This article is the second part in a series on education in orthotics and prosthetics. Part 1 describes the influences that spurred developments in the orthotic and prosthetic profession as well as the evolution of practitioner education programs. Part 2 describes the need for advanced orthotic and prosthetic education and a new model advanced education program.
A NEW INTERDISCIPLINARY GRADUATE DEGREE MODEL
Because of the documented need to prepare orthotic and prosthetic professionals for the future of health care and technology described in Part 1, a new entry-level graduate education model, different from the previous orthotic and prosthetic education programs has been developed. The new model begins by delivering advanced education in orthotics based upon the assumption that orthotists should be more than fabricators and designers. Orthotists should be fully involved collaborators with other professional health care providers. To accomplish this, the curriculum is designed to offer core courses in orthotics complemented by interdisciplinary courses in allied health and medical education culminating in the master of orthotic science (MOS) degree. This interdisciplinary graduate curriculum model aims to produce an advanced trained generalist practitioner. To make the orthotic core curriculum relevant and contemporary, segments of the curriculum are based on the recent assessments of contemporary orthotic and prosthetic practice. 1 The orthotic science core courses cover didactic theory and technical fabrication techniques together with clinical experiences. These courses are augmented by interdisciplinary supportive graduate courses in related allied health science programs. This concept aims to improve the level of collaboration and competence of orthotic science students in the same interdisciplinary environment wherein they will eventually provide services. The interdisciplinary supportive courses allow students to learn side-by-side with professionals from other disciplines such as occupational therapy, physical therapy, and special education (vocational counseling), 2 as well as industrial engineering, athletic training, nursing, and related disciplines (Hovorka CF, unpublished data, April 10, 2001).
The curricular philosophy of the MOS is to introduce intensive basic science and theory in the first semester and gradually build increasingly complex clinical aspects of patient care and technical orthosis design and fabrication each subsequent semester. By the second year, advanced patient examination, assessment, treatment strategies and orthosis design, fabrication, fitting, delivery and follow up knowledge, and skills can be developed. The combination of core orthotic science courses augmented by supportive interdisciplinary graduate health science courses produces a coordinated and effective graduate program. The clinically-oriented applied curriculum provides the necessary time for students to develop didactic as well as clinical and technical psychomotor skills within a 2-year professional graduate program.
Didactic, clinical theory, and fabrication skills are taught on the university campus within the College of Human Services supplemented by clinical internships completed off campus at local orthotic and prosthetic community facilities. Full-time orthotic science departmental faculty, possessing practitioner certification by the American Board for Certification in Orthotics and Prosthetics, Inc. (ABC), teach the core orthotic science courses. Adjunct orthotic science faculty who are Certified Orthotists also teach students the orthotics “essential competencies” established by the National Commission on Orthotic and Prosthetic Education (NCOPE) 3 and the Commission on Accreditation in Allied Health Education Programs 4 prior to the internship experiences. Following a foundation semester where core concepts of materials science, laboratory skills, and patient evaluation are learned on campus, students then begin to participate in off campus internships. These off campus internships are aimed at enhancing concepts learned in the classroom and laboratory.
PATHWAYS TO THE MOS
Two pathways have been developed that lead to the MOS. The first pathway involves students who are seeking a Bachelor’s degree (preferably in psychology, biopsychology, biology, or health, physical education, and sports science). In this pathway, 3 years of undergraduate preparatory coursework followed by 2 years of graduate interdisciplinary and core courses are coordinated into a 5-year program. Undergraduate coursework is completed in approximately 4 years. During the fourth undergraduate year, the student begins the MOS program, completing the Bachelor’s degree at the end of their fourth year, which represents the first year of the MOS. During the fifth year, which represents the second year of the MOS, students complete the program and are awarded a Master of Orthotic Science degree (Hovorka CF, unpublished data, April 10, 2001).
The option mentioned above is known as the 3+2 model, and it is similar to the accredited entry-level master’s degree program in occupational therapy at St. Ambrose University. 5,6 The 3+2 model is particularly innovative because it provides students the opportunity to begin completing prerequisite and orthotics related courses during the first 4 years of the curriculum while simultaneously taking courses with the future physical therapists, occupational therapist, and special education workers (vocational counselors, industrial engineers, athletic trainers, nurses, and related programs with whom they will eventually practice). Upon completion of the program, MOS graduates complete a 1-year residency that prepares them for the ABC certification examination (Figure 1). The other pathway is designed for students who already possess a Bachelor’s degree (in any area) and who have completed the required prerequisite coursework. This option, known as the 4+2 pathway, allows completion of the MOS in 2 years. The model is similar to the accredited entry-level Master’s degree program in physical therapy at St. Ambrose University. 7–10
The course content of the 3+2 pathway leading to a Bachelor’s and MOS degree is outlined as follows:
- Year 1: The student begins the curriculum by taking a course entitled, Introduction to Allied Health Careers, which is taught by faculty from occupational therapy, physical therapy, athletic training, and orthotic science. This course identifies the similarities and differences in these disciplines and informs students about prerequisites for each of the degree programs. It also offers informal advising regarding volunteer experiences essential for each discipline, application procedures for these programs, and, most importantly, describes what is entailed in each of these career choices. At the same time, students begin completing their general education requirements for the Bachelor’s degree (approximately 50–55 credits). During this first year, students interested in the MOS program will be encouraged to pursue a major in psychology, biopsychology, health, and/or sport science.
- Year 2: Students complete their general education requirements and continue coursework toward their chosen major.
- Year 3: Students continue working toward completing courses in their major and apply to the MOS program at the beginning of their junior year. Qualified candidates begin graduate courses in the MOS at the beginning of their senior year. Students not selected for the MOS would be on track to complete their chosen major in 2 additional years.
- Year 4: Students complete their undergraduate major (all courses for the major have been taken) and continue graduate-level coursework in the MOS program. By the end of the fourth year, students complete their Bachelor’s degree and begin MOS core and specific interdisciplinary courses shared with the Master of Occupational Therapy (MOT) and Master of Physical Therapy (MPT) programs at St. Ambrose University.
- Year 5: Students complete MOS core and interdisciplinary courses and present a research project to fulfill graduation requirements. Students are also required to pass a comprehensive written examination that involves the ability to respond to didactic and clinical information.
In the 3+2 pathway, the first 3 years consist of 60 semester hours of undergraduate coursework that include all prerequisite coursework 3,4 (Table 1). During the last 2 years, 66 credit hours of graduate-level course work will be completed (Hovorka CF, unpublished data, April 10, 2001). Because of the intensive curriculum, students are encouraged to begin planning for their undergraduate degree in conjunction with the MOS in their freshman or sophomore undergraduate years. Advanced students have the option of pursuing additional electives that will teach advanced patient evaluation and management, appreciation of the contributions of orthotic and prosthetic professionals in the care and management of specific pathologies, interdisciplinary case studies, and advanced research.
THE MOS PROFESSIONAL CURRICULUM
The final 2 years of the MOS graduate-level curriculum are distributed over five consecutive semesters. Eleven core orthotic science courses totaling 36 credits are complemented by 11 interdisciplinary courses totaling 30 credits (Table 2). Core courses are restricted to MOS students and are designed to integrate clinical practice with psychomotor development, technical design, and fabrication. These courses are designed to exceed the NCOPE essentials, and they will prepare students for contemporary practice. 1,3 Clinical techniques are taught on campus in faculty supervised clinical patient management settings wherein students work with patient models. These experiences are augmented by off-campus, supervised, clinical internships (Clinical Education Courses) under the guidance of a Certified Orthotist (Hovorka CF, unpublished data, April 10, 2001).
Interdisciplinary courses provide MOS students with opportunities to learn side by side with students in the MPT and MOT programs. These courses also integrate additional seminar-oriented interdisciplinary experiences with faculty and students from the departments of psychology, nursing, industrial engineering, and art. Since the MOS curriculum focuses on orthotics, students receive an unprecedented level of advanced education and training within a single discipline (Figure 2). To accomplish this, the MOS curriculum integrates several themes including research, clinical education, human anatomy and movement analysis, business and leadership/management, geriatrics, pediatrics and special populations, and unique topics.
THEME 1: RESEARCH
A group of four research courses comprise the first curricular theme. These courses are designed to teach students the essential methods of research in order to add to the body of knowledge and determine the efficacy of orthotic management and patient care. To accomplish this, courses are integrated with established curriculum in the MOT graduate program. MOS students develop research proposals alongside MOT students as part of the interdisciplinary experience. The first in the series of research courses begins in the first semester of the professional graduate program. This introductory course covers topics such as information search strategies and techniques of evaluating scientific literature. The second course offered during the second semester teaches students how to develop a clear, concise, and manageable research hypothesis. During the third semester, the third research course teaches students methods of data collection. The final course offered during the fourth semester includes data synthesis, interpretation, and report completion, which culminate in the completion of a research report. The sequencing of these research courses teaches students research methodology using a predictable organized approach. Interdepartmental research collaborations are encouraged during the fifth and final semester. This allows students sufficient time to complete their research report and deliver an oral presentation. All research manuscripts are archived in the university library and MOS program. Exceptional research manuscripts will be submitted to research journals for publication.
THEME 2: CLINICAL EXPERIENCE
Clinical internships commence during the second semester of the MOS curriculum and continue throughout the remainder of the program. These off campus supervised patient care and technical fabrication experiences allow students to apply the knowledge gained in didactic and laboratory courses. A series of rotations are arranged among regional clinical orthotics practices. These experiences exceed the 250-hour minimum NCOPE standard 3 to enhance relationships with local clinical facilities and prepare students for the required 1-year residency following completion of the MOS program. 11
THEME 3: HUMAN ANATOMY AND MOVEMENT ANALYSIS
The link between anatomy and kinesiology/biomechanics is reinforced through interdisciplinary teaching within the departments of Biology, Physical Therapy, and Occupational Therapy. An advanced cadaver dissection course in human gross anatomy, offered via the Department of Biology, is sequenced with the Kinesiology/Biomechanics course offered through the Department of Physical Therapy. These courses emphasize clinically-oriented advanced content in anatomy of the spine and extremities and trigonometry-based biomechanical principles. An additional course in upper-extremity kinesiology, offered through the Department of Occupational Therapy, enhances student knowledge in upper-extremity biomechanics. The combination of these interdepartmental courses provides MOS students with an unprecedented opportunity for interdisciplinary advanced learning and assessment of clinically-oriented applied human biomechanics and kinesiology.
THEME 4: BUSINESS AND LEADERSHIP/MANAGEMENT
Emphasis on leadership and management is addressed through a collaborative course taught by faculty in the departments of Occupational Therapy and Orthotic Science who possess clinical certification and a Master’s degree in business administration. Students learn concepts of practice management, strategies of cost-contained care, legal aspects of care, billing, service-quality assessment, and documentation. Each student develops an interdisciplinary project such as the formulation of a multispecialty rehabilitation clinic program, refining a billing and documentation strategy for clinical practice, developing efficient orthotic care strategies, etc. A written report and oral presentation is required. The report is archived in the departments of Occupational Therapy and Orthotic Science.
THEME 5: GERIATRICS, PEDIATRICS, AND SPECIAL POPULATIONS
An interdisciplinary course covers such issues as professionalism, ethics, assessment, and treatment of the multiply disabled patient. This course, entitled, “Capstone in Orthotic Science,” allows students to present clinical case studies that they encounter during their internship experiences. An interdisciplinary panel of faculty who promote interactive student learning supervise this seminar-oriented course. The course is designed to encourage students to utilize the knowledge and skills that they acquire throughout the program. This “finishing” course focuses on patient populations and cases that present unique treatment challenges and problem solving strategies in an interdisciplinary environment. Professionals from the clinical community, particularly the student’s internship preceptors as well as local orthotists and prosthetists, are encouraged to attend the class in order to expand their professional development and to contribute to the discussions.
THEME 6: UNIQUE TOPICS
The course used in Theme 6, entitled, “Introduction to Orthotic Science Fabrication Laboratory” includes topics such as safety training, laboratory compliance in Occupational Safety and Health and the Americans with Disabilities Act, operation of machinery, and the use of tools in a practical applied approach. The course begins with a foundation of materials science and progresses to use of laboratory machinery, culminating in the design of simple orthotic components. A clinically-oriented course in pharmacology allows students to learn how medications may impact their patient’s orthotic care. This course aims to cover the influence of a variety of drugs and their subsequent impact on the patient, as it also provides students with additional insight in formulation of the orthotic prescription. The neuroanatomy/neurophysiology course teaches advanced concepts with a clinical emphasis. The course is shared with students in the MPT program. The computer aided design/computer aided manufacture course integrates digital technology with clinical practice and teaches students the virtual methods of orthosis measurement, design, and fabrication. It integrates concepts of industrial engineering methods that are aimed at streamlining the fabrication process. The course in human pathology is clinically-oriented and interdisciplinary. It covers the signs, symptoms, and general diagnosis of neuromusculoskeletal conditions often treated by the orthotist.
ALTERNATIVE PATHWAY TO THE MOS
Students who already possess a Bachelor’s degree and have completed all the prerequisite coursework may choose to attain the MOS degree as an extension of title. Practicing orthotists and students from related health care professions in physical therapy, occupational therapy, athletic training, social work, nursing, or from other programs such as engineering and art, are candidates for this pathway because the MOS curriculum is designed as an entry-level practitioner program. The program assumes students have limited prior knowledge or experience in the profession of orthotics. Subsequently, the curriculum is designed to develop the knowledge and skills required to becoming an orthotist with advanced problem solving skills. Depending upon the student’s prior education and experience, strategies for awarding credit toward the MOS degree could be developed. This would include the award of course credit for individuals who successfully complete competency evaluations or display measurable skills and knowledge attained through life experience. These unique opportunities would allow students to complete the MOS in less time. Students from the allied health professions possessing the health science knowledge and practitioner skills could qualify for measurable competency evaluations and the award of credit for demonstrated clinical knowledge and skill. These individuals could attain the MOS degree to expand their repertoire of knowledge and skills and ultimately their employment opportunities. A student with an engineering or art background would enhance their existing degree with analytical aspects of problem solving, patient care and psychomotor technical orthosis design, and fabrication by attaining the MOS degree.
All MOS program graduates are required to complete a 1-year residency as a requirement for ABC certification. 11 The residency enhances the MOS graduate’s skills in both patient care, orthosis design, and fabrication under the supervision of a Certified Orthotist. In addition, the research initiated by the student in the MOS program can be furthered during this year in order to meet the NCOPE residency research requirement. 3
AIMS OF THE MOS PROGRAM
The MOS program aims to create a general practitioner with entry-level psychomotor and technical fabrication skills, advanced clinical and problem solving skills, and advanced research, teaching, and management knowledge. Students of this program will develop into the leaders of the orthotic and prosthetic profession in the 21st century.
Compared to other orthotic and prosthetic education programs, the extra course work in the MOS program will provide students with additional didactic, clinical, administrative, and research experience. In addition, students will become a more integral part of their patient’s health care team, and they will possess the knowledge and experience needed to actively participate in decision-making. Collaborative research would be performed at a more advanced level. To accomplish this, the MOS program includes course content and clinical experience that is aimed to improve the level of collaboration and competence of students in the same interdisciplinary environment within which they will eventually provide services.
ADVANCING ORTHOTIC AND PROSTHETIC SCIENCE
The rehabilitation of a person in need of an orthosis or prosthesis does not end when the device is fitted. Patients need long-term continual assessment to enhance their physical and social function. In 1992, the National Commission on Medical Rehabilitation Research developed a model of medical rehabilitation that recognizes the following major themes: 1) focus on function and on the dynamic linkages of function to pathophysiology, impairment, disability, and society; 2) concern for the limitation of the initial and succeeding impairments on the function of the whole person in the community; and 3) the concern for the evolution of the initial and succeeding impairments across the life span with development and aging. 12 Only an interdisciplinary approach to education, such as that offered by the MOS, provides future orthotists with the knowledge and skills needed to be an integral member of the rehabilitation process. This is supported by the National Commission on Medical Rehabilitation Research’s assessment that, “Cross-cutting issues are part of the rehabilitation system that can directly or indirectly enhance the function of a person with a disability; that includes: 1) developing assistive devices from new and existing biotechnologies; 2) devising state-of-the-art measurement tools, databases with items relevant to the problems faced by people with disabilities, and epidemiological studies providing information on primary and secondary prevention of impairment, functional loss, and disability; 3) evaluating medical rehabilitation treatment and service delivery; 4) training scientists to study rehabilitation research issues; and 5) coordinating medical rehabilitation related research.”12 In this regard, graduate-level interdisciplinary training in orthotics and prosthetics will enhance the advancement of the profession because it will allow sufficient time for depth and exploration of the evolving and complex nature of orthotics and prosthetics.
The MOS program will address the lack of research in orthotics and prosthetics. Most of the essential principles of the orthotic and prosthetic profession are based on broad generalizations that have not been subjected to the scrutiny of the scientific process. 13 The need for continued research to develop orthotic (and prosthetic) management as a science and an art has been well documented. 14–18 Richard Lehneis, Ph.D. addresses these issues, “There has been no real breakthrough (in orthotics) in many years … To achieve a major breakthrough and progress in areas of improved orthoses … research teams need to be working together closely to combine the skills of at least the … physiatrist, orthopedist, orthotist, engineer, and physical and occupational therapist”. 19
The MOS program allows an avenue for teaching the myriad of new procedures and knowledge, advancing technology, changes in health care, the growing need for research and teaching skills, and the changes in education standards that continue to challenge those involved in the orthotic and prosthetic profession. Other issues that can be addressed are the fluctuation of reimbursement in health care and the need for continued research, public relations, and educational efforts which require demonstration of the cost effectiveness of patient care. 20 The MOS program’s graduates will also help meet the needs of an unprecedented increase in the number of patients who require orthotic services that have been projected to continue for the next 20 years. 21–34
The MOS program provides important educational opportunities for both undergraduates seeking careers in the health sciences and for individuals who already practice in allied health (i.e., orthotists, physical therapists, occupational therapists, and other allied health care professionals). In addition, professionals from related professions in engineering and related programs will benefit from the MOS degree. The MOS research curriculum will result in an expanded body of knowledge and enhanced development in the orthotic and prosthetic profession. 35,36 The additional time spent in advanced orthotic science education allows more curricular time in advanced coursework. MOS graduates will be able to seek positions in clinical practice as well as a variety of other areas where opportunities will develop in manufacturing, ergonomics, research, and administrative management (Raschke S, unpublished data, 2001). 37 MOS graduates seeking faculty positions will have opportunities to apply their solid knowledge base and interdisciplinary approach to orthotic patient care, management, and research.
EXPANSION TO A MASTER OF PROSTHETIC SCIENCE
After the MOS program has been established and fully accredited, a parallel Master of Prosthetic Science (MPS) will be established. Students will have the opportunity to gain a graduate degree in either orthotic science, prosthetic science, or dual degrees in prosthetics and orthotics (MPOS). The dual degree MPOS option will involve a 3-year professional graduate curriculum that adds 1 year of core prosthetic science courses to the MOS curriculum. Separate 1-year residencies in each discipline must be completed after graduation in order to fulfill requirements to take the ABC practitioner certification examination(s). 11
Interprofessional education among health care students has long been regarded as an effective solution to improve interprofessional communication in clinical practice. 38–40 Others cite the effectiveness of multidisciplinary medical education and the effectiveness of health care provided by its students with positive outcomes displayed in practice settings. 38,41–46 Several studies suggest that learning to work in an interdisciplinary environment should occur early in the education of the health care professional (within the first 2 professional years) in order to reduce barriers in communication and promote collaboration. 47–50 The MOS program is based on the concept that interdisciplinary education enhances education of its students and fosters team building. The curriculum is built upon the foundation of core orthotic science courses that are supplemented by interdisciplinary supportive health science courses. The supportive interdisciplinary health science courses are established courses at the university’s related allied health programs and the curriculum is modified to fit the MOS curricular model. The sharing of coursework and faculty in the interdisciplinary courses avoids duplication of university resources. A challenge of this model is in negotiating common curricular content in shared interdisciplinary courses. Collaborating departments and faculty must establish professional boundaries of the shared curriculum to prevent encroachment among disciplines. Thus, the shared interdisciplinary curriculum will involve universal physical examination, communication strategies, and other topics. Treatment strategies and techniques specific to each discipline (i.e., techniques of impression taking or device fabrication) will be restricted to the program’s core curriculum. This process involves patience, collaboration, and sometimes compromise (Hovorka CF, unpublished report, April 10, 2001). Through the evolution of interdisciplinary course content, effective strategies will be developed to enhance the educational value of all collaborating departments. 51
The recommendation that future practitioners have the competency to work effectively in interdisciplinary teams is not new. Educating students to interact as an interdisciplinary health care team remains a challenge for the health care professions. 51–55 Interdisciplinary education can be hindered by many things such as licensure requirements and professional perogatives. 56 Medical, nursing, and allied health programs currently provide very little direct, collaborative, interdisciplinary education for their students, despite the fact that these programs train students for future health care roles. 57,58 The time has come for changes in orthotic and prosthetic curricula and begin to enhance communication and collaboration between other established allied health and medical professions.
The orthotic and prosthetic profession can learn how to develop interdisciplinary education programs through the documented experiences of other allied health and medical education programs. 51,56,59–79 In addition, a comprehensive textbook, resource guide, and handbook address strategies for successful program development. 58,80,81 These publications were developed by professionals in a variety of disciplines including education, medicine, and allied health, and they provide comprehensive recommendations for new interdisciplinary education programs in the health sciences. A number of these concepts are integrated in the MOS curriculum model. The interdisciplinary health science education literature can be summarized by James Warren, a noted expert in interdisciplinary education who states, “The complexity of problems facing health care in the 21st century are problems which often do not have a single answer, but require a very broad orientation. Health care providers must also listen to and work with each other, recognizing their diverse backgrounds and the multitude of agendas, values and priorities that affect the choices they make.”82
Faculty formulating the curriculum and teaching core orthotic (and prosthetic) science courses must possess ABC certification and should possess at least a Master’s degree with the Doctoral degree preferred. Because of the limited number of ABC certified practitioners possessing credentials beyond the Bachelor’s degree and formal training in teaching, plans should be established to develop core faculty. Faculty possessing teaching as well as clinical and technical experiences should be targeted for teaching positions in the program and supported with release time and other assistance to allow a pathway to attain an advanced master’s degree in education or a related field (Hovorka CF, unpublished data, 2001). Adjunct faculty can be selected to develop curriculum and lectures from each individual’s area of expertise. Because of the interdisciplinary nature of the MOS curriculum, it is essential that all faculty possess collaborative and team working abilities in a multidisciplinary setting. 83
Interdisciplinary faculty who teach the supportive courses should possess a terminal graduate degree (usually the doctoral degree) in their teaching discipline. Preferably, faculty from existing health science departments within the university should be utilized. This provides for efficient utilization of university faculty and other resources by reducing duplicative course development. Faculty from allied health and other science departments (i.e., physical therapy, occupational therapy, industrial engineering, medicine, etc.) will collaborate with the MOS program faculty to develop the interdisciplinary supportive courses.
The development and maintenance of orthotic and prosthetic education programs is expensive. The nature of clinical practice and device fabrication requires significant funding to cover costs for specialized equipment, supplies, didactic lecture space, clinical patient laboratory space, fabrication laboratory space, and the establishment of facilities that ensure safety and other standards. 84–87 In order for an effective orthotic and prosthetic graduate program to be developed at a university, the administration must be willing to lend financial support to its development. Atop the list of supporters should be the university’s president, provost, dean, and department directors from all interdisciplinary collaborating departments. In addition to the university’s administrative and financial support of the program, varied sources of funding must be secured as supplemental funding from federal sources (i.e., Department of Education’s Rehabilitation Services Administration, Health and Resource Services Administration, etc.) and foundations that support rehabilitation and allied health education. The support of university alumni is critical. Collaborations with manufacturers in the orthotic and prosthetic industry, clinical orthotists and prosthetists, and the medical and allied health care community are equally important. 80,87
MARKETING AND STUDENT RECRUITMENT
The course entitled, “Introduction to Allied Health Careers” will be offered to interested high school students during the summer session as part of an introductory university experience. This approach allows for recruitment of high school students who do not necessarily possess prior knowledge of the orthotic and prosthetic profession. 88 In addition, the course could be taught to first year college students as a way to introduce the orthotic and prosthetic profession and allow them to receive university course credits.
To recruit “traditional” undergraduate students, an effective and innovative marketing plan involving appropriate print, video, and web site information to educate individuals about the benefits of the orthotic and prosthetic profession must be designed early in the program’s development. This plan should target students and parents and illustrate the rewarding nature of a career in orthotics and prosthetics. The excellent employment outlook and above average income potential in comparison to other careers must be stressed. 89 Additionally, marketing and recruitment should occur at information booths held at regional college career fairs and on-site information sessions should be sponsored by the department of orthotic science. All of these efforts should be provided on a regular basis to establish the program’s identity.
Non-traditional students (such as those seeking second careers and individuals who possess life experiences in other professions or trades) should also be recruited through career presentations that emphasize the need for and value of postprofessional education. Research suggests that the major reasons allied health professionals pursue graduate education is to develop personally and to increase skills and knowledge. As age increases, interest in graduate school decreases, and interest is highest in those individuals with 3 to 6 years of post graduate employment. 90 The recruitment goal for these potential students is to reach adults who are already educated at a Baccalaureate level in allied health or related professions and who are looking for a Master’s degree. Also, individuals who are interested in allied health careers and are not aware of the graduate degree in orthotics and prosthetics should be recruited. Women and minorities should also be targeted as a means to enrich, expand, diversify, and offset the male-dominated orthotic and prosthetic profession (Shurr, D. G., American Prosthetics and Orthotics, Inc., personal communication: August 15, 2001).
Arranging presentations at high schools and universities is essential. This provides an avenue to reach additional students by presenting the orthotic and prosthetic profession to existing academic clubs at these institutions such as Pre Medical Club, Pre Engineering Sciences Club, Pre Physical Therapy Club, Pre Occupational Therapy Club, and similar programs.
Evaluation of any education program is critical in the measurement of outcomes to identify weaknesses or problems and to provide solutions as a means of growth and development. 56,73,75,87,91 Qualitative and quantitative performance evaluations should be regularly conducted to assess the program, its faculty, and students. The evaluation and accreditation standards for orthotic and prosthetic practitioner education exist only for the Bachelor’s degree and postBachelor’s certificate programs, and no evaluation or accreditation standards have been developed for an orthotic and prosthetic Master’s degree program. As a result, orthotic and prosthetic graduate programs must assume a leadership role and collaborate with Commission on Accreditation in Allied Health Education Programs and NCOPE to establish a new accreditation standard.
Evaluation of the educational program is tied to performance standards and identified outcomes aimed to assess the programs objectives and educational outcomes (Hovorka CF, unpublished data, April 10, 2001). 2 The purpose of this process is to improve instruction, curriculum, and student skills. Curriculum, course descriptions, and course outcomes are evaluated and approved by the institution’s educational policies and faculty committee prior to course offerings. An internal advisory board consisting of MOS core and interdisciplinary faculty, as well as an external advisory board consisting of orthotists, physical therapists, occupational therapists, orthopedists, physiatrists, engineers and researchers, will review the program annually. 2,6
MEASURING PROGRAM EFFECTIVENESS
The MOS program director, as well as the orthotic science and interdisciplinary faculty, will create the specific assessment methods, including:2
- Analysis of program goals/objectives using a matrix built on syllabus objectives, departmental objectives, and accreditation objectives to assure all objectives are covered in multiple courses. The design will determine how each course helps secure the necessary course-specific as well as program outcomes.
- Student assessment of how well each course meets its intended objectives.
- Assessment of student learning is achieved by evaluation of student research via a written report and poster presentation at the annual university research symposium and, preferably, at the orthotic and prosthetic professional meeting. In addition, students complete a comprehensive written, technical skills and clinical skills examination to assess understanding of the didactic, technical, and clinical components of the curriculum.
- Instructor behavior outcomes are measured through the use of a mid-term student evaluation as well as an end of term student course evaluation.
- Program analysis is conducted annually where students assess the overall delivery of the program including course content, registration, financial aid, support staff assistance (library, business office, etc.), and academic advising via a questionnaire.
- Assessing the assessment plan. This is measured through the process of annual external advisory board evaluation.
- Assessment of graduates is measured by surveying employers, residency directors, and practitioners and by monitoring the graduate’s scores and passage rate on the national board certification examination.
- Assessment by the off-campus Advisory Board. The external Advisory Board will review the MOS program outcome data and provide suggestions for improvement.
- Evaluation of the program director and faculty through an annual self-study and goal setting/action planning administrative assessment process.
For the advancement of any profession to occur, the research base it relies upon must expand and evolve. Because the orthotic and prosthetic profession relies on a limited research base, its future depends upon its ability to add new knowledge through structured investigation processes. The relatively small size of the profession, the shortage of certified practitioners, educators, and researchers, including reduced funding for schools, have contributed to the struggle for advancement of orthotic and prosthetic education. In addition, the curricular design in many education programs does not provide sufficient time to address advanced exploration of study. To address these issues, an interdisciplinary entry-level MOS degree program, and eventually a parallel MPS program, is proposed. This graduate program will provide new opportunities for advanced education and allow students to complete a Bachelor’s and MOS or MPS degree within a coordinated 5-year curriculum or an MPOS within a 6-year program. A secondary pathway toward the advanced degree is available for individuals who already possess a Baccalaureate degree. Research has shown the interdisciplinary allied health and medical education model to be effective in teaching students to work with their colleagues and in producing positive health care outcomes. An entry-level master’s degree program that consolidates core orthotic science and eventually prosthetic science courses complemented by interdisciplinary supportive graduate allied health science courses will provide advanced training and education of future graduates and prepare orthotists and eventually prosthetists for the new millennium.
1. Practice Analysis of the Disciplines of Orthotics and Prosthetics
, American Board for Certification in Orthotics and Prosthetics, Inc.: Alexandria; 2000.
2. Bozik DS, Shurr DG. Allied Health Project Grant.
[grant proposal]. Health and Resources Service Administration, U.S. Department of Education, no. 5D37HP0072803, 1999; 12:
3. National Commission on Orthotic and Prosthetic Education. February 27, 2002; http://www.ncope.org
4. Commission on Accreditation of Allied Health Education Programs. February 27, 2002; http://www.caahep.org
5. St. Ambrose University. St. Ambrose University Master of Occupational Therapy Program (2+3 program). February 1, 2002; http://www.sau.edu/ot
6. Listing of educational programs in occupational therapy, accredited professional programs. Am J Occup Ther. 2001; 55: 666–671.
7. St. Ambrose University. St. Ambrose University Master of Physical Therapy Program (4+2 program). January 28, 2002; http://web.sau.edu/mpt
8. American Physical Therapy Association. Guide to physical therapist practice, 2nd Ed. Phys Ther. 2001; 81: 9–744.
9. American Physical Therapy Association. A Normative Model for Physical Therapist Professional Education.[report]. Alexandria, VA: American Physical Therapy Association; 2000. 2–25.
10. Commission on Accreditation in Physical Therapy Education. Accreditation Handbook. Alexandria, VA: American Physical Therapy Association; 2000: 5–38.
11. American Board for Certification in Orthotics and Prosthetics, Inc. Practitioner Book of Rules. Alexandria, VA: American Board for Certification in Orthotics and Prosthetics, Inc.; 1999: 4–6.
12. National Institutes of Health. Research Plan for Medical Rehabilitation Research. Bethesda, MD: National Institutes of Health; 1992: 21
13. Lunsford TR. Types of clinical studies. J Prosthet Orthot. 1993; 5: 32–38.
14. Cox RC, West WL. Fundamentals of Research for Health Professionals, 2nd Ed. Laurel, NJ: Ransco Publishing Company; 1986; 1–14.
15. Horen IR. Back to the future. O&P Almanac. 1989; 38: 49
16. Lunsford, TR. Research, why? O&P Almanac. 1989; 38: 53
17. Teague CW. Promoting research for the profession. O&P Almanac. 1991; 40: 26
18. Retzlaff K Leading O&P education into the 21st century. O&P Almanac. 1992; 41: 32
19. Lehneis HR. Orthotics: The state of the art. J Rehabil Res Dev. 1993; 30: vii–viii.
20. Wiener JM, Clauser SB, Kennell DL. eds. Persons with Disabilities: Issues in Health Care Financing and Service Delivery. Washington, DC: The Brookings Institution; 1995; 10–45.
21. Fishman S. The professionalization of orthotics and prosthetics. O&P Business News.June 1, 2001; 10: 24–30.
22. 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 Comission on Prosthetic and Orthotic Education: November 1996; iii–21.
23. 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;
24. Benson V, Marano MA. Current estimates for the national health interview survey 1993. National Center for Health Statistics, Vital Health Statistics. 1994; 10: 190
25. Reiben GE, Boyko EJ, Smith DG. Lower extremity foot ulcers and amputation in diabetes.In: Harris MI, ed. Diabetes in America, 2nd Ed. Bethesda, MD: National Institutes of Health Publication #95–1468; 1995; 409–428.
26. You Can Make a Difference In People’s Lives … Become an Orthotist or Prosthetist.[pamphlet]. Alexandria, VA: Orthotics and Prosthetics National Office; 1997.
27. Campbell PR. Population projections for states by age, sex, race and Hispanic origin: 1993–2020.[report]. Washington, DC: U.S. Department of Commerce, Bureau of the Census; 1994.
28. American Orthotic and Prosthetic Association. Business Survey, 1995.[report]. Alexandria, VA: American Orthotic and Prosthetic Association; 1996.
29. Hsing CW. An assessment of the manpower demand for orthotic and prosthetic practitioners. A study funded by the Rehabilitation Services Administration, U.S. Department of Education.[report]. Dominguez Hills, CA: California State University; 1990.
30. 2001, An O&P odyssey. O&P Business News. 2001; 10: 122–132.
31. Farley M. O&P education: At the crossroads? O&P Business News. 2000; 9: 50–55.
32. Is there a prosthetist/orthotist in the house? O&P Business News. 2000; 9: 1–80.
33. St. Ambrose University to offer unique master’s degree program. O&P Business News. 2000; 9: 82–84.
34. Conn D. The state of education in O&P. O&P Almanac. 2000; 49: 52–56.
35. Umbrell C. Educating tomorrow’s practitioners, a practical debate. O&P Almanac. 2001; 50: 40–45.
36. Gough L. Industry leaders look ahead to a separate future. O&P Almanac. 2000; 49: 50–54.
37. Carter MA. O&P master’s programs. January 1, 2002; http;//www:oandp.com/news/2001121–02.asp
38. Deinst ER, Byl N. Evaluation of an educational program in health care teams. J Community Health. 1981; 6: 282–298.
39. Jacobs LA. Interprofessional clinical education and practice. Theory Into Practice. 1987; 26: 116–123.
40. Multidisciplinary education [editorial]. Med Educ. 1995; 29: 329–331.
41. Slack MK, McEwan MM. Pharmacy student participation in interdisciplinary community based training. Am J Pharm Educ. 1993; 57: 251–257.
42. Weise WH, Howard CA, Stephens JA. Augmentation of clinical services in rural areas by health science students. J Med Educ. 1979; 54: 917–924.
43. Nahata MC, Powell DA, Glazer JP, Barson WJ. Teaching pediatric disease to medical, pharmacy and nursing students during monthly rotations. J Med Educ. 1982; 57: 639–640.
44. Magarian EO, Peterson CD, McCullgh ME, Kuezel RJ. Role model ambulatory care clinical training site in a community based pharmacy. Am J Pharm Educ. 1993; 57: 1–9.
45. Taylor AT. Drug information requested by medical students and house staff members. J Med Educ. 1982; 48: 825–826.
46. Robertson KE, McDaniel AM. Interdisciplinary professional education –a collaborative clinical teaching project. Am J Pharm Educ. 1995; 59: 131–136.
47. Horak BJ, O’Leary KC, Carlson L. Preparing health care professionals for quality improvement: The George Washington University/George Mason University experience. Qual Manag Health Care. 1998; 6: 21–30.
48. Anvaripour PL, Jacobson L, Schweiger J, Weissman GK. Physician-nurse collegiality in the medical curriculum: Exploratory workshop and student questionnaire. Mt Sinai J Med. 1991; 58: 91–94.
49. Headrick LA, Neuhauser D, Schwab P, Stevens DP. Continuous quality improvement and the education of the generalist physician. Acad Med. 1995; 70: S104–S109.
50. Headrick LA, Richardson A, Priebe GP. Continuous improvement learning for residents. Pediatrics. 1998; 101: 768–773.
51. Lowry LW, Burns CM, Smith AA, Jacobson H. Compete or complement? An interdisciplinary approach to training health professionals. Nurs Health Care Per. 2000; 21: 76–80.
52. Shugars DA, O’Neil EH, Bader JD. eds. Health America: Practitioners for 2005, An Agenda for Action for U.S. Health Professional Schools. Durham, NC: Pew Health Professions Commission; 1991; 2–90.
53. O’Neil EH. Health Professions Education for the Future: Schools in Service to the Nation. San Francisco, CA: Pew Health Professions Commission; 1993; 11–29.
54. Pew Health Professions Commission. Critical Challenges: Revitalizing the Health Professions for the Twenty-First Century. San Francisco, CA: UCSF Center for the Health Professions; 1995; 34–56.
55. Bellack JP, O’Neil EH. Recreating nursing practice for a new century: Recommendations and implications of the Pew Health Professions Commission Final Report. Nurs Health Care Per. 2000; 2: 14–21.
56. Erickson B, McHarney-Brown C, Seeger K, Kaufman A. Overcoming barriers to interprofessional health sciences education. Educ Health. 1998; 11: 143–149.
57. Summers SH. Interdisciplinary courses: New arrangements for learning. Clin Lab Sci. 1997; 10: 12–14.
58. Duncanis A. Golinn AK, The Interdisciplinary Health Care Team: A Handbook. Germantown, MD: Aspen Systems Corporation; 1979; 2–20.
59. Hall P, Weaver L. Interdisciplinary education and teamwork: a long and winding road. Med Educ. 2001; 35: 867–75.
60. Rosher RB, Robinson SB, Boesdorfer D, Lee K. Interdisciplinary education in a community based geriatric evaluation clinic. Teach Learn Med. 2001; 13: 247–252.
61. Nielsen C, Altman R, Gillespie P, Douglas. A model for graduate education in orthotics and prosthetics. Clin Prosthet Orthot. 1987; 11: 63–66.
62. Scherger JE, Rucker L, Morrison EH, Cygan RW, Hubbell FA. The primary care specialties working together: A model of success in an academic environment. Acad Med: J Assoc Am Med Col. 2000; 75: 693–8.
63. Fields S. The interplay of biology and technology. Proc Natl Acad Sci U S A. 2001; 98: 10051–10054.
64. Ullian JA, Shore WB, Lewis R, First, MD. What did we learn about the impact on community-based faculty? Recommendations for recruitment, retention, and rewards. Acad Med. 2001; 76: S78–S85.
65. Summers SH. Interdisciplinary courses: New arrangements for learning. Clin Lab Sci. 1997; 10: 12–14.
66. Blue AV, Griffith CH, Stratton TD, et al. Evaluation of students’ learning in an interdisciplinary medicine –surgery clerkship.. Acad Med. 1998; 73: 806–808.
67. Browne A, Carpenter C, Cooledge C, et al. Bridging the professions: An integrated and interdisciplinary approach to teaching health care ethics. Acad Med. 1995; 70: 1002–1005.
68. Parsell G, Spalding R, Bligh J. Shared goals, shared learning: Evaluation of a multiprofessional course for undergraduate students. Med Educ. 1998; 32: 304–311.
69. Matthews MK, Koenisberg R. Neurobehaviour rounds and interdisciplinary education in neurology and psychiatry. Med Educ. 1998; 32: 95–99.
70. Smith M, Barton J, Baxter J. An innovative, interdisciplinary educational experience in field research. Nurse Educ. 1996; 21: 27–30.
71. Gordon PR, Carlson L, Chessman A, et al. A multisite collaborative for the development of interdisciplinary education in continuous improvement for health professions students. Acad Med. 1996; 71: 973–978.
72. Carpenter J. Interprofessional education for medical and nursing students: Evaluation of a program. Med Educ. 1995; 29: 265–272.
73. Buck MM, Tilson ER, Andersen JC. Implementation and evaluation of an interdisciplinary health professions core curriculum. J Allied Health. 1999; 28: 174–178.
74. Snadden D, Bain J. Hospital doctors, general practitioners and dentists learning together. Med Educ. 1998; 32: 376–383.
75. Betz CL, Turman J. A process of developing terminal competencies for an interdisciplinary training program. J Allied Health. 1997; 26: 113–118.
76. Greene RJ, Cavell GF, Jackson SHD. Interprofessional clinical education of medical and pharmacy students. Med Educ. 1996; 39: 129–133.
77. Matson C, Davis A, Steinkohl C, Blavo C. How did we make the interdisciplinary generalist curriculum project work? School level efforts to facilitate success. Acad Med. 2001; 76: S31–S40.
78. Susman J, Pascoe J. Recommendations to institutions. Acad Med.Apr 2001; 76: S137–S139.
79. Scherer JE, Rucker L, Morrison EH, Cygan RW, Hubbell A. The primary care specialties working together: A model of success in an academic environment. Acad Med. 2000; 75: 693–698.
80. Klein JT. ed. Interdisciplinarity: History, Theory and Practice. Detroit, MI: Wayne State University Press; 1990; 11–60.
81. Pew Health Professions Commission. Interdisciplinary Collaborative Teams: A Model Curriculum and Resource Guide. San Francisco, CA: Center for the Health Professions, University of California Press; 1995; 23–54.
82. Warren J. Thoughts on listening to a conference on medical education for the 21st century. The Advisor. 1985; 22–23.
83. Leathard A, ed. Going interprofessional: Working together for health and welfare. London: Routledge; 1994; 6–94.
84. Orthotic & Prosthetic Patient Care Management and Facility Accreditation Program, Standards of Performance Manual.[manual]. Alexandria, VA: American Board for Certification in Orthotics and Prosthetics Inc.; 1996;
85. Occupational Health and Safety Administration Priorities—Noise/Hearing Conservation. Month December 9, 2001; http://www.osha.gov/oshinfo/priorities/noise.html
86. National Research Council (U.S.). Prudent Practices in the Laboratory, Handling and Disposal of Chemicals. Washington, DC: National Academy Press; 1995; 27–150.
87. Uniform Federal Accessibility Standards. September 13, 2001; http://www.access-board.gov/ufas/ufas-html/ufas.htm
88. Thornton BC, Kreps GL. Perspectives On Health Communication. New York: Waveland Press, Inc.; 1996; 3–10.
89. Orthotics and Prosthetics Business and Salary Survey.[report]. Alexandria, VA: American Orthotic and Prosthetic Association; 1999;
90. Dickerson AE, Wittman PP. Perceptions of occupational therapists regarding post professional education. Am J Occup Ther. 1999; 53: 454–458.
91. Sackett DL, Rosenberg WMC. On the need for evidence-based medicine. Health Econ. 1995; 4: 249–254.
The entry-level master of Orthotic Science program at St. Ambrose University was recently discontinued by the university administration due to increasing financial challenges compounded by the U.S. economic crisis. The concept of the program remains viable and important for the advancement of the profession. However, from this experience it is clear that future programs will need diversified funding strategies to maximize their capabilities for development and growth. The president of St. Ambrose University fully supports the concept of masters degree education as the entry level degree necessary for the advancement of orthotics and prosthetics. The director is currently seeking to relocate this educational model to another university with sufficient sources of funding.