Introduction
This information package is intended to provide insight to the ISPO evaluators on the Addis National Training Program for Prosthetic and Orthotic syllabus with completion of a Certificate of Professional Competency (CPC).
The Government of Ethiopia is currently undertaking Emergency Demobilization and Reintegration Project (EDRP) with financial assistance from the World Bank. The objective of the program is to reduce the size of the Ethiopian National Defense Forces (ENDF), so as to relocate resources to social and economic infrastructure, and to provide reintegration assistance to demobilized veterans including the disabled veterans estimated at 22,000.
To provide medical and economic reintegration assistance to the estimated 22,000 disabled veterans, the Federal Programme Management Unit [FPMU] initiated an effort to strengthen the 5 regional Prosthetics and Orthotics Centers and establish the National Rehabilitation Center. Moreover, training of Para professional in the field of physiotherapy and Prosthetic and Orthotic is currently underway under the FPMU - EDRP.
The objectives of the Training Course in Prosthetics and Orthothics (TCPO) is to train and pro-duce Para professionals at diploma level in technical-orthopedics with adequate scientific and technical knowledge, skills and attitude so that they can be able to handle and manage persons with disabilities on lower limb extremities and patients in need of technical orthopedic services.
Taking into account the large number of disabled veterans as a result of conflict, the civilian victims of traffic accidents and land mines, and the limited number of trained manpower, this training is alleged to have a pivotal role in the future development of physical rehabilitation of persons with disabilities
The training program is run and managed by Ministry of Labor and Social Affairs [MoLSA], which is represented by the Social Affairs- Federal Project Management Unit of EDRP with close collaboration and support from the steering committee established for that particular purpose. The committee consisted of Government institutions, like Ministry of' Education (MOE) and Ministry of Health (MOH), Non-Government institutions and International Institutions such as the ICRC. The TCPO has been recognized by the MOE, on November 28th 2002.
Taking into account the long-standing cooperation of the ICRC, which started in 1979, particularly, considering the previous cooperation of ICRC in the area of prosthetics and Orthotic services, it seemed appropriate that the local authorities requested ICRC for its support. The ICRC supports entirely the clinical training with additional theoretical teaching.
While allowing a quick response to the immediate needs of the services provision, the call for higher-level trained staff is a necessity given that on return all students will practice clinical activities. With this in mind a meticulous framework is created allowing professional competency in the prosthetic and orthotic profession.
This tailored training program responds to both local requirements and CPC International demands.
The CPC Training was developed bearing in mind, these three principles:
1. The ISPO professional profile for Category II "Orthopaedic Technologist" to guarantee a professional level and a potential recognition.
2. The continuation of the service provision during the training, guaranteed by a minimum number of prosthetics and orthotics produced by the students
3. The flexibility, the learning objectives, the courses contents, the allocated hours, the minimum requirements, and the procedures founded in this package, represent the bottom line, which all training projects will followed, but the implementation of the training course, will be adapted to each situation.
As demonstrated above, the completion of the 4 modules may lead to ISPO recognition at the Category II level. In both cases, it should be known before the implementation of the training, that will be the goal of the training. If the Category II is chosen, ISPO will need to be contacted prior to the initiation of the training program to ensure that the training program is fully in accordance with the guidelines. In addition, the final examination will need to be organized in accordance with the ISPO guidelines.
Objectives of the Addis TCPO Training Program:
· To train professionals with proper knowledge and skills in the field of prosthetics and orthotics according to national and international professionally accepted standards
· To improve patient care
· To promote the long term sustainability of P&O services
· To promote the development of a rehabilitation team approach (relationship with other professionals)
· To promote individual development of leaders/managers/teachers in the P&O professional field
· To promote and develop the profession and to facilitate the development of a national standard for the profession
In the recent ICRC Round Table Conference [May 2003] it was confirmed that priority should go in sending students to ISPO CAT II recognized schools. However, realty tells us that schools are few in number and therefore enrolment is not always easy.
1. The Addis TCPO Training Package Module 1 and Module 2
The training format developed follows the local TCPO requirements and a sequence of 2 CPC. This modular course is designed to run alongside prosthetic and orthotic clinical and technical services and therefore allows flexibility in the training process. The course is managed within a well-defined structure, which allocates specific time to the training and education of students separate to the normal service provision of the POC[1] project in order to ensure an appropriate level of education. The balance between theoretical (38%) and practical (62%) will enable the trainees to perform the clinical service.
The training program is completely separate of the service provision, allowing the student the time to assimilate the new obtained knowledge during the theoretical and clinical demonstration. The P&O science session are done partly in conjunction with the practical courses in the allocated space. To ensure proper integration of knowledge, the students will work under close supervision from the ICRC teachers and assistant to the teachers. In addition, patients are selected to follow the training process. In order to ensure a maximum of practical experience, at least 600 devices will be manufactured. It is agreed upon that only the appropriate devices will be delivered.
The package explains how the CPC modules will be implemented. It contains a description of the professional profile of the CPC professional. It describes the learning objectives of the course, which include the two modules, and the learning objectives for each module as the modules can be performed individually. It provides the TCPO and CPC syllabus for each module, including hours allocated for each courses.
With exception of Semester 1 and 2, covering mainly the academic part of the program, the 21 students will be divided into 2 groups allowing both modules to start simultaneously. Each ICRC teacher will be responsible for one particular module. On accomplishment of each module the switch of modules will take place by the end of the month of April or early May. Before this rotation will take place, a CPC examination of each module will take place in the presence of an ISPO observer. CPC certifications will be handed over on successfully completion. On fruitfully completion of both CPC modules, the local diploma will be issued.
Module 1 Lower Limb Prosthetics and Module 2 Lower Limb Orthotics
The two first modules will be implemented to answer the local need. The necessity in respecting of the proposed curriculum creating the likelihood to send some graduates, in one of the recognized Category II School to complete their training is not negotiable. These recognized training school includes, VIETCOT (in Vietnam), CSPO (in Cambodia), TATCOT (in Tanzania) and, UDB (in El Salvador).
Module 1 and 2 are implemented, contacts with the regional recognized school came into operation on the visit of Harold Shangali, Principle of the TatCOT School and President elect for ISPO. We believe that any investment without creating a possibility for further upgrading is in vain; therefore we created a framework allowing graduates to complete their ISPO CAT II training.
The course duration will be 5 semesters of respectively 6 months. There is clear distinction between the national program and the CPC course. The locally suggested hours covers 864 theoretical hours attached with a practicum of 1408 hours. The CPC course adds 583 theoretical hours and 937 extra practical hours.
This means that at the end the entire will consist of 1403 theoretical sessions [864 TCPO and 583 CPC] and 2345 clinical and practical sessions.
Module 1 and Module 2 are established simultaneously, meaning that the common trunk curriculum [the theoretical part] is given to both student groups at the same time, while the specific training and practicum are implemented in an analogous way.
Because of the very practical nature of the profession, there is naturally emphasis on practical training throughout the curriculum. When implementing the complete package, 38% of the time is spent on theory in the classroom and 62% spent on hands-on practical training.
The timetable of each module is designed to ensure that practical subjects are taught in conjunction their corresponding specific theory. This allows students to get acquainted with specific terminology prior in commencing more detailed learning. It introduces without delay theoretical terms during clinical practice.
2. Curriculum
During the duration of the training course, there is a clear distinction between academic studies, which include formal lectures in the classroom and the practical studies. Academic studies, also name classroom studies, include formal lecture by, according to the subject, local or expatriate lectures. The practical studies, also name apprenticeship, include all activities surrounding the fitting process; assessment, casting, fabrication, fitting and delivery. During the apprenticeship, students are working under the supervision of the expatriate teachers backed up by their assistants. With the delay of certain aspects of the program, semester 1 & 2 concentrated on the theoretical aspects of the "trunk" course.
Table 1, below, describes the theoretical part of the TCPO requirements as originally put in the Memorandum of Understanding. It covers most of CPC requirements but initially also deals with local requirements.
Year 1 / Year 2Theory TCPO Addis / S1 / S2 / S1 / S2 / total
Introduction to social science and health / 32 / 32
applied psychology / 32 / 32
health, social and rehabilitation service / 32 / 32
ethical and legal aspects of technical orthopaedics services / 16 / 16
anatomy (I) / 32 / 32
anatomy (II) / 16 / 16
functional anatomy / 32 / 32
physiology (I) / 16 / 16
physiology (II) / 16 / 16
metric drafting / 32 / 32
mathematics (arithmetic) / 48 / 48
applied English / 64 / 64
Physics (mechanics) / 32 / 32
first aid and accident prevention / 16 / 16
Material technology / 32 / 32
workshop technology / 48 / 48
biomechanics / 64 / 64 / 64 / 192
pathology / 32 / 16 / 48
clinical P&O / 16 / 32 / 48
health education / 32 / 32
workshop management / 32 / 32
physical therapy / 16 / 16
496 / 96 / 96 / 176 / 864
In order to have the workshop setup completed, it was approved to complete all the theoretical sessions prior to commencement of the clinical sessions. This means that the TCPO theoretical sessions schedule in semester 1 and 2 from Year 2 were given in semester 1 and 2 of year 1.
The following index, table 2 on the next page, identifies the extra theoretical hours added to the TCPO original curriculum in order to comply with the CPC requirements. The timetable covering the theoretical trunk, meaning TCPO and CPC is nearly over a 2 semesters time span. Bear in mind that P&O science is required to alongside the clinical part of the course. Row A represents the TCPO, row B the extra planned CPC hours and row C is the effective teaching hours. The gray colored cells represent the calculated and required CPC hours.
A / B / CTheory / TCPO / CPC / Effective
anatomy (I) + anatomy (II) + Functional Anatomy / 32+16+32 / 80 / 12 / 92
applied psychology / 32 / 32 / 32
biomechanics / 192 / 192 / 98
clinical P&O / 48 / 48 / 32
communication / 18 / 18
ethical and legal aspects of technical orthopaedics services / 16 / 16 / 6 / 22
material technology / 32 / 32 / 60 / 92
mathematics (arithmetic) / 48 / 48 / 44 / 92
orthotic science / 187 / 187
pathology / 48 / 48 / 22 / 72
Physics (mechanics) / 32 / 32 / 60 / 92
physiology (I) + physiology (II) / 16+16 / 32 / 0 / 32
prosthetics science / 160 / 160
workshop management / 32 / 32 / 14 / 46
workshop technology / 48 / 48 / 54
applied English / 64 / 64 / 64
first aid and accident presentation / 16 / 16 / 80
health education / 32 / 32 / 32
health, social and rehabilitation service / 32 / 32 / 32
Introduction to social science and health / 32 / 32 / 32
metric drafting / 32 / 32 / 32
physical therapy / 16 / 16 / 6
864 / 583
Total Theory TCPO & CPC / 1409
With exception of semester 1 & 2, scheduling the classroom studies, clinical methods and P&O science will be thought prior (and later on simultaneously) to clinical and practical sessions. It needs to be clear that the student possess the necessary theoretical background before clinical activities can start. It turns out that specific theoretical sessions will be given before each specific subject. If during clinical practice the teachers notice that students did not grasp some theoretical topics, extra theoretical lessons need to come into operation. Handouts will be given to the students before commencement and during lecture time the teacher will revise the document in order to complete the manual. In April 2004, on accomplishment of the module and the student rotation takes place, the teacher will expect to revise once more the handouts finalizing the drafts by the end of the training program. The syllabus will be enriched with annexes allowing extra curricula information for the student. Table 3, below explains the breakdown of the clinical sessions. This analysis represents the hours yet in reality the practical side of the course will be according to CPC standards. A detailed breakdown can be observed on page 19.
practical / TCPO / CPC / TotalP&O / 512
512
384
total TCPO Addis / 1408 / 1408
CPC prosthetics / 469
CPC Orthotics / 468
total CPC extra requirements / 937 / 932
total practice TCPO & CPC / 2345
In each module, the orthopaedic devices are introduced in a particular way so that the lowest anatomical level is taught first. For example, trans-tibial prosthetics is instructed before the trans-femoral prosthetics, and ankle-foot orthotics before knee-ankle-foot orthotics. Patient's selection during the apprenticeship sessions have to take this into consideration. However, the current training program makes an exception in starting with the trans tibial prior to ankle and partial foot prosthesis because additional time to coordinate the patient subjects that are scares. We share the view that alignment principles at trans tibial level will be beneficial to further understanding the other level of prosthetic fitting. Each topic will be concluded with a 6 hours revision where the student will have a theoretical test and orally defend his subject. The marks of those tests will be accumulated for the final TCPO practical test.