The History of the Learner

In my last article I provided a brief overview of the
history of education and how it has and is changing as we move forward to
improve the clinical level of the profession. With that, the student or learner
has also changed. The demands of the student, adapting the curriculum to their
changing needs, technology and the industry have all been important factors
causing change at
Northwestern University.

Classroom dynamics

When I attended school at Northwestern University in
1986, the classroom dynamics were dramatically different than 2011. For
example, my prosthetics classmates were all men and the average experience
level of the class was at least 2 years. About half the students were sponsored
by the company where they had been working prior to school.

My class consisted of individuals who grew up in the
industry and their technical abilities matched well with the fast pace of the
certificate program. I was the guy that distorted the average because I had no
experience coming into school except as a therapist. The curriculum was based
on the technological aspects and the grading breakdown was 60% for fabrication
and 40% for the written exams.

We did not expect the exam protocol to be explained to
us. When the test was listed we studied everything. We were not given study
guides. It was our responsibility to know it. Even our notebooks were nothing
but outlines that required us to fill in during lecture. There were no power
point outlines because the lectures were on old slides. We had to multitask:
watch the lecture and write notes to fill in the gaps. Some guys would bring a
cassette recorder for certain lectures but not on a regular basis. It was a
simple design, see the instructor do the task and we would follow up

The learner

Make a connection

The curriculum matched the demands of the industry at
the time and also met the needs of the learner. There seemed to be a better
connect between student, school and the industry. The industry had many little
mom and pop facilities and many of the practitioners were required to know
every aspect of fabrication. I survived the program because I was a visual
learner and I was able to pick up the techniques quickly. This served me well
when I started working at J.E. Hanger in Chicago because we did not send out to
central fabrication unless we had too much work. I was forced to learn every
aspect of fabrication from my manager Robert Daniels and Steven Solyom the man
who carved all the wood sockets and knew the old-world techniques.

Even the
American Board for Certification in Orthotics, Prosthetics and
Pedorthics Inc.
exams were more technical when I took them in Dallas in
1988. When I took the clinical practice management exam it was a 3-day exam and
I was called upon to assess, take an impression, modify, and fit a patella
tendon bearing hard socket design for the transtibial and a quadrilateral
socket for the transfemoral level. If it were not for the technical experience
I had at J.E. Hanger anger in Chicago for the previous year of constant
fabrication I am not sure I could have passed the way I did.

Grade changes

When I began teaching at Northwestern University in 1992
not much had changed from the time I had left 5 years earlier. The students
were similar in design, they were more technical in nature then didactic, the
class was predominantly made up of men, textbooks were still outlines and the
bulk of the students grew up in the industry or wore a prosthesis. The only
change that occurred was the grade breakdown. I noticed that now the technical
portion was 50% and the written exam was 50%. The student was more visual in
nature and had good mechanical ability.

It was not until 1994 when Northwestern University
stopped admitting students with an associate’s degree and only accepted
bachelor’s degrees that I started to see change in the style of student
applying to the program. It was at this time we started to experience more
diversity with the background of the students. More students that did not grow
up in the field were coming to school and they had less mechanical ability. The
shift from hand skills and experience to more academics had begun.

Lecture changes

What also happened at this time is that lectures began
to be presented using PowerPoint and handouts could be distributed to the
students to follow along. Unfortunately this was a double-edge sword. We soon
found that the students had the lecture notes to follow along and pay more
attention to the lecture but the problem was that they no longer wanted to
write notes of their own and the ability to take notes started to diminish. In
essence, we started reinforcing the banking style of education, the student
would sit in the chair and the faculty would deposit the information during the

Soon afterwards, National Commission on Orthotic and
Prosthetic Education requirements changed and students were required to have
taken specific courses before they could be admitted to Northwestern University
and this further reinforced the more academically based student. Northwestern
University also started implementing separate courses in biomechanics, research
and materials science. The anatomy course was changed and presented like a
physicians program along with cadaver lab. We were raising the level of the
courses to challenge the changing academic and clinical needs of the student.

A technological shift

Technology also played a role in the changing landscape
of the learner. In order to introduce students to the suction systems,
CAD-CAM and gel liners, for example, something had to be
replaced. The items that required more hand skills and represented a lower
percentage in clinical practice were replaced by the newer designs that did not
require the same hand skills. The schools relied on the residencies to complete
the education during the residency and maybe pick up some of the hand skills

Now the student, school and industry were not as
connected as before and the complaints came rolling in from the supervisors,
“What are you teaching at school these days, these graduates can’t
make anything?” What can you say? The curriculum is changing, technology
is changing, the student is changing, all needing less hand skills compared to
years past. I was amazed about 10 years ago at the national meeting when a
graduate of the program from years ago asked me if we were still teaching
people how to carve wood sockets. I was speechless.

When Northwestern University switched to the blended
learning format where 22 weeks of education is online and 11 weeks of education
is spent fabricating in Chicago, it represented a further shift from hand
skills to academic and clinical ability. The type of student who performs well
is dramatically different than when I began teaching. We also have incorporated
more problem-based learning case studies into the program to simulate clinical
g, the student has
little experience coming into school and struggles with
fabrication. The student that has not come from a background
in the industry sometimes struggles to find a connection between understanding
components and their clinical application, making case studies that much more

I can hear the comments already and sides forming to argue hand skills
vs. academics/clinical. I’m not here to argue that point. I want residency
directors to look through a different set of lenses and understand the learner.
These are the characteristics of today’s student so hopefully the industry
understands what is needed to improve their development in residency.
Don’t be frustrated with the resident. Understand their education may not
be the same as when you went to school.

Thomas P. Karolewski

Thomas P. Karolewski, CP, FAAOP, is the director of
prosthetics education at Northwestern University Feinberg School of Medicine
and a member of the O&P Business News Practitioner Advisory

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