The Education of Prosthetists

[RENARDWC at ctrvax.Vanderbilt.Edu]

Further information on the education of a prosthetist with permission of
Lance Hoxie:  [WCR]

Date: Wed, 04 Aug 1999 09:09:16 -0400
From: Lance Hoxie <lhoxie at OPOFFICE.ORG>
Subject: Re: August 1,1999  International O&P License Requirement Poll
Sender: Orthotics and Prosthetics List <OANDP-L at lists.ufl.edu>

Dear Mr. Boyer:

I couldn't agree more. In fact, ABC certification, under its primary
pathways for certification, requires successful completion of a defined
educational program approved by the Commission on the Accreditation of
Allied Health Programs (CAAHEP). Following this, a candidate must
successfully undertake a one-year residency program approved by the
National Commission on Orthotic and Prosthetic Education (NCOPE).

Forgive me: I don't want to appear to be lecturing, but let me outline a
few points that may help everyone on the listserv understand ABC
certification and its underlying requirements:

CAAHEP is the largest specialized accreditation body (formerly sponsored
by the American Medical Association as the Committee on Allied Health
Education and Accreditation) that accredits allied health education
programs, including physician assistant and respiratory therapy
programs.

This body accredits O&P primary education programs according to
standards developed by, and adopted from, NCOPE. Such educational
programs are either baccalaureate-based (BS in O&P) or are
post-collegiate, one year certificate programs in O&P. Thus, in order to
be certified by ABC, an applicant must provide evidence of this
education.

Following his/her primary education, the applicant must show that he/she
has completed a one-year structured residency program accredited by
NCOPE.

These residency programs can be mostly described as medical-model based.
That is, the resident must deliver certain defined patient-care services
under the direction of an ABC-certified practitioner (in the appropriate
discipline); must demonstrate competency with defined areas of patient
care (lower limb, upper extremity, etc.) and must prepare a
research-based paper.

An applicant who completes these two educational pre-requisites must
then sit for three ABC certification exams:

       A 3-hour written, multiple-choice exam;

       A 3-hour written, simulation exam: essentially a problem-solving,
       logic-tree approach)

       A 3-day clinical patient management exam

All candidates must pass these three exams or they will not be ABC
certified.

While this may be our preferred pathway, we also have pathways to
certification that address significant experience. For example, a
practitioner who cannot fulfill the primary education requirements but
has at least 10 years experience and who has earned college level
credits in certain defined science subjects may also apply for
certification. In such cases of "unique qualifications," the applicant
must submit specific case studies (for specific types of O&P devices) as
a part of their application. Such applications are then individually
reviewed by our Applications Review Committee in order to determine
eligibility.

As an attestation of the validity of ABC's standards, the four states
with current licensure laws all mirror our certification requirements
for licensure (although admittedly, such requirements may be subject to
a "phase in" approach). In addition, the three states that have enacted
the law Florida, Texas, and Washington) have all contracted with the ABC
to administer the licensure exams.

I also admit that the current state of the art, with respect to
certification and competency, cannot guarantee competency, it is the
only available mechanism to at least subject practitioners to standards.
Outcomes measurements is desired next step. But, as with other health
professions, we have only just begun to develop such measurements. The
ABC will continue to pursue this next step as an integral part of its
competency-based evaluation mechanism.

Lance Hoxie

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Dear Mr. Hoxie - Thank you for mirroring and amplifying what I said. Let
me add that I feel certification certainly IS valuable, as an adjunct to
the much-needed expansion of other programs of preparation, notably
residency requirements of extended work under the eye of a master to
ensure the TALENT and preparation of the entrant. I see the push for
certification itself as a red herring drawing attention away from
necessary correction of deficits in the preparation for talented
performance (competence) in prosthetics.  George B.
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Lance Hoxie wrote:

Dear Mr. Boyer:

If your comments are that certification programs (including
examinations) do not guarantee that all who are certified or pass
certification exams are competent, then I agree.  There are many
examples in all fields of health care where a person who had every
credential possible still was not competent.