The Profession Weighs in: Impacts of O&P Residency Changes

In July 2025, the National Commission on Orthotic and Prosthetic Education (NCOPE) introduced significant changes to O&P residency requirements, marking a pivotal shift for new residency sites and those undergoing reaccreditation. The updated standards, set to be fully implemented for residents completing their programs after November 2027, aim to reshape the landscape of O&P education. We talked with representatives from NCOPE, as well as educators and residency directors, to get their perspectives on the rationale behind these changes, the phased implementation, and the potential impact on the profession. Chris Robinson, MS, MBA, CPO, ATC, FAAOP(D), part-time director of accreditation and technology service, NCOPE, emphasizes the importance of proactive planning for residency sites preparing to meet the new standards. “Getting a residency site accredited under the 2025 standards will require some effort, but planning ahead can save headaches and help ensure a successful application.” The updated standards introduce a structured approach to residency programs, focusing on key elements such as access to diverse patient populations, clearly defined program structures, and qualified mentors. Robinson highlights the significance of minimum activity volumes (MAVs), which ensure residents gain adequate hands-on experience across various O&P interventions. “A well-rounded residency provides residents access to a wide variety of patient populations, orthoses/prostheses, and full episodes of care,” he says. Changes made within the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) contributed to the decision to revamp O&P residency requirements. Jonas Ljung, MSPO, CPO, joined NCOPE in July 2025 as director of clinical and education services. He’s also taken the lead on outreach tied to the new standards. “The primary drivers for change were alignment with the upcoming dual-discipline ABC certification model and combined written simulation and CPM [Clinical Patient Management] exams, adoption of a competency-driven framework that is more similar to other medical professions, and reflection of workforce and educational trends,” Ljung explains. He emphasizes that the standards intend to provide clearer compliance guidance, integrate MAVs to increase uniformity in clinical learning, and allow more flexible training models tailored to individual clinics and mentors. Program Directors Shift Gears For program directors, the integration of MAVs and the shift from device-based training models to a competency-driven framework have proven the most challenging in the transition thus far. To address this, NCOPE revised some of its messaging to emphasize these changes, and to reassure directors and mentors that programs don’t have to change how they educate. “It is more a change in how the residency—and the resident—is addressed,” Ljung says. MAV requirements were derived from the fifth percentile of small- to medium-sized clinics. “That means 95 percent of existing residency sites do not have to make any changes to their day-to-day operations and the residents should meet their MAV requirements.” Directors have also been concerned about restructuring rotations, forming partnerships with other clinics, and whether or not residency sites that only offer a single discipline will continue to exist. However, NCOPE says that maintaining the same number of residency sites that existed under prior standards was a primary goal when revising the standards. To help usher in this modern era, NCOPE is offering resources for students and residency sites at state and national conferences. And the updated online development courses, which are now required for residency directors and mentors under the new standards, cover program preparation, development, and assessment. NCOPE developed webinars and YouTube tutorials, as well as guidance and FAQ documents to further clarify compliance standards and expectations. Ljung notes that students coming in under the 2025 standards have an advantage: They do not need to make the mental shift from prior device-based standards. He believes they’ll also benefit from the fact that the standards will now more closely reflect other medical residency formats. “The main challenge for them under the new standards is that there are more forms they must submit and a more rigorous feedback process,” he says. “Hopefully these all enhance the learning experience.” A Pivotal Moment Erin O’Brien, CPO, FAAOP, residency coordinator, Hanger Clinic, describes the 2025 standards as a pivotal moment for the profession. “When we first reviewed the new residency standards for 2025, we immediately noted the change from device-based competencies to skills-based competencies for residency completion,” she says. “I think this is a huge step forward for our residencies, as it emphasizes the shift in our field to being healthcare professionals, rather than providers of devices.” O’Brien believes focusing on the provision of healthcare services during early O&P career training will go a long way in how O&P professionals see themselves, and eventually how others in allied health view the profession. Jason Wening, MS, CPO/L, FAAOP, works alongside O’Brien as a residency coordinator at Hanger. He echoes her sentiment, emphasizing the potential benefits of the broader scope of the new competency framework. “The new standards shift the competency focus away from a specific device to the range of skills and abilities that we would expect of a board-eligible orthotist/prosthetist,” Wening says. “Biomechanics is biomechanics, anatomy is anatomy, gait is gait—the core principles do not change based on the part of the body being addressed. The only thing that changes is how the principle is applied.” Wening says residents who develop a sound foundation in the core principles of clinical care should be able to translate knowledge and experience from one area of O&P to another. And while MAV requirements establish good benchmarks, Wening says Hanger focuses on ensuring residents see more than the minimum number of cases. “NCOPE’s minimum for transtibial prosthesis exposures is 60 encounters across the observe, assist, and independent categories,” he says. “From reviews of NCOPE Tracker data, we know that 18-month residents at Hanger see an average of 300 transtibial encounters with only 10 percent of those being observational.” To that end, Wening says the tracker data and the revised requirements have helped Hanger identify residency sites where there is room for improvement in MAVs. “By being forced to report specific data to NCOPE, sites have the opportunity to really inspect the data and use it for self-evaluation and improvement,” he adds. Hanger plans to leverage the change to build a data-based approach to understand best practices and to share that knowledge across the organization and the profession. Ahead of the Game Lisa Abernethy, MSPO, CPO/L, associate program director of Clinical Education in the Orthotics and Prosthetics Program, Baylor College of Medicine, says her program has been well prepared for the transition. “We have had a dual-discipline residency program for more than ten years, we have tracked case logs, site and resident evaluations during that time, and we have been doing many of the activities which are now required in the new standards.” At Baylor, the introduction of MAVs has not posed a challenge. “Based upon our analysis of case logs, residents will not have challenges meeting the MAVs,” Abernethy says, “Many of our residency sites can offer a variety of experiences, and we know which sites are more specialized. We will continue to use this information to plan rotations.” Abernethy also highlights the importance of educating preceptors and residents on the new competencies. “We will be working with our group of dedicated preceptors to ensure everyone is able to complete the new mentor training requirements ahead of implementation of the standards,” she says. The updated standards have helped to clarify certain aspects of residency training, such as travel reimbursement for residents who must drive more than two hours to a site. “Advocating for the resident has been more prominent in the revised standards, and I liked seeing those changes,” Abernethy adds. Managing the Transition The transition has not been without challenges for other programs. O’Brien highlighted the complexity of managing a large residency program during the transition period. “Because each site rolls into the new standards at their reaccreditation date, we will have several years of running two parallel sets of standards for our residents,” she says. Wening says that the shift in how mentors evaluate competency has been a significant adjustment. “It is very different to ask a mentor to evaluate whether or not a resident is competent in a domain like alignment across all potential O&P situations,” he says. “More collaboration between site mentors will be required because the mentors will need to agree on competency for the resident.” Despite these challenges, there seems to be positive sentiment overall regarding the long-term benefits of the changes. “With the new standards, we are confident that our residents will be even more prepared for independent clinical practice once they are CPOs,” O’Brien says. Abernethy advises other program directors to carefully review the new standards with their teams and develop a plan of action. “If they don’t see a lot of a particular patient population, they have the option to partner with another site, so they need to think about that and identify those partners,” she says. Since the implementation of the revised standards, NCOPE estimates that approximately three dozen sites have registered under the latest framework. Ljung highlighted the flexibility offered as the transition to new requirements occurs, including variable program lengths, which have helped residency sites adapt. He reiterates the goals of the revisions, saying, “The standards were designed to maintain the number of residency sites while allowing programs to design their curriculum as they wish.” Single-discipline residencies remain permissible during the transition, too, although November 30 will be the last day a resident can begin a single-discipline residency. The most significant changes ahead include the launch of the ABC dual-discipline written simulation and CPM exams in spring 2027, and the November 30, 2027, deadline for all active residency sites to be fully transitioned to the new standards, Ljung says. For Hanger’s part, Wening says the organization is working with NCOPE to accelerate the timeline for transitioning all its sites even sooner than that deadline. Optimism Prevails Looking ahead, Ljung expressed optimism about the impact of the 2025 standards on the profession. He hopes the standards will improve clinical training through an emphasis on measurable competencies rather than device-based metrics. He believes this approach facilitates stronger clinical judgment and adaptability, while also reducing administrative burdens and easing the assessment process through increased objectivity for directors and mentors. “Competency-based training ensures residents can adapt to innovations such as digital workflows or manufacturing techniques like 3D printing, as the training is based on clinical skills rather than tied to a device or fabrication technique,” he says. Ljung also notes that the standards’ structure, with appendices that can be updated, allows them to evolve alongside the healthcare environment. Ultimately, Ljung, O’Brien, Wening, and Abernethy agree the updated standards will strengthen the profession’s credibility and enhance patient outcomes. “The 2025 residency standards support the profession’s continued evolution toward a unified, dual-discipline workforce,” Ljung says. “Long-term, I hope the enhancements to the residency process will foster innovation, interdisciplinary collaboration, and greater resilience for the field of orthotics and prosthetics.” Tara McMeekin is a writer and editor based in Colorado. The changes to the National Commission on Orthotic and Prosthetic Education (NCOPE) residency requirements are set for full implementation by November 30, 2027. These standards aim to modernize education, improve patient care, and create a stronger, more unified profession. Here’s a breakdown of the changes and why they matter: All residents must now complete training in both orthotics and prosthetics; single-discipline residencies and certifications will be phased out. The minimum length for residency programs is 18 months, with some programs extending to 24 months depending on structure and curriculum. Each program must provide at least 37.5 hours per week of O&P-related clinical experience. Residents are required to have no less than 40 percent of total experience in either discipline for more balanced exposure. Comprehensive, competency-based completion While there is a minimum duration, residents must demonstrate achievement of specific professional competencies to complete the program; some may require more time than the minimum. Residents must engage in a full spectrum of care, from patient assessment and treatment planning to follow-up and professional development. Introduction of minimum activity volumes (MAVs) Residents must meet specific benchmarks for the number and types of patient encounters across both orthoses and prostheses. These MAVs ensure robust, diverse, hands-on experience, and help standardize the quality of clinical training at residency sites. Accreditation and oversight All residencies must be completed at a facility with current NCOPE accreditation for combined O&P programs. Resident education is further supported by structured supervision and clearly defined program goals. Mentor and director qualifications, training Mentors and residency directors are required to meet defined education and clinical experience thresholds. All supervisors must complete updated NCOPE training modules to ensure their readiness to support resident learning and assessment under the new standards. Comprehensive documentation and tracking Residents are expected to maintain detailed procedure logs using the NCOPE Tracker system. Quarterly documentation submissions are mandatory in order to facilitate ongoing evaluation of progress and competency. Phased transition, ongoing support New residency sites were mandated to comply as of July 1, 2025. Existing accredited sites will switch over upon reaccreditation, with all programs required to be compliant by November 30, 2027. NCOPE provides resources, including training, templates, and data tools, to support program directors and educators. Why these changes matter The updates are designed to ensure every resident graduates with diverse, practical clinical expertise and professional readiness for the ever-evolving healthcare landscape, NCOPE says. The requirements raise the bar for consistency and patient care, foster greater innovation, and promote long-term satisfaction and credibility across the orthotics and prosthetics profession. For more information, visit the 2025 NCOPE Residency Standards Webinar on NCOPE’s YouTube channel . Opener image: unai/stock.adobe.com

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