Educational In-services: Benefiting the Healthcare Team, Patients, and O&P Providers

The O&P EDGE interviewed O&P company owners and clinicians who provide a representative example of courses and in-services that range from offering continuing education units (CEUs) to much simpler instructional programs held for staff at a hospital or nursing facility, and describe a variety of methods for approaching presentation of the material. When a patient's rehabilitation healthcare team understands, appreciates, and effectively utilizes one another's expertise, they can work together to achieve optimal patient outcomes. Educational courses and in-services provided by O&P practices and manufacturers to physicians, orthopedic surgeons, physical and occupational therapists, nurses, and community groups help advance that goal. Although some in-services may center on presenting a company's products and services, others focus on providing information that advances O&P knowledge among other healthcare professionals for the benefit of the patient. Of course, providing these educational and instructional offerings also raises the profile of the company as an expert resource. Different Presenters, Different Approaches HITTENBERGER ORTHOTICS AND PROSTHETICS Drew Hittenberger, CP, BOCO, owner of Hittenberger Orthotics and Prosthetics, headquartered in Petaluma, California, is a fourth-generation prosthetist/orthotist. Hittenberger's educational presentations include such subjects as sports for individuals with amputations; advancements in prosthetics; transtibial and transfemoral amputations and prostheses; post-operative amputation care; lower-limb orthotics; and knee and spinal orthoses. The presentations on transtibial and transfemoral amputations and prostheses describe indications and contraindications associated with these amputation levels, surgical procedures and factors, and biomechanical factors. The spinal orthoses presentation includes different types of injuries to the cervical, thoracic, and lumbar spine, along with operative and nonoperative treatment techniques and types of orthoses that are prescribed. Hittenberger has lectured about O&P around the world and has provided volunteer O&P care, including in post-revolutionary Nicaragua, to returning Soviet Russian veterans following their war in Afghanistan, and in Haiti after the 2010 earthquake. He says that "prosthetics is a universal language because these services are needed throughout the world." As to which in-services and lecture programs attract the most interest, Hittenberger notes that it depends on the audience. Physical therapists, for instance, are most interested in lower-limb orthotics and prosthetics while community groups are most interested in prosthetics in general, prosthetic advancements, and O&P in developing countries. Hittenberger's presentations do not have to be very technical when he is addressing community groups, he says, "But they do want to know what's going on." Hittenberger uses PowerPoint® and videos in his presentations. Occasionally he will include a patient model, but not generally, he says, since that adds to the complexity of coordinating and arranging the presentation. "Things can change at the last minute." He structures his presentations to be flexible. He introduces himself, provides some information about his background, and asks the audience if there is a particular question, type of patient, or type of device they want to know more about. "Then as I go through the presentation, I can address those issues." DO'S AND DO NOT'S FOR SUCCESSFUL COURSES AND IN-SERVICES Be thoroughly prepared. Practice, practice, practice. Check beforehand that all presentation technology and equipment is working properly. Make sure the room temperature is comfortable. Be enthusiastic. Enthusiasm breeds enthusiasm. In your introduction, describe the information you will be covering and why it matters. When you conclude, review the main points. Engage your audience. To make that connection, consider encouraging questions and discussions, whether during or after the main presentation. Create a friendly atmosphere that helps the audience feel comfortable participating. Use variety and visuals in your presentation, such as videos, photos, slide decks, and patient models when appropriate. This engages the audience and helps them remember key points. Provide note-taking materials. Include breaks in longer courses or in-services to help the audience avoid "seat fatigue." Breaks also help attendees to refresh mentally and be alert and attentive. Obtain feedback about what the audience liked and didn't like, and what other information they would like included. This can improve future course/in-service presentations. MIDWEST ORTHOTIC SERVICES "About 90-95 percent of our patient base is pediatric," explains Bernie Veldman, CO, founder of Midwest Orthotic Services, Surestep, and their parent company, Dienen, all headquartered in South Bend, Indiana. Midwest Orthotic Services includes 13 clinical practices in five states, and Surestep manufactures the Surestep supramalleolar orthosis (SMO) and other orthotic products for children. "So physical therapists and orthotists tend to be our audience for our courses," he says. Most courses provide physical therapists and other healthcare professionals the chance to earn CEUs because it is an incentive for them to take the course, explains Suzi Klimek , executive director of marketing for Midwest Orthotic Services and Surestep. Klimek works with professional organizations and state boards to obtain CEUs for the courses. "[Attendees] will not only learn valuable information but will receive credits toward their continuing education requirements." Courses can be from one hour to multiple days, Klimek explains. Generally, courses are planned based on which healthcare professionals are being educated and what time frame they are likely to have in their schedules. "You have to offer what makes sense for them, so we offer quite a few courses from one to four hours." The cranial remolding course has been especially popular, Veldman adds. A considerable amount of effort goes into developing a CEU-granting course. "Suzi and I did a tally and found that when we built a four-hour course, about 2,000 hours of work went into it," Veldman says. "That's about eight hours for every minute of presentation." The company has an education department that helps develop the courses and get them approved for CEUs and a research department that searches for clinical research relating to the course topics, Veldman notes. Courses are delivered using a multimedia format with PowerPoint, professionally shot photographs, and professionally shot and edited videos to engage the audience. "Explaining it to them is one thing, showing them by demonstrating it yourself is another thing, but showing them a video of an actual patient brings it all together because you've explained it to them, you've demonstrated it to them, and now they've seen it in the video-that tends to be a big hit with the group." With some short courses, Veldman may use patient models; however, since many courses are presented in the evening, that poses a challenge with using a child patient model. "But in our short courses and nonpediatric courses, they're always a big hit." Presenters take questions from the audience. "Some presentations are very interactive, and the questions can even take things in a different direction as long as it stays within the parameters of orthotics and prosthetics," Veldman says. "We try to guide those conversations-we want some of those things to become conversations, but in some courses, we really need to get the information across first, so the discussion period comes later." To engage audiences, speakers have to be dynamic, Klimek points out. "No one can expect to stand up and wow the crowd with just the information alone; they have to have the personality to do that." Although Veldman presents some of the courses, the company has people in each office that can present courses, he notes. "We look at who has the potential, and then we train them." UNION ORTHOTICS & PROSTHETICS Union Orthotics & Prosthetics is a second-generation, family-owned and -operated O&P practice, headquartered in Pittsburgh. The company provides courses approved for physical therapy CEUs on topics that include lower-limb prosthetics, prosthetic fitting criteria, and troubleshooting tips; orthotics interventions for acute or long-term physical rehabilitation; pediatric orthotic considerations and implementations; and cranial remolding orthoses for treatment of deformation plagiocephaly. "We do present courses to pediatricians and other physician groups, but the courses are only approved for CEUs for physical therapists," explains Laura Leimkuehler Mullin, CPO , director of pediatrics. To engage her audience, Mullin says, "I like to give them a scenario and ask them to develop a treatment plan- especially with physical therapists-to come up with an orthosis recommendation. I give them general patient information and then ask them to clarify clinical goals for that patient and what type of orthosis they would recommend to meet those goals. This gets them thinking and problemsolving rather than just reading case studies." Patient models are often used when presenting to physical medicine and rehabilitation students at the hospital as well as in O&P educational classes, she adds. DYNAMICS PROSTHETICS ORTHOTICS Dynamics Prosthetics Orthotics, headquartered in Los Angeles, provides simpler educational in-services that focus on information for nurses, physical therapists, other healthcare professionals, and patients' family members. Instructions are given on how to don, doff, care for, and use the prosthesis or orthosis, manage prosthetic sock use, and similar practical information, explains Sue Sean, CP, CFm , clinical director. Christian "Chris" Meier , a board-eligible prosthetist/orthotist, notes that in-services for nurses have been popular. "We teach the nursing staff how to don and doff braces for the patient, since we only explain this to the patient once when we deliver the brace at the hospital. Since patients are recovering from their illness or injury, they often forget the information, and the nurses then don and doff the braces for them and show them how to do it." Meier recalls, "We once did an inservice at a hospital for a large group of nurses because patients had been complaining that the nurses didn't know how to help them with their braces. So the hospital had every single nurse that worked in that section attend an in-service as part of their continuing education-about 200 nurses in all." Do's and Do Not's Since most of the interviewees have attended in-services and courses given by others, The O&P EDGE asked for their comments on what they observed that helped or hindered the success of the course or in-service. The most important need mentioned by almost everyone was thorough preparation. "Don't wing it," Mullin says. "Be very familiar with the presentation and practice a lot." "I could give you a list about ten miles long, but I would say the first and most important one is: Do not go into a presentation unprepared," Veldman says. "Where things break down is when the speaker can't answer a question or someone in the audience comments on some research that the speaker didn't even know existed." He continues, "If someone challenges them and asks a question they can't answer, then everything they've done up to that point is kind of shot down- likely not be taken as seriously. It's critical to be prepared and become an expert on the topic you're presenting." Veldman also points out the importance of controlling the physical environment in order to provide a good learning ambience. He recalls a time when a course intended for about 30 people ended up with 150. The removable wall in the conference center was opened, and since it was hot, the air conditioning was turned up. A main comment on the feedback forms was "it was too cold in the room." Veldman comments, "I went into this eight-hour course wanting to give them valuable information, and they went away with 'it was too cold in the room.'" Also important in controlling the environment is checking beforehand that all equipment is working well so valuable time is not lost waiting for repairs or tech support, he adds. Sean likewise mentions the importance of being sure in advance that all the equipment is working properly. "One time the presenter's projector broke, so five of us practitioners were gathered around one computer-not a comfortable learning environment." Two more "do not's" Sean mentions are looking steadily at the computer screen rather than the audience and hurrying through a presentation without trying to engage the audience. Sean appreciates it when presenters engage the audience with such questions as, "Have you ever thought about making this kind of design?" She also appreciates it when presenters employ the level of technical language used by most of the audience and create an atmosphere that encourages questions and discussions. "As much as possible, give people the information that they want and don't try to sell anything," Hittenberger says. "If you give them a sales pitch, they'll turn you off. If you give them information that is valuable for them and their patients' outcomes, addressing their particular situation, they'll listen." Educating Other Healthcare Providers About O&P In-services and educational presentations can serve to introduce and reinforce information about the documentation and L-codes the O&P profession uses that rely on coordination with other healthcare providers. Before going into a presentation, Mullin gives a brief overview of the orthotic profession, including education and credentialing. She explains how the L-code system works and that, although the cost of devices may seem high, it includes clinicians' time, evaluation, consultation, and a period of followup and adjustments at no additional cost to the patient. "There are a lot of misunderstandings about what we're doing," she adds. "The way our industry is going, I think we need to try to capture more physician audiences and discuss the types of documentation that are necessary," Sean says. "I've been to Medicare seminars that show that it just isn't required for doctors to get on board yet-one of the biggest obstacles we have to get over." She continues, "They need to understand what documentation is required in the patient visit, so that clinicians providing orthotic and prosthetic services for their patients can obtain authorizations, get reimbursed, and retain payment-and most importantly, so that their patients may receive necessary services without delay." The Benefits of Educational In-services Courses and in-services that educate other healthcare professionals on the patient's rehabilitation care team can lead to better patient care and outcomes. "Multiple disciplines are invariably involved in solving complex patient problems, making knowledge sharing across the disciplines foundational to effective care," points out a research article, "Interdisciplinary Evidence-based Practice: Moving from Silos to Synergy," by Robin P. Newhouse, PhD, RN, and Bonnie Spring, PhD ( Nursing Outlook , November- December 2010, 58 (6):309-17). Courses and in-services also raise the profile of the O&P profession among other healthcare professionals, payers, and the community, demonstrating that the O&P clinician is a valuable member of the rehabilitation team. However, for the O&P practices providing continuing education courses and in-services, the benefits may be hard to determine in terms of increased referrals and business growth. "We decided very early on that we wanted to become the go-to educators for our industry," Veldman says. "Our company has grown nicely, whether that is partly due to our educational courses is hard to quantify." However, Veldman adds, "Through O&P companies, we [the O&P profession] get to help thousands and thousands of people feel better, stand better, walk better, function better, [and] see the world about them better, and we educate people on how we do it. The bottom line for all of us is that we're helping people in ways that very few others can." Miki Fairley is a freelance writer based in southwest Colorado. She can be contacted via e-mail at miki.fairley@gmail.com .

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