Orthotics/Prosthetics Education -- A Guide to This Issue

More formal education programs in orthotics and prosthetics exist in the United States now than at any time in history. Many new programs are being initiated, and established programs continue to change their curricula and priorities to meet the needs of today's society. Prospective students are often confused about which programs offer what. We hope that this issue of IPO will help make decisions easier for the prospective O&P student.

The success of prosthetic and orthotic educational programs depends on how well they provide students with the insight and understanding required of practitioners and technicians today. The successful program should enable the student to meet the responsibilities of the profession. These responsibilities are reflected in the high standards of patient care required by the American Board for Certification in Orthotics and Prosthetics. Although the programs continue to progress, they have not lost sight of the basic responsibilities of the professional practitioner and technician:

To provide prosthetic-orthotic service to the disabled population, including the application of necessary intellectual and manual skills (design, measure, cast, fit, and align) required to supply care of the highest quality.
To serve as an equal member of the prosthetic-orthotic facility or clinic, provide consultative advice, participate in discussions, and share in decisions regarding prescription, evaluation, and formulation of the prosthetic-orthotic treatment program.
To contribute to the progress and growth of the profession through research and development activities, contributing knowledge to the profession, exercising leadership, and recruiting and training new entrants into the field.

In order to meet these responsibilities, students should be trained in the following six areas of skill and knowledge: (a) physical sciences and mathematics, (b) biological sciences, (c) psychological sciences, (d) mechanical skills, and (f) personal and cultural qualifications. Each of these areas composes a major portion of the formal education of the student of prosthetics and orthotics.

Practitioner Education

Practitioner programs prepare the student for patient management responsibilities and for the American Board for Certification (ABC) Practitioner Certification Examination.

Practitioner programs usually result in a baccalaureate degree or have that degree as a prerequisite. More stress is placed on patient management, science, and communications than in technician courses, although technical skills are also taught in practitioner courses. Practitioner education programs must be approved by the Educational Accreditation Commission of Orthotics and Prosthetics (EAC).

The prospective student should also be aware that the formal and entrance requirements for the practitioner programs vary widely from school to school. Some schools require the student to learn both orthotics and prosthetics, while other schools offer the option of learning either orthotics or prosthetics. One school may require a baccalaureate degree as a prerequisite, while another admits students at the junior level and awards a baccalaureate degree after two years of specialized education. Degree awarding programs teach orthotics and prosthetics as major courses taken with other electives. Certificate courses generally concentrate only on orthotics and prosthetics education.

Practitioner Certification

The American Board for Certification in Orthotics and Prosthetics, Incorporated (ABC) was established in 1948 to set standards in the field of orthotics and prosthetics. To become a certified orthotist (C.O.), certified prosthetist (C.P.), or certified prosthetist-Orthotist (C.P.O.), a student must successfully complete the ABC Practitioner Certification Examination in one or both disciplines.

ABC is approved by the National Commission for Certifying Agencies (NCCA). This approval testifies that ABC's credentialing effort is valid, that the testing procedures are fair and equitable, and that ABC offers various routes to achieve certification.

There are two basic routes an individual can follow to become eligible to sit for the American Board for Certification in Orthotics and Prosthetics (ABC) certification examination. They are as follows:

The candidate must (1) possess a Bachelor of Science degree in orthotics and prosthetics from a program accredited by the EAC (these programs can be found under the list of colleges and universities), and (2) have acquired a minimum of one year of acceptable experience after completion of the degree. This experience must be obtained under an ABC certified practitioner in the discipline (i.e., orthotics or prosthetics) for which the candidate is applying, or
The candidates must (1) possess a bachelors degree in any field, (2) have successfully completed an EAC accredited certificate educational program in orthotics and/or prosthetics (these programs can be found under the list of colleges and universities) and (3) have acquired a minimum of one year acceptable experience after successful completion of the certificate program. As stated previously, this experience must be obtained under an ABC certified practitioner in the discipline for which the candidate is applying. The above stated requirements can often be hard to understand. A flow chart on page 190 may help to better explain the methods of certification.

Individuals who do not meet the requirements explained above may be eligible to apply for the Practitioner Certification Program under the Unique Combination of Qualifications Clause. To apply under this clause, the applicant must possess qualifications which demonstrate a unique combination of education, clinical experience, and professional training. The education and experience must be at least equivalent to the qualifications defined in A and B above. Additional information about this clause may be obtained from the address below.

If you are interested in pursuing the profession of orthotics and/or prosthetics, don't hesitate to contact the credentialing coordinator at the ABC National Headquarters:

717 Pendleton Street
Washington, DC 20005
(703) 836-7114

Technician Training Programs

These programs prepare the student to assume important technical responsibilities in the fabrication of prostheses and orthoses. While the technician is not responsible for patient management, his duties require much knowledge and skill. Technicians may be registered by the American Board for Certification if they pass a technician's examination.

The registered technician provides essential support to the orthotist and/or prosthetist in various ways. The orthotics technician supports the orthotist in providing care to patients with disabling conditions of the limbs and spine by fabricating orthoses and their components. The prosthetics technician similarly supports the prosthetist in providing care to patients with partial or total absence of a limb by fabricating prosthetic devices and/or components.

The orthotics technician, as a result of his skills, fabricates orthoses in such a manner as to provide maximum fit, function, cosmesis, and workmanship. He also performs repairs to, and maintenance of, orthoses as assigned.

The prosthetics technician may make positive molds, and, as a result of his skills, fabricate prostheses in such a manner to provide maximum fit, function, cosmesis, and workmanship. As does the orthotics technician, the prosthetic technician also performs the repairs to, and maintenance of, prostheses as assigned.

The registered technician can be considered the backbone of the orthotics/prosthetics profession. Many individuals are given full recognition of their skills by achieving registered technician status. The prerequisites for taking the Registered Technician exam are as follows:

Applicants for technician registration must possess at least a high school education from an accredited education institution in the United States, or must possess the General Education Development Test equivalent.
Applicants must possess a minimum of two years of acceptable experience in the fabrication of orthoses, prostheses, and/ or their components. Such experience must be obtained under the direction of an ABC-certified practitioner in the applicant's field of specialty (prosthetics or orthotics).
Applicants who have successfully completed a formal orthotic/prosthetic technician education program accredited by the EAC are exempt from the experience requirement.

Applicants who qualify for technician registration by virtue of their education and/or work experience may be admitted to an examination designed to test their knowledge and application of tools, materials, and fabricating techniques for orthoses and/or prostheses.

Internship Programs

An internship program provides formal, structured experience in prosthetics and orthotics after the individual has completed an accredited practitioner level education program. An internship program is designed tofulfill the experience requirement for the ABC Practitioner Examination. Although participation in an internship program is not currently required in order to take the examination, it is anticipated that such a requirement will be in place by September, 1993. Contact the ABC National Office for information on the internship program.

Residency Programs

One form of internship is through a residency program. This issue of IPO lists several residency programs in progress at the time of printing. These programs are limited to one to three residents per residency period. However, internships are not limited to residency programs; they may also be completed at orthotics-prosthetics facilities.

Educational Accreditation Commission

In 1972, ABC developed the Educational Accreditation Commission (EAC). It was determined that the Commission's membership would consist of three certified practitioners nominated by ABC, three representatives of the educational community nominated by the University Council on Orthotic-Prosthetic Education (UCOPE), and one member who would be an orthopedic surgeon jointly selected by ABC and UCOPE. In 1988, the EAC moved out from under the wing of ABC and established itself as an independent body. The structure changed also. ABC now appoints one representative, the American Academy of Orthotists and Prosthetists appoints one representative, and the American Orthotic and Prosthetic Association appoints one representative. The National Association of Prosthetic Orthotic Educators (NAPOE), known formerly as UCOPE, appoints three representatives. The orthopedic surgeon is appointed by the Board of Directors of the Orthotic and Prosthetic National Office.

The functions of the EAC are as follows:

programs in orthotics and prosthetics at various levels of professional endeavor and, as a corollary, to assist interested educational institutions in developing appropriate orthotic and prosthetic educational programs; and
to accredit educational programs in orthotics and prosthetics according to established and approved guidelines.