciplines. The quality of the students and the practitioners that we are producing today is far, far better than I would ever have expected from looking at it 30 years ago!"

Making changes quickly isn't easy, Rhodes warned. "We can always look at things from hindsight and say that maybe ABC should have done this or that differently, but I think that if we look at what has actually happened, we've come a long way in a short time!

"When I started teaching at Northwestern in 76, I was one of the few people in the field who had a bachelor's degree," Rhodes continued, adding, "Now a baccalaureate degree is a minimum requirement, and many practitioners have advanced degrees."

Don Shurr points to more fuel for optimism: "I think the good news is that Ossur, for example, took the opportunity to assist Cal State Dominguez Hills, which was on the brink of closing its doors, and provided the program with wonderful space in California, virtually salvaging a failing program. Things like that don't normally happen. Ossur not only gave them the bulk of a very large building in southern California--which I'm sure is very expensive space--but underwrote the costs of maintaining the building just for prosthetic and orthotic education.

"That's the kind of generous support we need to make sure does not go unacknowledged," Shurr added.

"I have been glad also to see what I think is a new focus on education within the field of O&P," reflected Mark Geil, PhD, Georgia Tech Master of Science Prosthetics Orthotics (MSPO) Program, Atlanta. "The Academy's Project Quantum Leap has made great strides in trying to restore federal funding for education; the recent grant that the Department of Education has bestowed for a couple of national conferences was focused exclusively on education and educational standards in P&O. That is a tremendous amount of progress."

Despite the current storm of who is a "qualified provider," possible changes in credentialing standards, and funding issues, O&P education appears to making steady progress forward.

Current Programs NCOPE Executive Director Robin Seabrook provides a current scorecard of programs at press time:

New Programs Applying for Accreditation in 2003 Georgia Institute of Technology , Atlanta--Masters-level program in orthotics and prosthetics. Applied in spring 2003; undergoing accreditation review in December.

Eastern Michigan University , Ypsilanti--Applying soon for a program to begin as a post-baccalaureate certificate. The goal within the following year is to turn it into a masters degree program in O&P, Seabrook noted.

O&P Educational Programs Currently in Place Schools with Baccalaureate Programs: California State University Dominguez Hills (CSUDH) -- Bachelors program, prosthetics only.

This beleaguered program relocated this past summer in an effort to survive. Ossur donated one floor of its office building space in Aliso Viejo, California, to allow the school to operate a certificate program and then a bachelors program, but the program is teaching prosthetics only at this time, said Seabrook.

University of Washington, Seattle --Bachelors program.

University of Texas Southwestern Medical Center , Dallas--Bachelors program.

Schools with Certificate Programs: Newington College , Newington, Connecticut-- In addition to the certificate-level program, the school now offers its certificate via distance education for those pursuing their second discipline, Seabrook explained. "If you've already done either orthotics or prosthetics, and you want to extend your credential, then you're eligible to participate in its distance education program, if you meet all the other admissions requirements."

Northwestern University , Chicago, Illinois

Century College , White Bear Lake, Minnesota

Rancho Los Amigos Medical Center , Downey, California "The program is inactive this year," Seabrook pointed out. "The program is hoping to be able to reactivate next year, but did not take in a class this past summer due to the shortage of healthcare finance dollars in California."

Schools with Technician Programs: Baker's College , Flint, Michigan

Century College , White Bear Lake, Minnesota

Francis Tuttle Technology Center , Oklahoma City, Oklahoma

Median School of Allied Health , Pittsburgh, Pennsylvania

Spokane Falls Community College , Spokane Falls, Washington

Schools with Assistant/Technician Programs: This program is not really new, but revived and changed from a previous 70s assistant credentialing program, Seabrook explained. "ABC [American Board for Certification in Orthotics & Prosthetics] has revived the program; NCOPE has drafted new standards for the technician/assistants, and they were adopted December 3, becoming effective January 1, 2004. There's currently only one assistant-level program in operation."

Oklahoma State University-Okmulgee --Assistant program.

Was accredited in December 2003. This program had already applied for accreditation under an earlier and much tougher set of "associate level" standards devised in 1995-96 and implemented around 2000, Seabrook noted.

"Unfortunately, those standards were so high that most of the [schools] didn't want to offer the program, especially at the community-college level--because the course work being required was so great that they were only a couple of credits off from a bachelors degree!" Seabrook said. "This was part of the reason that ABC/NCOPE reexamined the assistant level based on the practice analysis survey results that ABC obtained three years ago. The survey made it clear that there are a lot of technicians who are performing some level of patient care. It was recognized that perhaps there was a genuine need to credential these individuals at the assistant level."

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