A New Case Study: The O&P Student
A NEW CASE STUDY:
Th e O&P S tu d e n t
By Yelena Mazur
We’re all familiar with the common phrase, “Children are the future,” or something resembling the sentiment. If this is a common understanding, why are students of O&P predominantly left out of the conversation regarding the future of the profession?
Students are rarely questioned about their education, experience, or expectations. With a high demand for O&P research and data, it is surprising that students aren’t sought out and questioned about the necessary means to provide a prime environment and tools for producing optimum, credible, and perennial data. If we’re neglecting our students, what precedent are we setting for future patient care?
AOPA decided to capture this missing dialogue and perspective by interviewing five O&P graduate students who attended the 2018 AOPA Policy Forum in March.
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Alyssa Haus Alyssa Haus, 23, is a first-year student at the University of Texas (UT) Southwestern Medical Center master of prosthetics-orthotics (MPO) program in Dallas. Determined to work in the health-care profession, she had originally thought physical therapy (PT) was her calling. But after shadowing the PT profession during her undergraduate career, “I knew something was missing. It didn’t feel like a full fit,” she says. “I had a family friend who worked the front desk at an O&P clinic, and I decided to shadow the practice. From that experience, I knew that I wanted to work with patients, and working with my hands was an ideal fit for me. O&P was not something that they talked about in college as a career possibility.”
Haus, who is set to graduate in December of 2018, is currently taking a lower-limb course, biomechanics, a research course, and an interprofessional course that encourages students to interact and engage with various health-care specialties apart from their own, including PTs, physician assistants, clinical nutritionists, etc. All O&P courses have a lab component, and students are readily fabricating the devices they learn about in class. Haus also is taking a 30-hour elective lab skills course this semester, where she is able to witness her professors as practitioners in the UT Southwestern on-site facility; there she also is learning tips of the trade from technicians. She cites this easy access as a definite benefit of the program. “It’s great to actually learn from professors who are currently in the field and are up to date on their skills and active in practicing and evolving methods of patient care.”
A typical day for Haus begins with a class, lab, or clinical lab hours from 8:30 a.m. until noon. Following a brief respite, she attends another lecture or lab, or has clinical hours from 1:00 to 5:00 p.m. When most professionals are calling it quitting time, the day is far from over for Haus and her class
of 11 students. There is much studying to be done, group article reviews to complete—not to mention the interminable assignments in lab.
Along with completing all of their coursework, O&P students must maintain a C or higher grade average in each course, have a GPA of 2.7 or higher, and demonstrate clinical competence and professional etiquette in order to receive their master’s degree. O&P-specific courses have two to three exams per semester, which can take the format of
Student meeting at the AOPA 2018 Policy Forum
written, oral, and practical exams. All final exams bear these three components to familiarize and prepare students for the style of the clinical board exams postresidency. “I’m hoping to learn more problem solving skills. It’s one thing to possess the book knowledge and hand skills, but I want to be able to problem solve for those unique patient situations. It’s also important for an O&P program to prepare me to readily work with and access other health-care professionals,” says Haus.
Although Haus has a predilection toward pursuing pediatrics during her residency, she understands that keeping a general and broad focus would allow her to see and gain hands-on experience with the vast array of the O&P population. She plans to start applying for residency programs this summer and encourages future students, who have not yet applied to a graduate program in O&P, to shadow O&P facilities and gain experience. “There are many great schools, but the right fit is incredibly important to find,” she says. With her numerous clinical lab hours and hands-on experience, it’s safe to understand why Haus is keen on finding the perfect fit.
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Alexis Gagliardotto Alexis Gagliardotto, 21, is into her third and final year of her O&P education, expecting to graduate in April of 2018. Her class was the last to graduate from St. Petersburg College, which recently ended its bachelor’s program. She transitioned to Florida International University, which offers a one-year master’s program in O&P online.
A Florida native, Gagliardotto discovered the O&P profession during high school, while interning for Westcoast Brace & Limb Inc. on summer break. “Literally the first day of my internship, I knew that’s where I needed to be,” she says. Gagliardotto had already accumulated 320 clinical hours by the completion of her undergraduate career.
A day in her O&P undergraduate schedule mirrors that of Haus’s master’s program. Students spend four days a week in classes, lectures, and labs, followed by a day of clinical rotation at an O&P clinic, which differs each semester. A few of her rotations were spent at a Hanger Clinic location and Shriners Hospitals for Children.
Although her current coursework is online, the master’s program still requires students to maintain one day of clinical rotations per week. In a class of 12 students, most are interning or working as fitters. “You can’t just be in an online
program and not keep up with your clinical skills. The master’s program is quite unique—it heavily incorporates engineering dimensions and how that integrates with O&P. It’s about stepping back and seeing the bigger picture of manufacturing different O&P componentry and being able to handle and design different devices by applying the research aspect as opposed to just clinical skills.”
Being in an online degree program can be a double-edged sword, admits Gagliardotto. There’s risk of regression if you’re not motivated enough to garner the imperative technical and patient skills. Students are still expected to accrue between 60 and 80 clinical hours a semester. “I am with the clinician more times than not. It’s 50/50 between seeing patients and fabricating,” she says. During rotations, students are asked to identify the pathology of any given patient, demonstrate competency in using a specific device, and anticipate the best case scenario to obviate any possible complications. Students are graded on how they present a patient during rotation. All coursework exams are proctored online through a computer-based webcam.
Classes in Gagliardotto’s program include statistics, project engineering, and engineering project management, where students must design and facilitate an entire engineering project that serves as an added value toward a lucrative business model. Gagliardotto chose to redesign a lawnmower and overhaul the safety features. Although the program does not have an official capstone requirement, Gagliardotto took a capstone class during her years at St. Petersburg College, where students had to review all of their O&P clinical skills through exams.
Group projects are another requirement for the online-based degree. “I actually view this as a benefit to an online program. Not only are you constantly learning how to manage your time, but you’re forced to accommodate
your schedule with other students in the program who are out of state,” says Gagliardotto. “All these challenges resemble those in the health-care world. I’m going to have to coordinate with physicians and patient-care teams with different barriers and scheduling restrictions. Learning to work through these barriers now will help you in the long run since patient care can get messy and complicated with more people involved.” Students regularly work in groups to complete critically appraised topic reviews, a process that requires keen discernment with detailed assessments in literature reviews of O&P research.
Gagliardotto hopes that her current skillset will serve as a launch pad to the residency programs she is applying to—a list that includes the Orlando Department of Veterans Affairs—Partners of Nemours Children’s Hospital, where she recently had an interview. “I prefer to undergo residency in a structured hospital setting, even though I just learned today that only 12 percent of residency sites are hospital based,” she says. Her goal is to complete a year in orthotics and a separate year in prosthetics; a dual 18-month residency in O&P does not meet the state licensure requirements for Florida.
Gagliardotto is already looking ahead into expanding her skillset with an interest in anaplastology, the fabrication of prosthetic facial parts for burn victims, cancer patients, and others. This particular profession is highly specialized and would require more education. The prospect of additional schooling doesn’t phase Gagliardotto, whose unremitting enthusiasm and insight could challenge any myopic approach to health care.
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Jovan Gonczar Jovan Gonczar, 31, will be walking across the stage this spring when she receives her graduate degree in O&P from Eastern Michigan University. For some, health care is a profession; for Gonczar, it’s a lifestyle.
For several years, this emergency medical technician licensee worked in an organization helping children and adults with disabilities learn how to ride bicycles in order to stay mobile and safe in their communities. Along with being a health director of a children’s camp, she held an internship working on lifestyle management of stroke patients and spent time shadowing their PTs. Once she was exposed to the O&P industry, she knew she had found her niche.
Gonczar has already accepted a 12-month orthotic residency position with Wright & Filippis, the largest O&P company in Michigan. “I’m fortunate enough that Wright & Filippis has many patient-care clinics around the state so I can experience a diverse population firsthand,” she says.
She credits her dynamic O&P program with preparing her for residency and the future. Classes focus on specific and specialized areas of the body, components, and methodology in order for students to discern how to approach each patient with a variety of factors. Classes focus on spinal orthotics, lower-limb orthotics and prosthetics, gait, research
Classmates are not only forever friends, but they’re the first professional contacts a young clinician may make—and those relationships are invaluable, especially for nascent professionals trying to penetrate the health-care industry.
methods, and advanced techniques— where different guest speakers, including O&P clinicians, address the students on specialty areas in O&P. Lectures encourage hands-on experience as students examine each other’s range of motion and conduct manual muscle testing.
Mornings begin with several hours of lecture, followed by a patient model demonstration in the afternoon. Students evaluate the patient and may take a cast to develop in the plaster lab while simultaneously fabricating. Typically there are modifications to be done on a prosthesis.
After a full day, Gonczar tackles her co-authored capstone project. “It’s an anatomical model of the shoulder, implementing pressure sensors on different bony prominences, to be used as a
teaching model for students,” she says. “Palpation is a really important skill to master, and this model gives you feedback that you’re palpating the correct area.” Providing students with the best tools will only serve them and their patients in the long run. Undoubtedly, a practitioner cannot provide a service that he or she is unfamiliar with.
It is with this open mindset that Gonczar was not only able to accrue more clinical hours, but also discover new methods and cross-cultural techniques by spending several weeks in Mexico and five weeks in Ecuador. “Our program director put me in contact with Marlo Ortiz, a practitioner in Mexico, who was willing to open and share his approach to O&P care. I learned about Ecuador through a previous student who had gone through that rotation,” she says. Gonczar is aware that not everyone has the means to garner experience abroad, but it’s not the place that matters, it’s the overall experience, she says. She advises future students to proactively form connections and seek additional opportunities to foster personal development.
As with any profession, networking is a lifeline. Classmates are not only forever friends, but they’re the first professional contacts a young clinician may make—and those relationships are invaluable, especially for nascent professionals trying to penetrate the health-care industry. Like Gagliardotto, Gonczar serves on the Student-Resident Committee for the American Academy of Orthotists & Prosthetists. She praises the committee’s efforts to engage with students and provide a well-rounded view of O&P outside of the classroom. For students, guidance and mentoring are the preferred currency.
There is no rest for this health-care professional. After completing her orthotic residency, Gonczar plans to take the board exams and become a certified orthotist, concurrently applying to complete a prosthetic residency.
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Yona Cloonan, PhD If you’re reading this article and surreptitiously racking your mind for your own “A-ha” moment, be advised that there’s a notable difference between the uncertain and the indolent. The uncertain can be a beautiful place to experience growth while you map out your path. For Yona Cloonan, PhD, one sees a nonlinear trajectory.
Cloonan, 42, was exposed to O&P at an early age after her brother was born with cerebral palsy. “I knew he had an orthotist and had to wear braces, and yet the reality and the proximity were just too close to home for me to separate his special patient-care needs from my own,” she says.
Cloonan has a PhD in epidemiology and has served on the faculty at the University of Pittsburgh for five years. She now adds “first-year O&P graduate student” to her academic career at said university. A concatenation of factors persuaded Cloonan to pursue the O&P track. “There’s incentive with the population I’m interested in, pediatrics. I grew up knowing kids with spina bifida, and with my brother who has cerebral palsy. When I was doing research for my former graduate program, I would come across those populations a bit. Even with positional plagiocephaly, I was curious about whether cranial helmets actually work. The way I see it, I’m still in health sciences, I don’t have to waste or forfeit my research degree, and I can apply it while I’m currently executing evidencebased practice,” says Cloonan.
The ultimate deciding factor to pursue O&P stems from the numerous enervating hours Cloonan has spent
Cloonan also believes kinesiology should be required as a prerequisite because simple body mechanics prove rudimentary to O&P.
Yona Cloonan, PhD
staring at a computer screen. In graduate school Cloonan would take classes, attend to her research assistant job, and then relish getting her hands dirty through pottery classes. Pottery curtailed the mundane; however, postgraduate life proved less than gratifying. “Before I would just sit behind a computer and each row was data, and each row of data was a person,” she says. “I can’t do that anymore. I want to see the person, interact with the person, and witness the immediate outcome instead of possibly waiting years for a piece of paper.”
Although interaction with patients commences next semester, the 24 students in her class practice casting on each other for experience and feedback. Cloonan’s coursework features transtibial prosthetics and lower-extremity orthotics classes, full days spent fabricating in the lab, and lectures provided by visiting practitioners. She will be expected to complete a capstone project before graduation and will need to fulfill a clinical internship in the spring of 2019.
With an extensive academic background, Cloonan staunchly supports the university’s requirement of prerequisite courses, which include anatomy, physics, basic sciences, statistics, and a minimum of 250 observation hours before applying at the graduate level. The prereqs help determine whether a certain program is right for a specific student, she says. Cloonan also believes kinesiology should be required as a prerequisite because simple body mechanics prove rudimentary to O&P. After all, how does one begin to assess gait? She also understands that a substantial amount of know-how will be gleaned from an intensive residency program, which she hopes to find in Pittsburgh.
Cloonan does not want to focus on pediatrics alone, fully aware that may limit or hinder the general scope of an O&P career. “I don’t want to specialize because I understand how that can trap you. I also have taught and love teaching. Whether I mentor future students or provide assistance in the lab, I’m open to variances,” she says.
Cloonan’s well-rounded history and years in academia propel her to provide feedback about a lack in general diversity within the O&P program, as well as the high costs of O&P education. “There should be more funding opportunities for students; it is really expensive even though I receive in-state tuition,” says Cloonan. These concerns are worth investigation for O&P programs that strive to attract the most qualified student pool.
Regarding the AOPA Policy Forum, Cloonan says, “I think that it’s a great benefit to the student attendees to learn about policies impacting the field and changes that are being proposed and pushed by AOPA. It also was a great opportunity to network with other students and O&P organizational leaders. I think that having students go with other delegates from their states provides an excellent opening to discuss internship or residency opportunities in an open and frank manner.”
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For O&P students, hands-on experiences serve as preparation for residency opportunities.
Ryan Sharry Ryan Sharry, 22, is no stranger to the sometimes precarious position of O&P in academia. A first-year student at the Georgia Institute of Technology graduate program for O&P, she is facing challenges as the university’s School of Sciences makes changes to its interdepartmental O&P program. “We [the O&P program] unjustly got deactivated. We are not closed as a program, but they are not accepting students for the fall,” she says. While nothing is official, “they’re saying it’s just a necessary pause to figure out how we’re going to readjust as a program.”
Sharry says a recent high turnover in faculty has the School of Sciences weary to house the O&P program under its jurisdiction, let alone provide future funding or support. Sharry, who has a bachelor’s degree in biomedical engineering, hopes that the O&P program moves to unify under the Engineering School, which has already proven its support through collaborations with the O&P program.
Despite the unknown future of the O&P program, Sharry believes her current O&P education excels in providing students with superior knowledge and skills. Students are required to complete 500 clinical hours and an O&P-based research project, and to excel during interview simulations that mirror a case study. During these simulations, students must interact with a
patient model and conduct a patient evaluation, including muscle testing. There are checkpoints and requirements that must be met before a student may advance in the program. It’s an automatic “fail” if students do not introduce themselves or forget to wash their hands.
Sharry has accumulated clinical hours with Hanger Clinic and is presently at ProCare. “I know some students who work at a late-night pizzeria somehow, but my schooling is a full-time job,” she says.
For O&P students, hands-on experiences serve as preparation for residency opportunities. Sharry recently participated in a roundtable discussion with residency directors at a meeting of the American Academy of Orthotists and Prosthetists.
It’s important to recognize the diverse experiences at different residency programs, according to Sharry. “Some places require you to commit to a permanent position afterwards while others make no guarantees and stress the unlikelihood a position will be available postresidency,” she says. “Some offer the 18-month dual residency or just the oneyear option of either prosthetics or orthotics.” Sharry will have to take all of these factors under consideration as she heads toward her own residency experience. She is eager to work with her hands and witness the newfound independence of her future patients. She remains focused on gaining and perfecting her skillset to provide optimal care for those who will come to depend on her expertise.
The Road Ahead Despite various backgrounds and perspectives, students and practitioners share a common anxiety concerning the health-care model. Practitioners worry about what’s next for patient care whereas students share trepidation about being equipped with the best knowledge and skillset to prepare them for any given scenario.
In reality, their concerns are the same, and their goals are similar: O&P is about improving the quality of life for each individual. Going forward, it will be necessary to set the best in education standards to promote ideal practices. If O&P is to succeed as an undoubtable and credible profession, recognized by the entire health-care industry, it is the O&P student who lays the foundation.
Students have much to learn from their future cohorts, and those in the field must design and maintain the best possible outcomes in O&P. Pragmatically, the day you stop learning and being a student is a day to announce your retirement. Now, for the sake of present and future O&P patients, get back to work.
Yelena Mazur is membership and meetings coordinator for AOPA.
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