In 1993 the National Commission on Orthotic and Prosthetic Education (NCOPE) adopted a new set of practitioner education standards. Those new standards reflected extensive research and lengthy debate, as well as concerns among the 10-member commission as to what constituted the core curricula for the education and training of today’s Orthotic and Prosthetic practitioner. The result was an adopted set of standards that transcended core orthotic and prosthetic subject matter by also emphasizing key peripheral knowledge in areas such as biomechanics, kinesiology, research, pathology, orthopedics, and rehabilitation. 1 Consequently, a comprehensive, accredited practitioner program often requires the expertise of learned professionals in all these aforementioned subject areas. This requires cooperation and collaboration between the allied health, medical, and academic communities, as well as the orthotic and prosthetic educators and the surrounding orthotic and prosthetic clinical community. The fact that NCOPE has never addressed the specific methodologies used to deliver said curricula was not an oversight on their part, but rather a deliberate decision to be nonprescriptive as to the various teaching strategies employed by different accredited programs.
The traditional delivery system employed for orthotic and prosthetic education has been a classroom setting where the instructor provides a lecture (or lecture/demonstration) and students listen, take notes and ask questions. This interactive component has traditionally been viewed as an essential learning element within this model, however there is very little documentation that quantifies or qualifies the value of classroom interaction. The virtual explosion of the information technology industry over the past decade has introduced resources beyond our comprehension. The result is that outside the orthotic and prosthetic community many of the nation’s 3600 colleges and universities have adopted distance and on-line education as the next logical step in matriculation programs. These systems are being heralded by some as the educational pedagogy of the future. Some people involved in the education arena have gone so far as to predict that the “residential based model” (students in classrooms at specific times) will disappear in the near future. 2
The fundamental question lies in whether or not the information technology and distance learning (DL) concepts can be effectively incorporated in orthotic and prosthetic education, and, if so, how would the outcomes be evaluated against the traditional methodologies used today?
While pragmatism rarely gets in the way of academia, orthotics and prosthetics students have often been faced with a crossroad at the end of their schooling. Today, the majority of students graduate from a postbaccalaureate certificate program. They then have to decide whether to begin their 1-year residency training in the completed discipline or return for the alternate discipline the following academic year, then enter a 2-consecutive-year orthotics/prosthetics residency training. While economics, practicality of displacement, availability of residencies, and demographics all play a role in the ultimate decision, the DL Program format may be a viable alternative that precludes this “either/or” dilemma (Figure 1).
METHODOLOGIES: TIME AND PLACE DIMENSIONS
The two-dimensional, four cell matrix can be applied when categorizing any educational system. The first dimension is time, and the second dimension is place. 3 The time component has two levels: synchronous time or real-time, i.e., when both delivery and receipt of the instructional materials occur simultaneously (as in the traditional seat class model; see Figure 2). Asynchronous instruction occurs when delivery precedes receipt and utilizes some method of recording the instructional materials. 4
The two levels of place can be characterized as: (1) same, where both instruction and student reception occurs at the same place; or (2) different, where the location of the instruction and receipt of the instruction are different. This matrix can be further described as: (1) current primary delivery, which refers to synchronous and same site; (2) DL, which is synchronous and different sites; (3) on-line, which is asynchronous and different sites, and (4) recorded, which is asynchronous and same site. 5, 6
As one reviews the Instructional Matrix (Figure 3), 5 a fundamental question that arises is: How does place and time impact on student learning or assimilation of skill sets? Is an asynchronous or synchronous method more effective with different types of curricula? The answers to these questions are largely unknown, as there appears to be very little research available to support one system over another in relation to the learning impact on students. 6
ONE POTENTIAL MODEL
At the present time, the Newington Certificate Program in Orthotics and Prosthetics provides students with a comprehensive knowledge of orthotics/prosthetics principles and entry-level skill sets in preparation for residency training. Through the traditional synchronous, same-location model, lectures, demonstrations, and laboratory experience are provided to students in all of the subject matter required by NCOPE’s education standards. The program is 1 academic year in duration (9 months), and each discipline (orthotics or prosthetics) must be taken independently of the other. All course work is categorized under one of two headings. Core courses are defined as any course that ends in the term orthotics or prosthetics, i.e., Lower Limb Orthotics I, Transfemoral Prosthetics, etc. The current curriculum incorporates 16 credit hours of core orthotics courses and 14 credit hours of core prosthetics courses. Noncore courses, by the Newington definition, are those peripheral courses that, while mandated by NCOPE standards, relate to subject matter relevant to, but not specifically covering, orthotic and prosthetic science, i.e., Biomechanics, Research, etc. While successful matriculation through the entire curriculum is required in order to achieve graduation, a minimal grade of C+ must be earned in all noncore courses in order to be exempt from repeating the noncore course upon return for title extension. In addition, according to our recency clause, the second discipline must be studied within 5 years of graduation in order for the noncore exemptions to apply. Current NCP students are required to take 20 noncore course credits during the academic year.
THE NEWINGTON DISTANCE LEARNING PROGRAM
Following the current format, any NCP student who has successfully matriculated through one discipline of study and wishes to extend title within 5 years, would be eligible for the DL Program. Figure 4 depicts our proposed format for DL.
The DLP program introduces several interesting potential advantages over the traditional education model offered on the Newington Campus. In the current system, students complete lab projects, i.e., casting, modifications, fittings, etc., with the help of professional patients (typically prosthetics) or model patients (typically, each other). This system is mirrored in most of the academic programs, and, historically, it has sufficed in the preparation of the students for real patient care. The reality of performing the task on real patients in an accredited patient care facility (under the auspices of a Board-certified mentor) could actually enhance the academic value. In addition, the delivery of 3 or 4 hours of intensive orthotic and prosthetic principles in lecture format can be difficult to assimilate by the seat student. Audio tape recordings help and are often used in comparison with notes taken during the lecture, but the students are nonetheless faced with deciding whether to listen, absorb and comprehend, or frantically take notes. In the DLP format, the student has the opportunity to review the CD as many times as necessary in order to comprehend the given principles, which is a distinct advantage over the traditional model.
Educational outcomes assessment (examinations) can also be enhanced with the proposed 3-day oral practical exam at the end of each academic semester. This will potentially give the instructor a much better opportunity to assess knowledge and skills (not unlike the current ABC CPM exam) over a much longer, more intensive testing process.
If the true test of educational efficacy is first, the orthotic and prosthetic student’s preparation for and performance in residency training and, second, performance on the Board exams, then the true assessment of the DL format won’t be possible for at least 3 academic years. This will enable a large enough sampling of graduates to compare to previous NCP graduates and their performance in the two aforementioned areas. The control group will also be those traditional first-year seat students matriculating through the same curriculum and comparing how they perform in like circumstances.
The primary mission of the program; the creation, presentation, integration, transmission, and application of knowledge, remains fundamentally unchanged. The delivery systems will merely be modified to create a culture of learning for today’s society, taking advantage of the new educational opportunities made available through new information technologies. The paradigm shift has begun.
1. NCOPE Education Standards. Commission Accreditation Standards, Guidelines for an Accredited Educational Program for Orthotists and Prosthetists.Adopted 6/ 1998: 93.
2. Blustain H, et al. Assessing the new competitive landscape.In: Katz R, ed. Dancing with the Devil. San Francisco: Jossey-Bass Publishers; 1999: 51–72.
3. Duderstadt JJ. The future of the university in an age of knowledge. JALN 1997; 2: 78–88.
4. Graves WH. “Free Trade” in higher education –The Meta University. Journal of Asynchronous Learning Networks 1997; 1: 97–108.
5. O’Malley J. Students perceptions of distance learning
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6. Moore GC, Benbasat I. Development of an instrument to measure the perceptions of adopting an information technology innovation. Information Systems Research 1991; 2: 192–222.