There are only four O&P technician programs in the United States accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP). These colleges are in Washington, Illinois, Minnesota, and Kentucky. This article focuses on changes within the O&P technician program and paraprofessional training for the technician program at Spokane Falls Community College (SFCC).
Essential Changes
In my years as a faculty member at SFCC, it has become apparent that there is a genuine need to change the way we teach O&P technicians. The predominant factor driving these changes is that the traditional education format is cost prohibitive from both a student and institutional perspective. Over the past few years, the cost of enrollment and attendance in a two-year program has risen dramatically. Beyond institutional-wide increases in tuition, skyrocketing material costs for laboratory projects, and extrinsic factors such as the lack of housing have become significant hurdles for a student seeking formal training. For example, the cost of resin, foam, and metal uprights has increased by 15 to 75 percent since 2019, resulting in a significant increase in laboratory fees to cover these costs.1 These unfortunate economic realities have contributed to record low enrollment numbers.
“It is challenging just to find someone who wants to work as a technician,” says Amy Watts, CPO, Sanford Health Equip, North Dakota. She notes that the practice prefers to hire someone educated and trained at an O&P technology program or a technician with previous work experience.
“The need is for ‘hybrid technicians,’ meaning someone trained to fabricate using new digital methods and 3D printing but also able to fabricate classic O&P devices,” says Jonathan Naft, CPO, founder, Geauga Rehab Engineering, Ohio.
Desmond Masterton, MS, CO, CPed, retiring O&P technology professor, Joliet Junior College, echoes concerns about higher materials costs and resulting lab fees. He also notes that the decline in enrollment may be partially due to the improving economy. Statistics have shown that when the overall economy is good, the number of students applying to community colleges declines.2
Another major factor driving curriculum changes is the increasing demand for O&P technicians, which has driven employers to hire someone off the street.3 The new employee must subsequently be trained not only in fabrication skills, but also in fundamental knowledge areas such as anatomy, medical terminology, and materials. Rex Miller, CP, Cutting Edge Orthopedics, California, states that finding a qualified O&P technician has been difficult. “To be a qualified tech requires a unique skill set,” he says. “Off-street hires require more experience to train and teach.”
Employers of our graduates require skilled technicians today and many cannot afford to wait two years for an entry-level technician from an accredited education program. As O&P business expenses increase at a rate greater than reimbursement increases, having an adequate supply of knowledgeable and proficient technicians has become more critical. To best support the O&P profession, the faculty at the SFCC O&P technical program have set a primary goal of delivering formally trained individuals to the workplace as efficiently as possible.
When the pandemic occurred, it caused major disruptions across higher education, even to the well-established O&P technical programs, forcing rapid adaptation to the curriculum. Historically, all O&P technician courses were in person, but the pandemic forced educators to learn about alternative educational models, enabling some components of technical education to occur outside of the institution. Many alternative approaches to education worked well, and others simply didn’t work at all; but most importantly, the educators learned what could be possible if the education models were revised and updated. Similar to the changes at SFCC, changes are also being made at Century College and Joliet Junior College.
Proposed Changes
The basis of the SFCC changes was to identify and educate students in the underlying fabrication processes. The emphasis in these curriculum changes is developing the basic knowledge and requisite hand skills and a sense of professionalism through the development of soft skills that enhance student employability. Collaborating with members of the advisory committee, other technical educators, and program alumni, the faculty identified knowledge and skills that are universal to O&P fabrication.
Once the shared knowledge and processes were defined, the list of devices that required fabrication projects as mandated by the CAAHEP standards were reviewed. From this list, the faculty identified and eliminated redundancies and overlaps in the skills demonstrated during fabrication. As a result, the faculty was able to condense the curriculum and shorten it to an accelerated one-year certificate program. Another factor enabling a shortened program was shifting much of the didactic curriculum into online modules, a method typically referred to as flipped classroom, an approach successfully implemented in other professional training programs. We believe our approach to active learning on campus will enable long-term student success in a timeframe that addresses industry demands. In this way, lab time is focused on the development of applied knowledge and demonstrating fabrication competencies. With these planned changes, the SFCC O&P Technology Program will be operating as a hybrid program beginning in 2025.
In the accelerated one-year program, students will begin as a cohort in the fall quarter. During this term, we focus on foundational content areas including lab safety, O&P terminology, plaster work, plastic identification and processing, metal processing, finishing work, sewing, material technology, componentry, basic alignment and understanding of the gait cycle, functional anatomy, the roles and scope of practice of O&P professionals, and professional behavior development. We also present basic device fabrication. The focus in this introductory term is on foundational knowledge and fabrication skills in both orthotics and prosthetics. While there has traditionally been a divide between these two disciplines, we aim to highlight the overlapping skills in the curriculum with specifics in each discipline provided later in the year.
Once students have completed the introductory coursework, they will move into one of the discipline-specific quarters of instruction. These courses focus on the biomechanical principles of orthotics or prosthetics, lower-limb orthotic or prosthetic technologies, and upper-limb technologies in either discipline. Fabrication skills continue to be refined, anatomy and biomechanics are explored in a discipline-specific manner, and advanced concepts are introduced. Digital workflow competencies have also been added to the curriculum. In the following quarter, students switch disciplines.
Following three quarters of instruction, students will complete two six-credit technical internships with each lasting 198 hours. Since students need a full course load to receive financial aid, the amount of time required for each practicum was increased to meet these requirements. It has been very difficult for students to afford to travel outside the Spokane area without access to financial aid. This expanded format also allows a student to be exposed to a broader array of fabrication experiences, if desired. Technical internship experiences can be paid or unpaid, depending on what the student negotiates with the host site.
At the conclusion of the one-year program, students will be awarded a certificate recognizing formal training in both orthotics and prosthetics. Pending CAAHEP approval, graduates of the accelerated one-year certificate program will be prepared to deliver immediate value to employers and be eligible to sit for the ABC technician exams. The fundamental curriculum content and relevant competencies remain the same, but projects including rarely fabricated devices that demanded excessive time for techniques not beneficial to the entry-level O&P technician were removed. These changes result in fewer repetitions, but the faculty believe shifting the focus to relevant knowledge and skills delivered using modern teaching approaches is necessary to address the challenges outlined above.
According to Chris Robinson, MS, MBA, CPO, ATC, FAAOP, clinical resource director, NCOPE, “The O&P technical standards are actively being revised, and the stakeholders/workgroup members who have offered input made it clear that the educational requirements must truly meet the needs of employers, ensuring that new graduates bring value to contemporary clinic or fabrication settings. While I still see occasional patients that request an exoskeletal lower-limb prosthesis or a conventional HKAFO, the ABC Practice Analysis studies showed that endoskeletal transtibial or transfemoral prostheses and thermoplastic orthoses are the most commonly provided interventions by a large margin. The new standards must consider real-world data to ensure foundational knowledge and skills essential to technical practice continue to be emphasized, while recognizing traditional techniques rarely performed might best be taught on a conceptual basis alone….”
The Future
These changes are just the beginning of the reimagining of the O&P technician and paraprofessional training at SFCC.
The new program was built to include the possibility of remote training for technicians who live and work outside of Spokane, allowing a person to participate in the program without having to relocate. While this model will likely include brief trips to Spokane for skills testing, the college is exploring several remote options for testing. This option may help solve employability challenges in high cost of living areas where students have had difficulties relocating. If employers can recruit from local populations, while allowing SFCC to provide education and training, dramatic changes in the workforce are possible. “While some technician positions in the Midwest have recently been filled, one position in Phoenix for a technician has been open since January,” says Alicia Smith, PHR, human resources manager, Boston O&P, headquartered in Massachusetts.
An ongoing goal is to have the SFCC program offer an Associate of Applied Science (AAS) degree once again. To do so, we are working on augmenting additional coursework that leads to other certificates, for example, orthotic fitter or pedorthist. There is also much interest at the local, state, and national levels about the concept of microcredentialing or stackable certificates, a model that may work well for this level of training and education. These changes will be provided in the form of abbreviated training sessions (one quarter each in length). These sessions will result in specialty certifications that may be taken as either an individual or when an employer deems them necessary. Students will be awarded college credits and after completing a specific number of certificates awarded an AAS degree.
SFCC recently launched several new Bachelor of Applied Science (BAS) degrees. The Allied Health Department is exploring the development of a general allied health BAS degree. This degree will be designed to satisfy the prerequisites for a graduate degree in different allied health professions, including physical therapy, occupational therapy, audiology, and O&P. While not every technician is interested in a career providing clinical care, some students do have that goal in mind. We believe a foundation in O&P fabrication, combined with a strong undergraduate education and experience in the industry, will provide an extremely well-prepared practitioner student.
Conclusion
As the current program director for the Orthotic and Prosthetic Technology Program at SFCC, I have never been so excited about the possibilities that lie ahead. On a national level, our colleagues in O&P technical education are also innovating and implementing program changes, including condensed curriculums and fabrication techniques leading to an accelerated certificate. We are collaborating in many ways to improve our offerings collectively. NCOPE has been supportive of revision to the CAAHEP standards by hosting in-person standards development activities to bring together representatives from each O&P technical program along with members of the profession at large.
Ambrose Cavegn, BOCP, CPA, CTPO, is the program director for the Orthotic and Prosthetic Technology Program at SFCC. He can be contacted at [email protected].
REFERENCES
- Data collected from SFCC O&P financial statements 2019-2024.
- Community College Enrollment Down Bryan Mena CNN 01.07.24 Why Has Community College Enrollment Declined Davis Jenkins Community College Research Center 05.01.2023.
- Dobson and Davanzo report: https://ncope.org/wp-content/uploads/2024/05/projecting-the-adequacy-of-workforce-supply-to-meet-patient-demand.pdf 2015.
