The OPA: Advancing orthopedic education to a new level

Jason Mazza

In the ever changing world of orthopedics where conditions, technologies and techniques are constantly evolving, what level of knowledge and skill sets should allied health professionals know to be immediately effective in their role as an assistant to the orthopedic surgeon? Obviously, the answer to this question is somewhat surgeon and practice specific.

In general, surgeons are looking for individuals who are well educated and trained in their respective roles as physician extenders. Traditionally, some of this knowledge is acquired from formal education, while many concepts and skills sets are derived from on- the-job training and years of experience. The problem is that with such a large knowledge base needed to become proficient in the role of an assistant to an orthopedic surgeon, it often takes years to reach that level. While there are a handful of post-graduate programs that focus on orthopedics for nurses to specialize in their field and physician assistants to advance their training beyond a standard 4- to 6-week clinical rotation, there has been a lack of formal education in teaching the specialized knowledge that is needed at the university level.

A catch-22

In my April column, I discussed the role of an Orthopaedic Physician’s Assistant (OPA-C) in a clinical practice. In a 1961 address to the American Medical Association, Charles Hudson, MD, presented the idea of having assistants work under the direct supervision of a physician. This new model of care led to the founding of our profession by the American Academy of Orthopaedic Surgeons, in which the concept of the OPA was developed for three reasons: assisting the surgeon with patient-care responsibilities, immobilization techniques and assisting in surgery. The science and theory behind each of these three areas is taught as a part of a medical science curriculum, but the skills needed to perform these duties proficiently is not.

In regards to allied health professionals who work in orthopedic practices and surgery, regardless of credentials, it is imperative that they be well versed in these areas. It is the proverbial catch-22: You need to get a job to learn these skills to be able to take care of patients, but at the same time, need these skills to get the job.

A new master’s program

Stanley Paris, PhD, PT, FAPTA, founder and president of the University of St. Augustine for Health Sciences, in St. Augustine, Fla., which has served as the leading institution for advanced educational programs in physical and occupational therapy, spent a great deal of time looking at this same issue. The university has worked closely with orthopedic surgeons to get an in-depth focus on the needs in orthopedic practice settings and the operating room. With the lack of formalized education seen in this area, the university has created an innovative educational program that is the only of its kind in the country.

The Master’s in Orthopaedic Physician Assistant program was recently launched to provide the most comprehensive educational experience for individuals to be trained to work with orthopedic surgeons. It is comprised of an intensive didactic component and a thorough set of clinical rotations that focus on each of the different specialties within orthopedics. This 2-year program will provide graduates with extensive clinical knowledge and skill sets that will allow them to better serve within a surgical practice. Graduates of the program are eligible to sit for the National Board for Certification of Orthopaedic Physician Assistants examination following graduation.

As presented by the University of St. Augustine for Health Sciences, the program will provide graduates the ability to execute the skills necessary to participate in patient triage, evaluation and management of orthopedic injuries and disease processes commonly found in clinical practices and hospital settings. Training will encompass conditions found across the lifespan, from pediatrics to the elderly.

Students of the program will be trained to work with orthopedic surgeons to plan evidence-based, surgical, nonsurgical and pharmacologic treatment approaches, and demonstrate technical skills for a wide variety of orthopedic procedures. Topics including ethical, legal and regulatory responsibilities of the profession are a standard part of the program. Similar to the training of a surgeon, students enrolled in the program will spend time in subspecialty clinical rotations, including lower extremity, upper extremity, spine, sports medicine, trauma, pediatrics, musculoskeletal oncology, hand/microvascular and orthopedic rehabilitation.

There are many benefits to hiring graduates of programs such as these. The orthopedic surgeon may need to spend just a fraction of time educating the assistant in the specialty, and more time can be spent taking care of patients and improving the delivery of care. Countless times I have heard that a surgeon spent months, and in some cases years, training assistants to get them to a level of expertise that they were comfortable with only to have their assistants move on to another practice.

A dynamic relationship

As I opened the article with the statement that orthopedics is constantly changing, the need for quality continuing education is paramount to meet the demands of a changing health care system. Examples of some challenges we are and will be facing include conversion to electronic medical records, coding conversion to ICD-10, constant changes with procedural coding, and developing strategies to improve patient care and outcomes. These concepts are not usually learned from a medical science program.

While it is true that many practices have individuals who are specially trained to deal with these aforementioned issues, it is important for the practicing OPA to be equally as proficient and knowledgeable in these arenas. The concept is simple, the more knowledgeable we are in these areas allow our supervising surgeons to practice more efficiently and effectively.

The American Society of Orthopaedic Physician’s Assistants (ASOPA) represents OPAs nationally for educational purposes and advocacy. As an organization, it is our role to find ways to educate our members in these areas. We have partnered with dynamic organizations like the National Association of Orthopaedic Technologists (NAOT) to provide all allied health providers, including nurses, physician assistants, surgical assistants and athletic trainers, educational programs that benefit those of us who serve as assistants to orthopedists. NAOT does an outstanding job at teaching what they do best — fracture immobilization. Combining the efforts of both organizations allow all orthopedic allied health professionals the chance to advance their knowledge and skills in areas that most of us use in everyday practice.

With the increasing demands placed upon orthopedic surgeons and higher patient expectations, the need for education and training with a specialized focus continues to grow. While it is true that there are certain skills that simply cannot be taught in a formal educational program and there will always be some practice-specific learning that will need to take place, we have taken the next step to tailor the educational needs of OPAs to match the needs of surgeons. The recent launch of the masters program in OPA studies and continuing educational programs offered by the American Society of Orthopaedic Physician’s Assistants will provide OPAs with a greater breathe of knowledge and continuum of medical education that will allow us to better serve our patients and surgeons.

We work in a dynamic state of constant change, in which our past measures of success are not necessarily valid today. Therefore, we must advance our training, knowledge and skills to create new standards. For more than 35 years, the hallmark of the OPA profession has been to assist the surgeon and take care of orthopedic patients. As a profession, we will continue this endeavor at a higher level.

Reference:

• Hudson CL. Expansion of medical professional services with nonprofessional personnel. JAMA. 1961. 176:839-841.

• Jason S. Mazza, MSc, OPA-C, CSA, SA-C, OTC, CCRC, is president of the American Society of Orthopaedic Physician Assistants and works with John H. Shim, MD, at Florida Sports, Orthopaedic & Spine Medicine in Tampa, Fla. Please direct all questions or comments to orthoopa@mindspring.com.