The O&P fields continually face the challenges brought on by cutting edge technologies and expanding methodologies. These changes impact each person affiliated with day-to-day patient care on every level – from practitioner to technician – as well as students in educational programs preparing to deliver that care.
To better calculate the changes being felt on the orthotic and prosthetic technician level, the American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) along with the National Commission on Orthotic and Prosthetic Education (NCOPE) joined forces at the first-ever Technician Summit held January 24-25 in Dallas to discuss changing trends in technician performance and how those trends will change the future of the profession.
Summit
Robin Seabrook, executive director of NCOPE, and Catherine Carter, executive director of ABC, credit both organizations with the success of the first Summit.
“I was extremely excited about the Technician Summit,” Carter explained adding that the meeting had the full support of the ABC board of directors. “We want all programs to be valued equally.”
The Summit, attended by 27 technicians, practitioners and educational program members, explored three areas of current technician concern: education, the practice analysis and potential exam revision.
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The educational aspect of the Summit discussed the state of the registered technician, training and possible changes to credentialing – moving from registering technicians to certifying technicians.
The practice analysis work group drafted a survey, expected to be distributed this spring, which is intended to become an exam blueprint.
The exam revision group looked at the existing exam and discussed possible improvements and alternatives to the traditional delivery method.
“The timing [of the Technician Summit] worked out well for us because we needed to look at some other aspects of technician education by pulling together a variety of people,” Seabrook said.
She acknowledged the Summit as recognition of the different levels of practice within O&P.
“Some [levels] get more attention in a given year than any others,” Seabrook said stating that now is the time for focus on the technician level.
Traditional roles
Traditionally, the occupation of the technician required advanced hand skills, which according to Stan O’Connor, MEd, CP, technician instructor and prosthetic program director at Century College in White Bear Lake, Minn. is still the foundation of the successful technical career.
“[Our students] are not learning a lot of new technology,” O’Connor said. “I say that in a good way … You need to learn the basic hand skills to build upon them … these basic hand skills do transfer to the endoskeletal systems.”
Also a specific attribute of the technician role has been the behind-the-scenes nature of the work. Information gathered within the last decade indicates that the technician has taken on a more prominent clinical presence than ever before.
In the same way the technician role is changing so is that of the practitioner. Practitioners of the past had more technical knowledge than today’s practitioner, Tony Wickman, RT (OP) and treasurer of the Orthotic and Prosthetic Technological Association, explained.
“The point where the practitioner and technician interface has moved slightly closer to the clinical aspect,” Wickman said explaining that a lot of practitioners do not have a good understanding of materials and design in comparison to the practitioner of earlier days. “It used to be the practitioner’s job to see the patient and also develop a core concept for the device.”
Now, Wickman explained, many practitioners are relying more on technicians to help develop design concepts and inform them on materials.
Modern trends
Wickman, who has been a technician for 24 years, has extensive experience working with ABC to further technician registration and education. As the current chair of the practice analysis survey group, Wickman explained that as ideas were shared at the Technician Summit, varying theories on the role of the modern technician emerged.
“I think it’s the general consensus of the [practice analysis] team that the role of the technician is expanding,” Wickman said. “We don’t know the depth or the breadth of that expansion but we feel like technicians are.”
Seabrook and Carter also agreed that the role of the technician seems to be evolving. They have both heard, anecdotally, that the clinician is depending more and more on the technician but have no evidence, at this time, to support this claim. But that is not to say those statements are untrue.
“The [technicians] who are involved in the clinical practice are taking on more clinical responsibilities and the ones who are involved in a more central fabrication atmosphere have to grow their knowledge base to make up the difference between what practitioners know now and what they used to know,” Wickman told O&P Business News.
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Current scope
In order to gauge the current trends on the technician level, ABC is preparing a practice analysis survey of O&P technicians, to be released for comment this spring. This will be the first survey to measure the activities of the technical O&P career since 2000, Carter explained.
The practice analysis published in 2000 indicated that a percentage of technicians were providing a level of patient care, Seabrook said. The problem with that study, she continued, is that it did not delve deeper to find out what kinds of services they were providing, at what level, and under what kind of supervision.
According to ABC’s code of professional responsibility, technicians should not be providing patient care.
“That doesn’t mean they aren’t doing it,” Seabrook said. “That also doesn’t mean we won’t educate them down the road.”
This also raises the question of the career ladder. Both O’Connor and Seabrook addressed the need for this kind of advancement system at the technician level.
“There are certain technicians that [say] this is all they want to do. They have no interest whatsoever in providing any level of patient care,” Seabrook said. “They want to work with their hands and they want to work in the lab. Then you have other people who might see this as a career ladder. They want to become a technician, get into the profession and provide some level of patient care services. Those individuals might go on to be practitioners. Then you have those who like experiencing some level of patient care but they don’t want to [handle] the complex cases that would require additional education.”
This kind of curriculum changing prospect is one of the many reasons why a practice analysis is so vital at this time.
“The technical program has not been a front-burner issue and now it is and we have time to take a look,” Wickman said expressing what is already known about the current state of the technician level including statistics that show that technician registration is on the decline and registered technicians are not staying in the profession as long as they once did.
Carter recognizes these declinations and explained that the first steps toward reversal of these trends is to not only identify ways of raising interest and bringing more people into the profession but also to convey to technicians why their career choice is so important in addition to explaining how to do the job through education.
The more information that ABC can gather through the practice analysis, the more comprehensive and complete their results will be. These results could greatly impact the future of the profession and answer the existing needs of technicians.
“If 100% of registered technicians did the survey, we’d still only have, by some estimates between 5% and 30% of the industry,” Wickman said encouraging all technicians who receive the survey, ABC credentialed or not, to take the time to think about the state of their careers and what changes they are experiencing in their daily tasks as they complete the survey. Then, he implores them to let someone know these changes are taking place.
Carter agrees that the technician role has evolved adding that she is expecting when all is said and done a different technician to emerge.
Effect on education
Through the Technician Summit, Seabrook explained, a core curriculum guide was drafted based on the Commission on Accreditation of Allied Health Education Programs (CAAHEP) template standards.
“We are bringing all of the technician programs under the CAAHEP system,” Seabrook said. “Our practitioner level programs – our orthotist and prosthetist programs – have been under the CAAHEP system since the beginning and it was always our goal to bring the technician program under that system but we got behind doing other things.”
In late 2008, NCOPE received approval from CAAHEP to bring the technician programs into their system. Now the first of a series of steps before that can be finalized is to create the standards. Among other changes, the technician level programs are going to have to adjust to being outcomes-based.
“What that really means is that our technician programs are going to have to start collecting data and information twofold,” Seabrook said. “Internally within the school [they will need] to evaluate the course after it takes place as well as the faculty. The other type is external data including how the students do on the ABC registration exam and employer satisfaction surveys.”
Seabrook added that some of the five NCOPE accredited schools already have these measures in place but under the CAAHEP guidelines the rest will also need to comply. Then all findings will need to be turned into NCOPE to satisfy guidelines.
NCOPE expects to begin instituting the new CAAHEP guidelines as soon as January 2010. Transitioning current programs to the CAAHEP system would start after that time when those schools come up for reaccreditation.
“It could happen sooner but … you never know what is going to happen as we go through the process,” Seabrook said.
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Practice Analysis impact
Once the ABC practice analysis survey responses are tabulated and a snapshot of the modern technician is generated, in what ways will technician education and career progression be effected? It is hard to speculate but there are a number of ways that these aspects could change.
Wickman suggested that if the hypothesis that he, along with the other members of the practice analysis survey team, created is found to be reality, that does not mean that changes are coming down the line for technician education.
Carter explained that if it is disclosed that technicians are delivering a level of clinical care, that does not mean ABC will change the scope of practice for a registered technician right away.
Wickman explained, “It may not cause [ABC] to do anything with regards to technician [credentialing]. Basically, we just need to know. We still have to find a comfort zone. Ideally we want to know, if this is a trend, what can technician education do to either do a better job of delineating the roles of technician and practitioner or [the technician’s educator] may have to make a decision … to teach technicians a little more anatomy and a little more physiology.”
Perhaps finding that the role of the technician is slowly merging with the role of the clinician may require ABC to redefine these roles. Regardless of possible changes to technician education, the practice analysis will allow ABC to update the technician exams and describe current trends and future directions of the technician profession.
“A lot of people agree it’s a non-traditional role for a technician to act as a clinician and the hard part is … the reality of the situation is that [by asking these questions] it may help us to realize that we need to do a better job of asking technicians not to [take on clinical responsibilities],” Wickman said.
Evolutionary change
Wickman offers the general technician consensus on education which is that the more education the better, specifically in terms of continuing education.
“We don’t need to build any more hurdles to becoming a registered – hopefully certified– technician but we do need to do a better job of offering continuing education so whoever is working right now can continue to evolve with the industry,” Wickman said.
As a continuing education provider, Wickman adds, that he has shifted his focus from explaining specific technicians roles and why they are carried out to include more of the fundamental background in what technicians do. This also includes a closer look at anatomy, physiology, kinesiology and diagnostics.
“When I am speaking, I tend to shift my presentations more toward what I see as a gap between the technical and the clinical,” Wickman explained. “I think technicians these days need a much better understanding of who their patients are, what their lifestyles are and what their pathologies are. I think that technician education, just like clinical education and every other education whether it’s cutting hair or building rocket ships, it has to evolve,” Wickman said. “It has to be a constant state of evolution and I think what we’re dealing with right now is more kind of evolutionary change than a revolutionary change.”– by Jennifer Hoydicz
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