O&P Education Reaching Master's Level and Beyond

Despite upheavals, turmoil, and changes in the U.S. and international healthcare arenas, O&P education is revved up and moving ahead. All of the current O&P practitioner programs accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) in cooperation with the National Commission on Orthotic and Prosthetic Education (NCOPE) are moving toward the NCOPE-mandated entry-level master's degree in prosthetics and orthotics by 2010 (2012 for existing accredited programs), according to NCOPE Executive Director Robin Seabrook. NCOPE notes that this enhanced educational pathway to entering the O&P profession will apply only to new O&P students and will "not impact an individual's certification or his or her ability to practice once he or she is certified.... The goal is that all new students entering an [O&P] education program by 2012 will be working on a professional master's degree." Burdett English Hovorka Lin Michael Oros Phillips Rhodes While the change will not impact currently certified practitioners and will be fairly transparent to current and future O&P students, it will impact those academic institutions that currently offer CAAHEP/NCOPE certificate and bachelor degree programs in O&P. The change also has wider implications for the O&P profession. Given the scope of this article, it is not possible to cover every possible impact; however, what follows are some of the more immediate implications, as well as a discussion of how current master's programs have evolved to meet the needs of the profession. Why an Entry-Level Master's? "Is it just degree elevation for the sake of degree elevation, or 'keeping up with the Joneses', [as in] 'the physical therapists are moving toward a DPT'?" asks Bob Lin, CPO, FAAOP, program director of the Newington Certificate Program, Newington, Connecticut. "The body of knowledge, skill sets, and core competencies encompassed by orthotics and prosthetics is so vast, diverse, and comprehensive now that a master's degree is the only way to package it," he explains. "You can't package it in a baccalaureate or certificate program." Leading educators, clinicians, heads of national organizations and certifying bodies, and other stakeholders have expressed their reasons for wanting the profession to embrace a master's degree. A landmark conference in 2005, "O&P Education Summit: Forecasting the Future," brought together national organizations as well as about 30 O&P leaders and experts in education, clinical practice, and certification to discuss the subject. A follow-up strategic planning meeting in 2006 aimed to "categorize and harness the O&P environment for effective transition to the entry-level master's degree," according to the meeting report. "The conclusions from the strategic planning meeting should provide NCOPE with an overall blueprint that establishes an appropriate and informative pathway toward an entry-level master's program." (Editor's note: To view the complete summit report, visit www.ncope.org/assets/pdfs/edsummit_final_report.pdf ; for the strategic planning meeting report, visit www.ncope.org/assets/pdfs/finalreport706.pdf 2006). Lin, who attended the conference, says that the participants considered what is needed for today's orthotist/prosthetist, and the panoramic picture comprises far more than simply keeping up with knowledge and clinical application of advanced technology. The practitioner of today-and tomorrow-must understand and manage complex diabetic, pediatric, sports-related, and other disorders; understand and apply new research for better clinical practice; and better understand the roles of other medical specialties in treating the whole patient. Lin also points out the need to develop evidence-based practice so that practitioners can tell third-party payers, "You need to pay for this because it works-we've done the research." However, the biggest beneficiary of the changes associated with the movement to an entry-level O&P master's curriculum is expected to be the O&P patient/client, according to Michael Oros, CPO, chairman of the NCOPE Board of Directors. "The body of knowledge has continued to expand, and as such we could see an expansion in our scope of practice resulting from the movement to the entry-level master's," Oros says. "I think...we will attract not only more but also higher caliber students into our profession. We've also seen an increase in the number of schools that are interested in starting an O&P program as a result of the [transition to an] entry-level master's requirement." Noted O&P consultant John Michael, MEd, CPO, FAAOP, FISPO, believes the heightened education requirement would create entry-level graduates who have the skills and knowledge to face tomorrow's challenges, facilitate wider participation in clinical research and in the application of valid research into daily practice, further distinguish graduates from NCOPE-accredited programs as practitioners who understand the "Why?" and "When?" of care in addition to the "How?" of care, and further professionalize the perception of the field from "technician-vendors" to "clinician-providers." Objections to the Entry-Level Master's As is true with almost any change, there are those who object to the entry-level master's requirement. Some employers may believe that new master's-level graduates will "not know anything, will demand more money, and all this will just drive costs up," Lin says. "Some feel that a higher degree requirement will just cause a bottleneck and have a negative impact on manpower." Could this be "déja vu all over again," in the immortal words of Yogi Berra? Says Lin, "These were the same exact arguments that were made when we had discussions about the mandatory bachelor's degree. Some who favored staying at the associate level said, 'You're going to raise salary demands and choke off the manpower....' None of that came to fruition." Challenges: Where Are the Instructors? One of the biggest challenges to the entry-level master's requirement is finding instructors with the academic and professional qualifications required to teach at the master's level, Lin notes, but adds that NCOPE and the programs are working to meet this challenge, with faculty on track for a master's or doctoral pathway. According to NCOPE, almost all of the directors of accredited programs have a master's degree or higher, in addition to their certification status. The NCOPE website states, "There will be an impact on our current O&P faculty as the need to attain a master's degree or higher is typically university required." NCOPE is working on a transition plan to ensure that all current faculty members who teach in accredited O&P programs have adequate time to bring their education in line with their university's requirements and NCOPE standards. (Editor's note: For more information about the professional master's degree requirement and its impact, visit www.ncope.org/assets/pdfs/final_qna_on_masters_for_web.pdf ) The Transition Plan The current accredited bachelor's and certificate programs will cease to exist by 2012 (the last baccalaureate and certificate students would finish their course work in 2013). This creates a space between a two-year associate degree, currently provided by NCOPE/CAAHEP-accredited technician programs, and the master's level, comments Sam Phillips, PhD, CP, FAAOP, dean of the J.E. Hanger College of Orthotics and Prosthetics, St. Petersburg College, Florida. "It's possible in the future that something will come in to fill that space-there's been some discussion about revisiting the concept of an orthotic/prosthetic assistant. But that's probably a few years down the road." "We're the newest of the bachelor's-level programs," Phillips says. "We are just completing our bachelor's-level accreditation with NCOPE, and so now we are transitioning between the initial development of the program and working toward developing a new master's program. "I think this move to a master's requirement in O&P is good for the profession," Phillips continues. "When other health professions, such as physical therapy and physician assistant, went to a master's level, this strengthened their organizations and their profession." The newest master's program will be offered by the University of Pittsburgh, Pennsylvania, within its School of Health and Rehabilitation Sciences. The program has already been approved by the university and is currently seeking NCOPE/CAAHEP accreditation, according to Ray Burdett, PhD, PT, CO, CPed, director of the Master of Science Program in Prosthetics and Orthotics (MSPO). The program is slated to begin in the fall of 2009 with about 16-20 students. Learning from the Pioneers Georgia Tech MSPO students at work in the fabrication lab. These new and transitioning O&P programs will have the good fortune of benefitting from the experience of established O&P master's degree programs. For example, scheduling changes to core courses and electives to avoid time conflicts has been a necessary tweak for the master's program at the Georgia Institute of Technology (Georgia Tech), Atlanta, which began in 2002, and the master's program at Eastern Michigan University (EMU), Ypsilanti, which started in 2003. "We're continually making tweaks and adjustments," says Robert Rhodes, MPA, CO, FAAOP, director, Orthotics and Prosthetics Programs at EMU. "For instance, we've changed course sequencing to make more academic sense and have adjusted scheduling for core and elective courses to allow students more flexibility." Sometimes adjustments have also been required in instructors' areas of expertise. Georgia Tech's MSPO program, for example, added a course in clinical methods to develop the student's knowledge and skills in patient interaction and rapport building, patient-interviewing skills, and physical examination and assessment skills and techniques. The course was originally taught by an orthotist. "However, we felt that the skill set of an instructor who is a physical therapist and a physician would deliver the course content and skills training to our students more effectively," says Christopher Hovorka, MS, CPO, FAAOP, MSPO program director. "Therefore, we upgraded the course several years ago by adding two instructors; one is a physical therapist, and the other is an internal medicine physician." Georgia Tech also enhanced its clinical practicum. The practicum, which is an off-campus supervised clinical experience in which students attend clinics in a supervised setting under the guidance of a board-certified physician, therapist, orthotist, prosthetist, or pedorthist, is ongoing throughout the student's tenure in the MSPO program. Initially, the focus is more on medicine and physical therapy, with MSPO students attending clinics in podiatry, vascular surgery, physical medicine and rehabilitation, and physical therapy. Hovorka explains, "This provides students a better understanding of how their future referral sources to O&P think, act, and are trained, as well as how these professionals go about assessing and treating patients. This tends to open up the way in which students think, beyond the traditional ways of thinking in O&P." Later, the focus shifts toward orthotics, prosthetics, and pedorthics. Another course, Clinical Pathology, provides O&P students essential knowledge and background on various diseases and disease processes from a physiological perspective and by using evidence-based treatment algorithms. Instructors from various disciplines, including physical medicine and rehabilitation, orthopedics, dermatology, vascular medicine, endocrinology, counseling and psychology, physiology, radiology/diagnostic imaging, and podiatry, teach students how professionals in those disciplines assess a patient's problems and how they formulate treatment plans. Students thus begin to learn how other medical and allied health professions use a body of knowledge to formulate a treatment plan and learn how to make an educated guess as to what the anticipated outcome may be, based upon a body of evidence. Hovorka points out, "Since we don't have this process well [integrated] in O&P, we decided that students needed to get this...template to healthcare via other, more established professions and then adapt it to O&P." In another adjustment, Georgia Tech streamlined and enhanced the content of its research seminar courses. Under the guidance of a faculty member in the School of Applied Physiology or another unit on campus, students are required to undergo a research experience culminating in an investigation. Students engage in assessing the body of knowledge, formulating a preliminary question, and then tackling the research question by developing methods and an experiment. "Students usually have not had any prior knowledge or experience in the research method, so all of this has to be taught in some regard," explains Hovorka. "For the research experience to be successful, we have learned...that faculty-directed and applied research with a dose of student input is more successful than having the student formulate the research and procedures independently-and thus flounder without direction. Also, we learned that simply telling the students what research to do may not create as much interest or student buy-in. So we chose to have students undergo faculty-directed research, along with discussion with their research mentor in which the students could play a role in deciding the area of research." Hovorka continues, "We are not aiming to create independent research investigators in the MSPO program, but rather clinicians who are aware of the importance of developing a body of knowledge by which the profession can continue to define itself. [We want] these students to understand and have experience in formulating discrete, feasible, and measurable research questions. By doing so, the student can perhaps become an influence in helping to expand the body of knowledge of the O&P profession." First O&P-Focused PhD Program in the United States Georgia Tech has also pioneered the United States' first PhD program with a focus on O&P, which began in the fall 2008 semester. The PhD in applied physiology with a focus on prosthetics and orthotics will prepare students to become leading-edge academicians, teachers, and research investigators in general rehabilitation medicine, and specifically in orthotics and prosthetics, according to a university news release. The program accepts three new students per year and has developed collaborations with Georgia Tech's College of Engineering and the School of Medicine at Emory University, Atlanta. Students and faculty in the PhD program will collaborate in research projects and educational experiences with the faculty and students in the MSPO program. The PhD program will help bridge a gap between academic research and clinical practice. Generally, research studies have been led, up until now, by principal investigators from outside the O&P profession, so the development of a research cadre within the profession would enhance clinical relevance and practice. Geza Kogler, PhD, CO, LO, has recently joined Georgia Tech's MSPO program faculty and is involved with the new PhD program. According to program director Robert Gregor, PhD, Kogler is a forerunner among educators who combine the research and academic skills of a PhD with the clinical expertise and experience of a certified practitioner. "To develop questions and solutions relevant to O&P, we need people who have 'been there, done that'-we need to be in close communication with professionals," Gregor says. The PhD program aims to train more researchers and academicians who combine this type of expertise with clinical knowledge and experience. The University of Washington's PhD in Rehabilitation Science is an interdisciplinary program that includes students who are prosthetists and/or orthotists. Currently, two such students are enrolled in the program and are involved in a broad range of course work, from statistics and research methods to foundations of rehabilitation science, according to Jean Dietz, PhD, OTR, FAOTA, professor emeritus, Department of Rehabilitation Medicine. Both students are participating in interdisciplinary research teams, with the ultimate goal of preparing them for leading state-of-the-art research efforts in their fields. In addition, both students are or will be involved in course work to support their development as teachers and in teaching within the Prosthetics-Orthotics Program at the University of Washington. According to Ann Yamane, CO, LO, senior lecturer and director, Division of Prosthetics-Orthotics, students in the P&O program have opportunities to attend presentations by the PhD students, and "the faculty for the PhD program teach courses and provide guest lectures in the physical therapy, occupational therapy, and prosthetic and orthotic educational programs." A Promising Future, but Questions Remain Georgia Tech MSPO students work on refining their skills. All the programs incorporate individual strengths, as well as fulfill the requirements of NCOPE and their own university for a professional master's program. They will be drawing students from diverse backgrounds, such as engineering, physical therapy, and other health sciences. As Phillips notes, "There's a lot of different backgrounds that do well in O&P. Coming from a good, solid starting point leads to a strong student." The entry-level master's degree is expected to increase the profession's body of knowledge, elevate the quality of clinical practice, provide evidence-based practice for better patient outcomes and research-based justification for reimbursement, and attract more students from other fields to consider a career in O&P. But are there other, even farther reaching impacts? Will the transition impact certification by the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) and the Board of Certification/Accreditation International (BOC) as well residency requirements? Will the change affect the O&P profession's standing relative to O&P licensure, national and state legislation and lobbying efforts, and the Centers for Medicare & Medicaid Services (CMS) regulations and reimbursement? Will it affect third-party payers? Time will tell. Miki Fairley is a contributing editor for The O&P EDGE and a freelance writer based in southwest Colorado. She can be contacted via e-mail at linkEmail('miki.fairley','gmail.com'); O&P Master-Degree Program Highlights Dynamic changes are under way as O&P programs ramp up their new entry-level master-degree programs. Here are a few highlights. Century College , White Bear Lake, Minnesota, will continue its emphasis on sequential, affordable "career-ladder" education, according to Ed Haddon, MEd, CO, director of orthotic and prosthetic education. "Our students can enter the orthotic, prosthetic, and pedorthic profession at the level of competence that they choose, with an option to elevate their education and credentials to the next level of competency in the future." After 2012, in addition to technician programs, Century College is planning to offer a fitters program and a pedorthic- management program. "Our plan is to have all technician, fitter, and pedorthic credits be applied to a bachelor's degree in health and human services awarded through Metropolitan State University, [St. Paul, Minnesota]," says Haddon. "This bachelor's degree will offer appropriate courses that will prepare students to enter the O&P master's degree program at Metropolitan State University ." The master-degree program at California State University Dominguez Hills (CSUDH) , Aliso Viejo, is getting under way, according to Director Scott Hornbeak, MBA, CPO. More information will be available at a later date. The master-degree program at Eastern Michigan University , Ypsilanti, is offers evening and weekend courses, thus allowing students to pursue a master's degree while working part-time-an important consideration for students with families. The program offers two tracks, notes Director Robert Rhodes, MPA, CO, FAAOP: A clinical track in which students do an independent study for their terminal project, and a research track, in which students write a thesis as their terminal project. The Newington Program , Connecticut, is changing affiliation from the University of Connecticut to the University of Hartford, a fully accredited private school. There will be two ways that students can enter the program, according to Program Director Bob Lin, CPO, FAAOP. One will be the traditional master's pathway, with a bachelor's degree followed by application to the two-year master's program. The other is the "Three-Plus-Two" program, in which students can start taking required course work their sophomore year and finish with a master's degree in five years. In their last semester, students can choose a focus area, such as clinical, research, or education, and take specialized courses in their chosen area. Northwestern University's Prosthetic-Orthotic Center (NUPOC) , Chicago, Illinois, will offer two pathways, according to Mike Brncick, MEd, CPO, administrative director. Students can opt for a clinical route with the professional master's pathway, or an academic thesis-based master's degree, linked with Northwestern's Prosthetic Research Laboratory (NUPRL) Research Department, in which students would develop master's-level research skills. The program at St. Petersburg College , Florida, will be strongly clinically oriented, according to Sam Phillips, PhD, CP, FAAOP, dean of the J.E. Hanger College of Orthotics and Prosthetics. The Florida Association of Orthotists and Prosthetists (FAAOP) and the Florida Chapter of the American Academy of Orthotists and Prosthetists (the Academy) helped to develop the program, Phillips notes, and the school is committed to educating students to meet the state's need for highly qualified practitioners. Students in the University of Pittsburgh , Pennsylvania, master's-degree program will receive a well-rounded education in the clinical practice and science of O&P, as well as healthcare and rehabilitation in general, including ethics, evidence-based practice, and psychosocial issues of disability, according to Program Director Ray Burdett, PhD, PT, CO, CPed. Master-degree students in the Prosthetics-Orthotics Program at the University of Texas Southwestern (UT Southwestern) Medical Center , Dallas, will receive an education with an emphasis on the "campus-wide convergence curriculum," says Susan Kapp, MEd, CPO, LPO. "Health-professions students will be knowledgeable about clinical and basic research applications to healthcare. This includes inter-professional training and effective integration of this knowledge into healthcare delivery. The convergence program is shared between the UT Southwestern Medical School, the Graduate School of Biomedical Sciences, and the School of Health Professions." The State of Texas has approved the degree, and the school will take its last baccalaureate class in May 2009, Kapp noted. - Miki Fairley For additional information on the entry-level master's degree, visit www.ncope.org/reports+studies/

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