In a large corporate environment

1. In a large corporate environment Residency Training

2. Fundamentally the same as residency training in a small private practice.

3. Mission Statement: The mission of the Hanger Residency program is to prepare the new graduate for competent, autonomous clinical practice in the field of orthotics and prosthetics. We utilize a comprehensive, gradual, experiential model within a broad-based professional and academic environment conducive to the education and training of tomorrow’s corporate and industry leaders.

4. Excerpt from Hanger’s residency web page: “So why entrust your residency training to Hanger? Despite the enormity of the corporation, the quality of your individual experiences will be most impacted by the few practitioners that you actually interface with during your 12-month tenure. Because this is true, you should be secure in the knowledge that Hanger is committed to ensuring that each and every office understands and achieves or aspires to exceed the NCOPE Residency Standards.”

5. Patient Assessment Domain:“Ascertaining critical information is of paramount importance to the successful management of any patient.” • Advance Preparations: • Reviewing chart of scheduled patient prior to appointment (if possible). Research unknown diagnoses / syndromes, etc. • Reviewing accompanying documentation, I.e., PT/OT reports, physician notes, X-rays, etc.

6. Patient Assessment Domain: • Performing a thorough H/P • Verbal intake • Diagnosis, etiology, onset, symptoms • Surgical history, therapy modalities, pharmaceutical profile, O&P history • Physical Exam • Perform MMT, ROM, select neurological/clinical tests (Babinsky, Duncan Ely, Silverscold, Adams, ect.) • Examine extremities (if available) • Inspect for skin changes (callouses, color, erythema, ulcers, eczema, capillary refill, distal pulse, etc.)

7. Patient Assessment Domain: • Mark Appropriate Landmarks • Bony prominences, skin at risk • Take & Record Appropriate Measurements • Linear, circumferential, angular • Observe by Function Without Existing O/P System, If Possible • Static • Dynamic • Review with Preceptor and Have Select Tests/Measurements Rechecked

8. Implementation of Treatment Plan“See one, practice one, do one.” • Observation • Copious notes- for future reference/discussion • Left & Right or Copy Cast • Independent mold rectification: comparison and contrasting • Re-modify as necessary • Fabrication Even at a facility with modest fabrication capabilities one can refine those technical skills that relate directly to clinical practice

9. Example: KAFO • Padding • Add posterior proximal roll of pelite • Pad medial/lateral malleolus with aliplast • Add Spenco inner sole

10. Example: KAFO • Thermo-plastic • Trim back to PLS distal section • Heat relieve specific increments • Fenestrate • Weld polypropylene Gillette modification at heel • Closure • Remove straps- replace with Dacron reinforced straps

11. Example: KAFO • Uprights • I.e., Remove distal medial upright and replace, maintaining joint congruency/alignment • Remove all rivets and raise knee centers • Mark upright and remove marks on grinder/sander

12. Formulation of Treatment Plan “Synthesizing all the given data/information to map out a course of treatment. Determining the orthotic/prosthetic design, components, materials,procedures necessary to carry out the plan.”

13. Formulation of Treatment Plan • Formulate a synopsis of the information received to map out a (written) strategy. • Make a verbal presentation of recommendation to preceptor. Include all aspects of O/P treatment (design, components, materials, methodology, CAD, casting, delineation, etc.) • Document findings/recommendations for future discussion with preceptors.

14. END