by Rebecca St. Andrie

If it’s been a while since you graduated, your skills might be out of date. O&P is a rapidly-evolving field, and students today are being taught skills that weren’t part of the syllabus five years ago.

But don’t worry. We spoke with educators at several different universities to discover the latest crucial skills they’ve included in their curriculum. Read on for a quick in-service on what you need to know.

1. Know how to help diagnose patients.
“We used to be purveyors of things—now we’re purveyors of care,” says Bob Lin, CPO, FAAOP, an associate clinical instructor at the University of Connecticut. Consequently, students today now know much more about the peripheral sciences related to O&P, such as gait analysis, than they used to.

And it’s necessary. Lin talks about how doctors’ requests have changed from prescriptions to help with diagnosis.

“Often, we get ‘Please evaluate’,” Lin says. “Patients come to us with a problem and we have to have a dialogue with the referring physician about the musculoskeletal deficit.”

Lin says students take more courses in gait analysis. “We equal, if not exceed, a PT’s knowledge of gait and pathomechanics,” he says. And his program is planning to offer more courses in the neurosciences and biomechanics labs.

“Ten years ago, we had a very superficial understanding of the clinical manifestation of cerebral palsy or stroke. Now we have the time and resources to go much more in-depth and understand the pathophysiology of what’s going on, and what we can affect in rehab. It helps us make better bracing choices,” Lin says.

For instance, now O&P students can identify how stroke medicine might affect a patient’s balance and memory. They also know that stroke patients can improve as long as two years after the stroke. All of this helps them evaluate whether a bracing strategy is working well or not.

There’s also been a corresponding increase in technology. For example, with CAD/CAM technology, O&P practitioners can do something more with a plagiocephaly patient than say “He looks better to me—does he look better to you?”

“Today we get called so much more for consultation,” Lin says. “In order to consult, we need knowledge.”

He thinks that the work environment will dictate that practitioners keep taking university courses.

“I have former [students,] certified practitioners, who audit [our] lectures on new materials,” he says. “It’s going to be like orthopedic surgeons and arthroscopic surgery. You’ve got to get your butt in there and learn how to scope, or your practice may become outdated.”

2. Know how to improve your patient interaction.
For Dan Abrahamson, CPO, assistant director of the University of Washington O&P program, the newest skills have come from an old source: Bloom’s Taxonomy of Learning.

This framework, which describes three domains in which people learn, was developed in the 1950s. So it’s nothing new. What is new is how its application to O&P is changing what—and how—Abrahamson teaches.

“As we get master’s degrees, we are learning more about teaching,” he explains. As a result, the skills he teaches are much more specific—and often much more about students’ interaction with patients.

“In the old days, a lot of O&P education was ‘Learn how to make a leg; learn how to make a brace’,” he explains. This would fall into the psychomotor category of learning—acquiring manual or physical skills.

Next, O&P education moved into the cognitive domain. Students were asked to understand gait, for instance, and how an orthosis might affect it.

Now Abrahamson focuses on the affective domain—the patient interaction skills needed to be able to apply all the other learning.

“The way you dress, make eye contact, address somebody, your listening skills for understanding what your patient tells you—instead of just trying to teach by example, we’re trying to acknowledge that this is a part of successful patient care,” he says.

When patients come in to the University of Washington’s clinic, Abrahamson has them rank students in all of these areas. He also ranks the students, and the students rank themselves. Then he leads class discussions on very specific aspects of professionalism. For instance, they will discuss the appropriate use of humor, or how much personal information a practitioner should disclose.

While these topics may sound like “things your mother should have taught you,” as Abrahamson puts it, “we could probably all use some feedback.” Practitioners who want to improve their skills, he says, should open themselves up and ask for feedback from their colleagues.

“Nine times out of ten, students are aware that something is wrong, they just don’t know how to fix it,” he says. The same solution that applies to them works for practitioners.

“See somebody who has those skills,” recommends Abrahamson. “Say, ‘Would you just come in with me next time?’”

3. Know how to keep your business alive.
“O&P is not the field that I was introduced to 15 years ago, and I’m not even a practitioner,” says Anita Liberman-Lampear, administrative director of the Orthotics & Prosthetics Center at the University of Michigan. “It’s harder. You have to understand how to stay alive in our field.”

To that end, she pushed for a semester-long business course in the University of Michigan’s O&P program. She has taught it now for several years, and as of the winter of 2008, it will be required for graduation.

Liberman-Lampear covers a wide range of topics in her class: marketing, managed care, Medicaid, Medicare, billing, interviewing, hiring, business policies and procedures, and an overview of O&P law. By the end, her students should be able to create an operating statement of how they would run their own O&P business.

Liberman-Lampear gets some resistance from students, because many of the topics can seem overwhelming and unfamiliar. But once they get out into the field, she says, they appreciate having the background.

For instance, she’s had students tell her that the marketing section of the course was helpful because they had to cold-call doctors once they started practicing. And Liberman-Lampear firmly believes that even getting an overview of a topic is helpful. “I teach something about everything so they can at least ask a good question and come across as intelligent; that way they’ll get a more intelligent answer,” she says.

“Some say ‘I’m just going to go work for somebody else,” but they will need to be able to write a good letter of medical necessity. And to do that, they need to understand the reimbursement system.”

Current practitioners probably understand that necessity more than students. For those who need to educate themselves on business, Liberman-Lampear suggests several different resources.

“Anyone can take my class online at EMUOnline.edu. And AOPA offers opportunities—the coding & billing seminars, the OPC report and the Business Optimization Analysis Tool (BOAT) that has been developed. Or people can go to the local community college and take accounting classes or a marketing course.”

With the growing sense that the O&P market is getting tougher, this may be the skill O&P practitioners will want to acquire first.

4. Know how to ask the right questions.
Conducting and understanding research has been a big topic in O&P lately. But Chris Hovorka, CPO, FAAOP, director of the O&P master’s program at Georgia Tech, says that he has focused on one particular skill that’s crucial to doing or understanding research: formulating a relevant question.

“We found that students couldn’t just magically conduct research and be productive—they needed faculty investigator guidance,” he said.

Now Georgia Tech’s program offers a more structured research experiences. Since students are just learning how to be clinicians, the program guides students in how to formulate a relevant question from the clinical experience that they’ve had.

For example, two students initially proposed a group research project on gaining more control over how an O&P device was thermoformed.

“‘How can we control the entire thermoforming process’? That’s a lifetime project!” comments Hovorka.
Instead, he had the students break down thermoforming until they focused on one specific aspect: the cooling phase. Then he had the students work with a plastics engineer and a fabricating technician to examine the crystalline properties of polypropylene during vacuum forming.

“That’s pretty reflective of a lot of the research challenges in O&P,” says Hovorka.

For practitioners who want to gain more experience in learning how to conduct or evaluate research, Hovorka suggests finding an expert who would know how to work on your question.

“It depends on a person’s knowledge, but the best thing is to team up with local medical schools or engineering schools…it would be best to work with a seasoned researcher, young Ph.D. student interested in new research collaborations, physician or clinical investigator,” Hovorka says. That way a practitioner wouldn’t be trying to learn how to do research on his or her own, but could bring a relevant clinical question to work on with others.

In fact, Hovorka thinks that role could be valuable to O&P practices in the future. He would like to see practitioners “work with schools to bring knowledge and experience to the clinic. They could be the feeders of information from the real world” into the new masters’ programs, he says.

5. Know about new materials.
“In the last ten years, there’s been an explosion in the amount of materials available,” says Alicia Davis, CPO, FAAOP at the University of Michigan.

That explosion has meant that Davis has changed both her curriculum and her teaching style.

“Before, we were teaching how to do; now, we’re teaching how to think,” she says. “It comes down to teaching students how to think in much more complex terms because of the variety of possibilities for components. I’m teaching the students principles of materials sciences and their application to the patient.”

“Before, if you had foot drop, you would make an AFO,” she says. “Now you have to decide between carbon fiber and plastic, consider medical issues—you have to pick the exact material that does the very best for the patient.”

The benefit to this explosion of information is that “there is a much greater respect for O&P and what [the profession is] capable of, and that in order to be respected you must have a deeper knowledge of these things,” says Davis. She says that their new physician residents come and ask questions about such differentiation all the time.

She encourages current practitioners to take shorter, formal courses instead of trying to educate themselves. “How do you differentiate between all the socket designs and materials for KAFOs, the pros and cons of each one, without the clinical knowledge and skills that you learn in a classroom setting?” she asks.

But, she says, O&P offers a lot of opportunities to get such classroom knowledge.

Davis says those who have been in the field for many years can be well-versed in these new technologies if they’ve been diligent in maintaining their CEUs. She mentions the M.A.S. course and the Becker courses as examples of the many courses offered in the newer technologies.

The wide range of topics may seem overwhelming. But all educators agreed: O&P’s expansion of knowledge is bringing it more recognition and respect. Get some of that respect yourself: take some time to learn the latest.

Rebecca St. Andrie is managing editor of the O&P Almanac.