History of Prosthetics & Orthotics Education

History of Prosthetics & Orthotics Education

The concept of an advanced education program in prosthetics and orthotics (P&O) is not new. In 1984, many years before P&O education programs were evaluated by a national accrediting body, the Education Accreditation Commission (a subsection of the American Board for Certification in Orthotics and Prosthetics, Inc.) recognized the need for advanced education leading to a master’s degree (1). As a result of these recommendations, one post-professional master’s degree program was created at the University of Connecticut (2,3). The program focused on expanding the role of the orthotics and prosthetics professional in the health care system and was designed to prepare board eligible or American Board for Certification in Orthotics and Prosthetics, Inc. (ABC) certified prosthetists and/or orthotists for positions of leadership in health care. Only two other master’s degree education programs have been created (Rutgers University and St. Ambrose University). Funding shortfalls lead to the closure of both programs. The closure of these programs highlights the need for future education programs to develop support from the university’s administration, collaborating departments and medical community. In addition, it emphasizes the need for expanded funding resources from the university, the alumni, and the P&O profession.

Since 1992, the P&O industry officially became recognized by the American Medical Association as an allied health profession. Since then, rapid changes in managed health care, and the unprecedented growth in computer technology and material sciences have pressured the P&O profession to keep pace (4). Some have identified that the slow response by the P&O profession to keep pace with these changes is primarily due to its small size in relation to larger allied health science professions (i.e. physical therapy, occupational therapy, etc.) (4). Adding to the problem of small size, there is an increasing number of orthotists and prosthetists nearing retirement. The number of individuals preparing to exit the profession is marginally offset by the number of graduates from accredited schools preparing to enter the profession (4). Combined with the expanding number of elderly persons in need of orthotic and prosthetic care (5,6,7), other professions have begun to encroach their scope of practice by attempting to treat patients in need of orthotic and prosthetic services (5). Subsequently, inter-allied health competition for orthotic and prosthetic patient care has been forcing certified practitioners to operate in areas where in some cases, other allied health professionals are better educated or just as skill-oriented (i.e. upper extremity orthotics, splinting) (6,7). In other areas, companies manufacturing pre-made orthoses and prostheses are directly marketing to the patient (4). These developments could weaken the quality of services provided to patients in need of orthotic and prosthetic care.

The majority of individuals from other professions who are providing prosthetic and orthotic services typically possess little formal knowledge and training in P&O. Formal instruction usually consists of a single short-term course. The shortcoming of these brief entry-level education programs spanning a few days to a few weeks (taught in schools of pedorthics, occupational therapy, physical therapy, chiropractic, podiatric and medical programs) is that there is insufficient time to teach essential P&O theory and practical clinical skills (4). Sacrificing depth in curricular content through consolidated alternative education programs in order to rapidly produce a greater number of clinical practitioners will produce individuals who remain unprepared for the demands of rapid advancement in technology and health care (8).

While the number and type of prosthetic and orthotic devices are constantly changing due to new developments in technology and materials science, the level of curriculum that provides the education and training of future certified orthotists and prosthetists has not kept pace (9). Some suggest several basic problems in P&O education exist: a.) the lack of a uniform vision of the future of P&O (10), b.) the lack of contemporary curricular design, and c.) the lack of texts designed to provide a comprehensive overview to teach students about the evolving, fragmented and complex discipline of P&O (11). Because the Bachelor’s degree and certification by ABC have been viewed as the terminal qualification in P&O, administrative and faculty positions in P&O education programs have been typically occupied by persons with years of experience or by persons who have been internationally recruited (2). As a result, most education programs are not operated by individuals who possess an advanced degree or by individuals who possess formal training or instruction in either curriculum development or research methodology. Subsequently, a small number of individuals from within the P&O profession have contributed to the information base through research processes and advanced education. Concomitantly, a large portion of advancements in the profession have been developed outside the P&O profession by individuals who possess formal knowledge and advanced training in medicine, allied health, and engineering.

In summary, upgrading the level of education to a master’s degree offering advanced prosthetic and orthotic training/instruction is requisite to leading the profession into the new millennium.

Note:

In April 2005, a landmark meeting in New Orleans, Louisiana convened a group of 35 educators, researchers and political leaders in prosthetics and orthotics profession. Known as the Education Summit, the meeting focused on examining the need for education programs in P&O to upgrade to the master’s degree. The outcome of the meeting was a consensus for all American schools to move the professional education of orthotists and prosthetists from the current certificate and baccalaureate levels to the master’s degree level by 2010. Georgia Tech’s MSPO program was selected to serve as the model program to provide guidance and leadership during this national transition (12). In 2007, it was further clarified that all existing P&O education programs would need to transition to the master’s degree by 2012 and that any new school that was aiming to create a P&O education program would need to do so at the level of a master’s degree or higher (13).

With the advent of a PhD program in Applied Physiology with emphasis in Prosthetics and Orthotics in the School of Applied Physiology at Georgia Tech, graduates of the MSPO Program now have the additional option to advance their studies to a terminal academic degree with a focus on Prosthetics and/or Orthotics to prepare for a career in research or academia.

References
  1. Education Accreditation Commission of the American Board for Certification in Orthotics and Prosthetics, Inc [policy statement]. Alexandria, VA: American Board for Certification in Orthotics and Prosthetics, Inc.; November 1984.
  2. Nielsen C, Altman R, Gillespie P, Douglas P. A model for graduate education in orthotics and prosthetics. Clinical Prosthetics and Orthotics. 1987;11:63-66.
  3. Master’s degree program: University of Connecticut. Journal of Prosthetics and Orthotics. October 1992;4:273-275.
  4. Hovorka CF, Shurr DG, Bozik DS. The concept of an entry-level interdisciplinary graduate degree preparing orthotists for the new millennium part 1: History of orthotic and prosthetic education. Journal of Prosthetics and Orthotics. June 2002;14:2:51-57.
  5. Nielsen CC. Issues affecting the future demand for orthotists and prosthetists, a study prepared for the National Commission on Orthotic and Prosthetic Education [report]. Alexandria, VA: National Commission on Orthotic and Prosthetic Education; November 1996;iii-23.
  6. Massey JT, Moore TF. Design and estimation for the national health survey interview 1985-1994. National Center for Health Statistics. Vital Health and Statistics Series 2. [report]. Atlanta, GA: Centers for Disease Control and Prevention; 1994.
  7. Benson V, Marano MA. Current estimates for the national health interview survey 1993. National Center for Health Statistics, Vital Health Statistics. 1994;10:190.
  8. Sardesen KE. Education in a profession, the place of continuing education. American Orthotic and Prosthetic Association Almanac. 1990;39:31.
  9. Bozik DS, Shurr DG. Allied health project grant [grant proposal]. Health and Resources Service Administration, U.S. Department of Education, no. 5D37HP0072803, 1999;2.
  10. Michael JW. The phoenix report. American Orthotic and Prosthetic Association Almanac. 1990;39:27-30.
  11. Shurr DG, Cook TM, eds. Prosthetics and orthotics, 1st Ed. Norwalk: Appleton and Lange, 1990;vii.
  12. O&P Education Summit: Forecasting the Future. Findings and Recommendations, April 8-9, 2005. New Orleans, La. Website URL: www.ncope.org/summit/pdf/EDSummit_final_report.pdf
  13. Personal communication, Robin Seabrook, Executive Director, National Commission on Orthotic and Prosthetic Education; June 27, 2007