Education Elevation

The next generation of O&P practitioners, currently sitting in a
transtibial prosthetics class in Florida or following up on their patients
during a clinical experience II rotation in Texas, will become the perfect
blend of clinician, researcher and business owner, if they choose. They will
navigate through the monotonies of processing the correct L-codes for
reimbursement justification, they will conduct studies and research that will
push the field in scientific and biomechanical directions never thought
possible by previous generations and they will recognize the importance of
creating a focused and sound business plan in the sometimes volatile and almost
always uncertain health care profession. The transition to a master’s
level program by all
National Commission on Orthotic and Prosthetic Education
(NCOPE) accredited schools offers new avenues for prospective O&P students.
With new tools and technology at their fingertips today, future O&P
practitioners will have the educational background necessary to solve
tomorrow’s problems.

  Education Elevation
  Image: © Rich

New students represented

Robin Seabrook, executive director of NCOPE, believes the master’s
level degree will not only attract a higher caliber student, but also create
them. The master’s level degree will attract students who are otherwise
unfamiliar with O&P and who may be studying at a master’s level in a
different profession.

“There are those students looking for professions and choices once
they are in school but still not quite sure what they want to do,”
Seabrook told O&P Business News. “The master’s level
program will attract students who are just finding out about the O&P
profession and want to extend their education. They will view O&P as a
professional choice.”

  Robin Seabrook
  Robin Seabrook

For Susan Kapp, CPO, director of the O&P program for the newly
converted master’s program at the University of Texas Southwestern Medical
Center at Dallas, the master’s level degree is attracting students with
diverse educational backgrounds. She found a significant increase in students
with engineering degrees expressing interest in the O&P program. She noted
that in previous years, those students were likely to attend other
master’s or certificate programs, since they had already earned an
undergraduate degree, instead of earning a second bachelor’s degree.

“We’ve always had engineering students apply, mostly
biomechanical engineers, but not at the rate that we have had them with the
first and second master’s prosthetic and orthotic (MPO) class,” she
said. “It seems as though once they graduate with a [bachelor’s] in
biomedical engineering and began their careers they found that there just was
not enough personal interaction. The students who joined our O&P program
did not want to sit behind a computer and do engineering modeling all day long.
They wanted patient interaction. The UT Southwestern Program was a good fit for

Biomechanical engineering students are often drawn to the O&P
profession because it offers technical skills as well as the personal touch of
patient care. For biomechanical engineering students, as well as students with
different educational backgrounds, the master’s level O&P program is
another career opportunity that was not available before. Kapp also noted that
most students who graduated with a bachelor’s degree are not interested in
obtaining a second one. If they are willing to go back to school, they want an
advanced degree.

  Susan Kapp
  Susan Kapp

A more mature student

“I get a sense that these students in our MPO program are more
mature and perhaps more focused,” Kapp said. “Because they are older,
they are committed to the profession and take their studies seriously.”

With additional education comes a different type of student.

“I do not think a graduate from today’s program will
automatically make a better prosthesis or orthosis,” she said.
“Plenty of people that have not gone through a program such as ours are
excellent clinicians. But in the long run, they will practice smarter than they
would have otherwise. They will be able to manage challenging cases through
innovative design and component selection. They will become better problem
solvers. It is pretty easy to put a prosthesis on a patient, but when problems
occur, that is when you will see that the education we are offering today is

Time for re-evaluation

The transition to a master’s level program not only provides a
potential new avenue for students, but offers O&P schools and institutions
the opportunity to re-evaluate their curriculum. The transition to a
master’s level program is an opportunity for some schools to push the
reset button. They can determine what works and what needs to be modified or
deleted from the program entirely.

At UT Southwestern, the process began with early discussions in 2005.

“We felt that the amount of information we wanted our students to
graduate with was probably at a point where it could be justified at the
master’s level,” Kapp said.

They received formal word from NCOPE in 2007 about the changes and began
to move forward.

“We took a look at our curriculum and made some decisions about
where we wanted to expand and take out for additional room,” Kapp said.
“That took us a good 18 months of evaluation. It was a wonderful
opportunity to start with a clean slate. We felt we were already doing a great
job at the baccalaureate level but there were always things we wanted to add
and never had the space for.”

Kapp recalled sitting with other members of her staff thinking,
“Let’s assume we have no program.”

“We started at the beginning,” she said. “We examined all
the things we viewed as strengths and we gathered all of the ideas that we had
and brought them to the table.”

Through the process, they developed ideas such as teaching courses
together as opposed to teaching a semester of orthotics and then a semester of
prosthetics, which is what they were doing at the time.

“Why not teach lower limb O&P care to the students during the
same semester?” Kapp asked. “It was an idea we had floating around
for a while, but we were so locked in time wise, we never had that flexibility.
The two subjects are so closely related that it made sense.”

Kapp developed the curriculum and had to go through the approval process
at UT Southwestern and to the UT System coordinating board in Austin, Texas.
She was happy to report that UT Southwestern’s first MPO class entered in
May 2010. As of press time, the re-sequenced curriculum is in its third
semester and working well.

Different programs

There are a variety of ways to meet NCOPE’s standards, according to
Seabrook. Kapp took advantage of the opportunity to expand the program’s
curriculum. Seabrook noted that St. Petersburg College is moving towards a
consortium, partnering with Florida State University.

“Basically we are partnering with FSU department of industrial
manufacturing engineering,” Arlene Gillis, CPO, LPO, MEd, clinical
coordinator for St. Petersburg College, said. “The program will change
significantly from a 2-year to a 3-year model, where the student will receive a
bachelor’s and master’s degree.”

In this model, there will be a significant increase in contact hours in
the sciences, as well as a requirement for calculus 1, calculus 2 and
statistics for engineering that will transfer to the master’s side of the
program, according to Gillis. The first 2 years are clinically focused,
including clinical rotations every semester. The third year will focus on a
more advanced clinical rotation and is considered more hands on, according to
Gillis. The third year is also unique in that students will focus on the
business side of the profession as well.

“The nice thing about it is that it gives us more time with our
students to develop their clinical skills,” Gillis said. “It gives
the students the opportunity to develop and focus on research, along with a
nice blend of clinical and business courses.”

Learning the business

St. Petersburg College’s consortium consists of Florida State
University’s (FSU) College of Business, the medical school and industrial
engineering department. Gillis called St. Petersburg College’s unique
focus on business “critical” and “imperative.”

“We have changed the way we teach the business component,” she
said. “We have integrated it completely into our program. We have OPIE
software and all of our students use it throughout each of their core courses.
Each class they have OPIE software for assessment and patient needs, but also
for L-coding.”

Students are required to go through the process of L-coding for each
project they complete in class. Gillis emphasized learning OPIE software and
L-coding is not just a one time, or one class education. For each project,
students must go through the entire process, including the delivery and
justification with L-codes.

“And that is happening in the first 2 years and then they will take
core business courses in the master’s program on top of that as
well,” Gillis said. “Throughout our curriculum we are using that
approach. Everything they do, they have to code it and they have to go through
the full gamut of business courses.”

St. Petersburg College made the decision in 2010 to spread the business
component throughout the curriculum. As they moved toward the master’s
degree program in 2012, they emphasized additional business skills in their
curriculum. Gillis credited the American Orthotic and Prosthetic Association
for sharing their business tools including the BOAT and L-code search that
helps reinforce the importance of proper coding and processes.

“What we are doing with the business courses is unique and
something that is not really seen anywhere else at the moment,” Gillis
said. “We are taking it to the next level by working with the FSU business
school. It gives the student a broader perspective. The patient is always
first, but ultimately we have to be able to run a business to serve these
patients and keep the profession moving forward. It is critical that the
students understand that these aspects of O&P — patient and business
— actually work together.”

The profession moves forward

Kapp anticipates that once the master’s deadline comes and goes and
universities are comfortable with their programs, more institutions will
discuss developing PhD programs, like those at Georgia Tech and the University
of Washington.

“Some students will choose to go on to PhD programs and they will
contribute to our literature,” Kapp said. “Literature in O&P is
limited. If people who have been through O&P training conduct O&P
research, they will conduct clinically practical and relevant research.”

Gillis predicted more programs will do a better job of communicating as
colleagues rather than rivals. Like Kapp, she expects more PhD programs in the
future. In fact, Gillis and the FSU Industrial Engineering department are
entertaining the notion of an O&P PhD program.

“We are in the process of starting a program utilizing faculty from
the University of Pittsburgh,” she said. “We are thinking of sharing
a research course that we will offer using video conferencing system and we may
combine the two cohorts from both institutions so the students get to work with
one another. We have also talked to FSU about developing a PhD program. We
foresee eventually moving a level up.”

As master’s programs develop, it is only natural to assume that
there is going to be a need for PhD programs focusing on research and grants
and contributing to the other end of the O&P spectrum — literature.

“There will be clinicians focusing on clinical care and some who
will migrate toward research,” Gillis predicted. “There will be a
definite need for development as more practitioners come up to the
master’s level. Eventually, we will be able to move our profession forward
and we will be able to use evidence based practices.”

New Schools Take Initial Steps Toward Master’s Level

According to Robin Seabrook, executive
director of NCOPE, since announcing the new master’s level standards, she
has received a candidacy application from Loma Linda University, with a goal to
begin fall classes in 2011. Also, at the American Academy of Orthotists and
Prosthetists Annual Meeting and Scientific Symposium in March, Seabrook learned
that Alabama State University hired a full-time director to oversee the
master’s level program with a goal to apply for candidacy, which is the
first step in pursuing accreditation. Alabama State has a goal to begin classes
in 2012. Seabrook also noted that as of press time, a national search for a
director is underway at Baylor University Medical School in Houston.
Baylor’s goal is to begin classes starting in 2013, once they find funding
and hire a director.

“Nothing is guaranteed, but it looks as
though all of the accredited schools have either transitioned or are in line to
transition to a master’s level program by our 2012 deadline,”
Seabrook told O&P Business News.

NCOPE recently hired a consulting firm to
conduct a best practices study. They interviewed schools and institutions that
are in the process of or have already made the transition to a master’s
level program. The best practices study outlines the processes other schools
took in order to become approved for a master’s program for future
institutions interested in implementing an O&P master’s level

“We are waiting on that final report,” Seabrook
said. “Our goal is to share this with the national organizations in the
late summer or early fall at this year’s American Orthotic and Prosthetic
titioner who is a good
clinician, who can run a business properly and conduct research, is critical in
moving the profession forward,” she said.

Seabrook has witnessed an expansion of clinical service in the O&P
profession. What makes the O&P profession unique is the practitioner’s
ability to custom-build the device he or she provides to the patient. But the
way in which the education is changing is also adding more recognition to the
higher level of clinical service that they provide.

The O&P practitioner’s mark in the allied health arena is no
longer just as a device provider. Seabrook believes the O&P practitioner is
now a patient care provider, who provides a unique device.

“It is one of the things that the younger generation must be in
tune with — the advocacy side,” Seabrook said. “Students need to
be aware of the profession they are joining. They must realize certification is
the driving force behind and the benchmark for credibility.” — by
Anthony Calabro

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