O&P Ascends Professional Summit

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By Miki Fairley

"The O&P profession has the opportunity to control its own destiny and set the course for the next decade and beyond. Decisive action is necessary, not just to keep pace with other allied health professionals, but to be proactive in our own behalf. Moreover, O&P must mix vision with a more imperative sense of the need for decisive, rapid action."-William Barringer, MS, CO, FAAOP

Barringer's statement is included in the landmark O&P Education Summit held in New Orleans, Louisiana, in April 2005. The conference, which brought together more than 30 education content experts representing different orthotic and prosthetic communities of interest, convened to examine the issue of entry-level degree requirements and educational philosophy.

The conference was a collaborative effort between the National Commission on Orthotic and Prosthetic Education (NCOPE) and the American Academy of Orthotists and Prosthetists (the Academy), underwritten by a grant to the Academy from the US Department of Education and by NCOPE.

The main consensus point to emerge was the recommendation to move O&P education toward an entry-level masters degree. "This was deemed necessary for the delivery of quality patient care due to the dynamic base of knowledge and rapidly emerging processes and technologies in the O&P field," noted an NCOPE report on a follow-up strategic planning meeting held February 11, 2006, in Scottsdale, Arizona.

Timeline

A proposed timeline was developed at the planning session in February:

  • 2006-Curriculum guide for bachelors degree programs finalized;
  • 2007-Masters degree curriculum guides/standards developed and a proposed first draft available;
  • 2008-The draft presented to the profession and standards/guidelines finalized;
  • 2009-Feedback considered and adjustments/modifications made as necessary;
  • 2010-Entry-level masters degree requirement implemented..

Other drivers for the recommendation included consumer expectations, demands for accountability, marketplace forces, and the direction of other allied health professions.

Additional meetings to address the "nuts and bolts" of implementing the transition are planned.

O&P has not been alone in seeking professional advancement through education and higher standards of entry into the profession. "The history of medical practice is a saga of increasing professionalism and greater levels of education for practitioners," observed the 2005 Educational Summit report, noting that the Flexner Report in 1910 [Medical Education in the United States and Canada by A. Flexner, published by the Carnegie Foundation for the Advancement of Teaching] "set the stage for a century of enhancements in medical education." This trend continued in the 1990s, as physical therapists and physician assistants built the reputation and standing of their professions through advancing educational levels.

Challenges to Meet

Both the 2005 Education Summit and the 2006 Strategic Planning Meeting address a complex plethora of challenges and issues. To read the complete reports of both conferences, visit NCOPE's website: www.ncope.org

A big challenge confronting masters and doctorate-level programs is recruiting qualified faculty. Logically, teaching students who are masters degree candidates would require instructors with at least a masters degree if not higher. At this point, since the masters-level O&P education programs are so new, there are very few persons with a masters degree in O&P, although of course, there are a greater number of persons who possess higher degrees in areas that relate to O&P, providing a possible source for instructors.

What to do?

The current and emerging masters degree programs are finding solutions. The O&P EDGE talked with Chris Hovorka, MS, CPO, director of the Master of Science program in Prosthetics and Orthotics (MSPO) at the Georgia Institute of Technology, Atlanta, and Bob Lin, CPO, FAAOP, program director of the Newington Certificate Program, Newington, Connecticut. Georgia Tech has the pioneering masters degree O&P program, and Newington hopes to have a masters degree program by 2008, according to Lin.

"O&P has good education programs to train clinicians, but we don't have a network of programs to train the trainers,'" Hovorka observed. "So many of the faculty in O&P education are teaching students how they learned to treat and manage patients based upon years of experience and often trial and error-techniques adopted and rejected until they found what worked for them. There is a paucity of evidence as to how instructors are training students to evaluate patients and develop a treatment plan." However, this relates to the push for evidence-based practice, one of the drivers for institutions to develop a body of knowledge to substantiate what is being taught and practiced, Hovorka added.

Meeting State, University Requirements

When a new baccalaureate or masters degree program is developed, the standards and requirements of the university and the state enter in-a factor which is not involved in development of post-graduate certificate programs, Lin pointed out. "Certain specific university policies and procedures come into play when the university confers a degree. We also have an additional challenge, since we're a state university [University of Connecticut], so the State Department of Higher Education becomes involved with the curriculum. Every change we make in the curriculum must be submitted to the Department of Higher Education Academic Credentials Committee." Plus, of course, all O&P programs accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) in cooperation with NCOPE must also meet the requirements of these organizations. Thus there is a plethora of various requirements to be considered and met when planning a curriculum and developing a program, not to mention obtaining needed funding.

Finding Qualified Instructors

Noting that there are very few persons currently with a masters degree in O&P, since the program is so new, Lin said that instructors in Newington's proposed masters program could have "a bachelors degree and a good track record as an O&P instructor." These instructors would then "piggyback" with professors involved in the program who have a masters or PhD degree in a related subject, such as biomechanics or other health sciences.

As the programs continue and new ones emerge, a cadre of masters- and doctorate-level instructors would become available in time, alleviating the shortage.

Tweaking the Curriculum

Georgia Tech's MSPO program has fine-tuned its curriculum as it receives feedback from graduates and current students, as well through other evaluation measures. "The curriculum we had when we started is not the same curriculum as we are teaching today; it has evolved," explained Hovorka. Feedback includes detailed questionnaires sent to graduates during their residencies. "We ask such questions as, Now that you have been into your residency for awhile, what do you feel are the strengths and weaknesses of the MSPO program? Did Georgia Tech prepare you well? What do we need to do better to prepare you for the profession?'"

The faculty discusses target areas to better meet students' needs, as well as the program's strengths. The program also conducts internal evaluations at the middle of a semester and at the end of the term. "We have measurement scales, feedback, and evaluations in place in both a short cycle and a longer cycle," Hovorka said. A strength he feels the program has is that no courses are taught during the summer. Students engage in clinical work or research, which allows the faculty to have sufficient lead time to evaluate and modify the curriculum if needed, plus having time to work on their own research.

When the curriculum was first planned, the faculty developed what it considered to be the skill set and knowledge base needed by orthotists/prosthetists, then presented this to the profession. "Some people agreed with it; others challenged it," Hovorka said. This too helped in developing a program that would meet the needs of the profession.

Other Programs Developing

Besides current programs, Eastern Michigan University, Ypsilanti, offers a masters degree program and a graduate certificate program which are in the process of earning CAAHEP/NCOPE accreditation. The masters program was approved by the university's Board of Regents last year. "We currently have about 20 students in the programs and plan to admit a new class in January 2007," said Robert L. Rhodes, MPA, CO, director, Orthotics and Prosthetics Programs. "We also have a recommendation to the regents to change the program to allow completion of the degree in either a research track or in a clinical track," he continued. "We anticipate approval of this to be very soon."

Northwestern University, Chicago, Illinois, is working toward offering a masters degree, according to Mike Brncick, MEd, CPO, administrative director. "We are [currently] scheduled to approach the graduate school in April of 2008."

Good news for persons wanting to advance their education is the pioneering PhD in Applied Physiology program at Georgia Tech. This program began in the fall of 2005 and matriculated its second class of students in August 2006.

Also, pending approval by the Board of Regents, the University of Washington will offer a PhD in Rehabilitation Science, according to according to Jean Deitz, PhD, OTR, FAOTA, professor and graduate program coordinator, Department of Rehabilitation Medicine.

The State of Washington Higher Education Coordinating Board (HECB) voted unanimously in July to recommend adoption of the program. The proposed program is described online at the University of Washington website. The site defines rehabilitation science as "an interdisciplinary field that focuses on human function and disability. Basic and applied research from health sciences, social sciences, engineering, and related field are directed toward (1) enhancing physical and psychosocial functioning, participation in life situations, and quality of life of people with disabilities; and (2) informing relevant social and healthcare policy." The program will target students from diverse background in rehabilitation-related fields including occupational therapy, physical therapy, speech and language pathology, rehabilitation counseling, medicine, nursing, prosthetics and orthotics, and engineering.

"We expect that graduates of the PhD Program in Rehabilitation Science will be prepared as researchers, educators, and leaders in the field of rehabilitation science, who will work in academic institutions, service delivery systems (e.g., hospitals, public schools), government agencies, and the private sector," the site stated. "These individuals will be prepared to address research, education, service delivery, and policy challenges requiring an interdisciplinary perspective."

With current and developing programs to raise the level of the O&P clinician and researcher, as well as providing needed training and education for technicians, fitters, and others who play an invaluable role in O&P, the future is looking bright for the profession, despite the plethora of current challenges.