The Changing Face of O&P Education: Can
We Make a Better Practitioner?
William J. Barringer, MS, CO
Susan Kapp, CP
Charles H. Dankmeyer Jr., CPO
Darrell Clark, CO
Terry J. Supan, CPO
Robin Seabrook
ABSTRACT
The National Commission on Orthotic
and Prosthetic Education (NCOPE)
has re-evaluated O&P educational philosophy for the past 18 months. Important decisions have been made concerning both primary education and postgraduate training.
Primary education will now focus on
clinical knowledge with the technical aspects de-emphasized. Postgraduate education will be structured and essentials
will be written to address the clinical and
technical skills necessary to educate
competent practitioners.
O&P education is now recognized by
the American Medical Association as a
legitimate allied healthcare profession,
and NCOPE has become a member of
CAHEA, the major accrediting agency
for health-related occupations. This affiliation has forced NCOPE to rewrite
and upgrade its primary and certificate
programs' accrediting procedures.
These are important advances for
O&P education. This shift in educational philosophy will produce more
competent practitioners for the future.
Introduction
Education does not stand alone as an
unchanging entity; it constantly reflects
on history and tradition to determine
its future. When NCOPE began its
journey in July 1991, the commissioners brought with them a "sense of history" as it related to the O&P profession. Each of us realized the history
and tradition of orthotic and prosthetic
education had shaped our individual
perceptions of the profession and
served as our own personal rites of passage to orthotic and prosthetic maturation. But this knowledge of history and
tradition also leads us to question if our
current educational process provides
future practitioners with that same rite
of passage.
The "jewel in the crown" of any profession is the quality of education it
provides. Each of us as guardians of
our profession must look at higher education and ask serious questions about
why history has led us to where we are
and whether we should change our
course for our future well-being.
History
Orthotics and prosthetics is a late
bloomer in the garden of allied health
and medical education. Until World
War II, formal education for practitioners did not exist on any university
campus. This is in stark contrast to
medical education, which has existed
for more than 400 years. During the
early part of this period, surgeons were
not considered doctors or even highly
educated; they worked under the supervision of physicians. They were often called in with bloody aprons and
tools to do work beneath the physician's level of knowledge and training.
This tradition persisted until surgeons
elevated their status through education, thus redefining themselves and
their specialty.
Orthotics and prosthetics has
reached a similar crossroad and must
prepare for the future by embarking on
a new educational pathway. It will not
be a pathway concerned with new information, but one that will redefine
and change our educational philosophy. This new pathway will also alter
the demands we place on practitioners,
provide for the mastery of an ever-growing body of knowledge necessary
to administer the best care and secure
our place in the medical community.
EAC Task Force
In 1972 the American Board for Certification in Orthotics and Prosthetics
Inc. (ABC) created the Educational
Accreditation Commission (EAC) to
confront the O&P profession's need
for an institutional accreditation program. That same year the EAC set out
to establish criteria to assess and compare O&P curricula. These criteria,
called "Essentials," were developed
and revised to meet the profession's
needs. Through the Essentials EAC
created written rules and regulations
for short-term courses, certificate programs, baccalaureate programs and required clinical hours. It also established and modified common application and site visit processes.
Despite the EAC's accomplishments, several problems remained.
Accrediting bodies operate best when
they are politically and administratively independent from the educational
and professional arenas they serve. Political separation is usually defined as
including both financial and programmatic independence. Financial independence was achieved in 1988, but full
programmatic and administrative autonomy was not.
In April 1990, the EAC recognized
that problems existed and established a
five-member task force that included
representatives from the American Orthotic and Prosthetic Association
(AOPA), ABC, the American Academy of Orthotists and Prosthetists
(AAOP), the National Association of
Prosthetic-Orthotic Educators (NAPOE) and the O&P National Office.
The EAC Task Force set forth to
accomplish the following goals:
- Investigate and evaluate the relationship between O&P training curricula and patient needs.
- Coordinate a needs assessment
considering such things as patient care
availability in relation to educational
funding.
- Report facts, findings and conclusions regarding the investigations and
studies to the commission and make
specific recommendations.
In March 1991, the leadership of
AOPA, ABC and AAOP formally accepted the task force recommendation
to reorganize EAC and hire dedicated
staff. The leadership and profession
had made a firm commitment both financially and administratively to the
EAC.
The new EAC met in July 1991 and
changed its name to become NCOPE.
Already NCOPE has addressed issues
critical to O&P education, assumed the
role of O&P accrediting agency, and
with the support of the profession, will
continue to grow and mature.
The New Essentials
Primary O&P education is currently
conducted in one of two formats: bachelor's degree and postgraduate certificate programs. Programs were offered
originally at New York University,
Northwestern and University of California at Los Angeles. Today nine accredited programs (four bachelor of
science and five certificate programs)
are offered at these and other institutions. These programs are governed by
a set of Essentials that outline the minimum requirements for accreditation.
As the profession has experienced
more rapid change, it has become apparent that the Essentials should reflect a maturing profession and the
changing roles of practitioners. Patient
evaluation and treatment methods now
play a more significant role in the duties of practitioners. Most technical
tasks are completed by technicians,
and an increase in the number of central fabrication facilities and prefabrication systems allows practitioners
more time for patient contact. Also,
the economics of today's health delivery system require certificants to devote the majority of their time to direct
patient care.
Coupled with these factors are recent advances in O&P technology. The
use of computer-aided design and manufacturing and new materials requires
continual education on the part of the
practitioners. As these techniques become integrated into common practice.
they will need to be taught during undergraduate or postgraduate education.
The previous Essentials called for a
mix of didactic instruction, laboratory
experience and clinical affiliation. The
lab component was tightly defined with
a list of specific fabrication projects
and skills that must be taught. Little
time remained in the curricula for the
addition of classes that might reflect
the state of the art in current practice.
Such topics as radiology, computer science, business practice and pathology
were not easily integrated into curricula designed around the old Essentials.
The EAC Task Force identified several common concerns:
- A need to include more clinical and practice-related education in the
undergraduate component.
- A desire to decrease the time and
cost of laboratory projects in undergraduate education.
- A need for an organized postgraduate experience.
Because most universities have credit-hour limitations, expanding curricula to include topics such as computer
science and pathology could not occur
unless the necessary hours were available within the prescribed credit limits.
Shifting laboratory projects from undergraduate training to residencies
could free up the necessary hours.
NCOPE realized undergraduate and
residency Essentials would need to be
developed concurrently to provide a
smooth transition. The committee developing the undergraduate Essentials
considered decreasing or eliminating
the laboratory content and developed
Essentials to allow flexibility for
schools and the development of new
curriculum and programs that introduce new technologies and practices
while still ensuring quality education.
NCOPE is providing a transition
phase from the previous Essentials to
the revised ones. Currently-accredited
programs will maintain their accreditation under the "old" Essentials and not
be required to phase out the teaching
of lab skills for a set time. This time will
be used for implementing the new Essentials and constructing a new program. In addition, the 250-hour per discipline clinical experience requirement will be maintained until the transition to the new Essentials can take
place and residencies are available for
all students. Draft proposals of the undergraduate and residency Essentials
are being developed.
The Residency
The Residency Development Committee is creating minimum requirements,
curricular objectives, evaluation forms
and an application process to assist in
selecting training sites. The Accreditation Committee will work closely with
the Residency Development Committee to develop an accreditation program similar to the current process.
A New Phase
The development of Residency Essentials is the most important task facing
NCOPE. The genesis of a new educational phase where none previously existed is a difficult task. The Residency
Essentials will contain guidelines for:
- Where a program can be housed.
- How long the program will run.
- Qualifications for teaching staff.
- Resources necessary for teaching
students.
- Due process procedures.
- What the resident must be taught
clinically and technically.
The Residency Essentials outline
clinical and technical requirements that
a student must fulfill. Clinical experience will be divided into acute, rehabilitation and chronically ill patients
with further subdivisions according to
age groups: pediatric, adult and geriatric. Within each group the resident
must achieve technical competence in
upper- and lower-limb prosthetics or
upper-limb, lower-limb and spinal orthotics. Permission to house a residency program will not be granted unless
sites can demonstrate availability of
the aforementioned categories.
The curricular objectives state the
resident must be qualified for independent practice upon graduation. The
curricular objectives, taken from the
ABC Role Delineation Study, are the
essence of what must be taught within
every residency program. NCOPE will
help facilities teach residents by providing a curricular guide and evaluation forms.
Accreditation of each program will
be important. Accreditation sets standards and lends credibility to educational programs at any level, and as
part of this process, a program of self-study, evaluation and site visitation
will be enacted. NCOPE will monitor
programs and residents to maintain
quality educational standards.
The Residency Development Committee
is composed of representatives
from all levels of O&P practice, including small private practices, institutional
practices and larger, multi-office practices. NCOPE hopes input from these
areas will ensure development of a program that is accessible to all. The overall goal is to combine the undergraduate and residency experiences to produce practitioners with a better .
well-rounded education at a lower cost to
students and the system.
The Accreditation Process
Accreditation of residency sites will include the establishment of standards for
evaluation, guidance in the self-study
process, program evaluation and reevaluation by qualified authorities, and
publication of a current list of accredited
programs. NCOPE will help programs
analyze their performance and improve
their effectiveness. NCOPE also will
protect the welfare and safety of the
public by ensuring some degree of uniformity among prosthetic/orthotic educational programs.
O&P's accreditation process is not
unlike those used by other professions
for the purpose of evaluation and accreditation. Requirements include:
- Programs seeking initial accreditation must submit a letter of intent.
- Programs must complete self-study reports, which will be reviewed
by evaluators.
- Programs must undergo on-site
visits conducted by evaluators.
- Programs will be able to review
evaluation reports for accuracy.
- NCOPE will review all reports to
determine accreditation status.
NCOPE accreditation ensures all
O&P educational programs adhere to
basic essentials and that quality education is offered to students. This process
encourages programs to incorporate
the profession's newly-developed techniques and concepts as they become
widely recognized.
The accrediting process will be the
keystone for ensuring quality programs. It will also be used for residency
program evaluation and to follow the
recommendations of the Committee on
Allied Health Education Association
(CAHEA).
Becoming Recognized
Directors of orthotic and prosthetic
programs will need to justify their program and its requirements to the college or university administration.
When they identify the program as accredited by NCOPE, they may be
asked: "Who is NCOPE and by what
authority does it make the decision to
accredit?" NCOPE needs to be able to
answer that question for each program
director and identify itself as a legitimate accrediting organization to the
education community.
A search of similar programs revealed many were accredited through
the American Medical Association's
CAHEA. Programs accredited by CAHEA also meet standards established
by the U.S. Department of Education.
CAHEA is well known within the allied health education field and is recognized as an accepted accrediting organization.
It was decided that developing a relationship between NCOPE and CAHEA
was an integral part of becoming acknowledged as the accrediting body for
O&P education. NCOPE applied to the
AMA for recognition of orthotics and
prosthetics as an allied health profession
and to establish NCOPE as a review
committee within the framework of CAHEA. The application was approved in
August 1992. This step linked orthotics
and prosthetics with a respected, well organized accreditation system, which in
turn will provide a solid base for our
education programs.
Conclusion
Orthotic and prosthetic education cannot evolve one phase at a time. All of the
components require growth and development as they become intertwined.
Our residency and primary education
programs will depend on one another to
fill certain voids in student education.
The success and credibility of these programs will depend on our relationship
with CAHEA and the NCOPE accrediting process. All must develop simultaneously-with an eye toward the future
NCOPE must also explore other areas
that influence O&P's future as a profession. We must study our technician programs to ensure their readiness to move
into the next century, encourage more
colleges and universities to offer O&P
education programs, and develop graduate O&P programs that offer advanced
degrees.
NCOPE will continue to develop orthotic and prosthetic education that
draws upon the lessons of history and
tradition.
WILLIAM J. BARRINGER, MS, CO, is
assistant professor in the department of orthopedic surgery and rehabilitation at the
University of Oklahoma, Oklahoma City,
Okla. He is also the current chairman of the
National Commission on Orthotic and
Prosthetic Education (NCOPE).
SUSAN KAPP, CP, is assistant professor
and acting director of the prosthetic and orthotic program at the University of Texas
Southwestern Medical Center, 6011 Harry
Hines Blvd., Suite V.5100, Dallas, TX
75235-9091.
CHARLES H. DANKMEYER JR.,
CPO, is president of Dankmeyer Inc., 2010
Maryland Ave., Baltimore, MD 21218.
DARRELL CLARK, CO, is director of
orthotics at Rancho Los Amigos Medical
Center, Downey, Calif., and serves as an
adjunct faculty member at California State
University, Dominguez Hills, Calif.
TERRY J. SUPAN, CPO, is director of
orthotic and prosthetic services and assistant
professor of clinical surgery at Southern Illinois University School of Medicine in
Springfield, Ill. He is also past president of
the American Academy of Orthotists and
Prosthetists.
ROBIN SEA BROOK is director of
NCOPE and worked previously for the
American Board for Certification in Orthotics and Prosthetics.
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