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3D Printing in the O&P field of study - Thomas More (BE)

Orthopedics at Thomas More college: Strengthening tomorrow's orthopedic technicians with the latest technologies.

The footscan technology developed by rs scan has been in use for many years in very diverse disciplines in research from biomechanics to orthopedics and posology. Colleges and universities from all over the world have included the technology in their students' curriculum.

Since RS Print was founded in 2014 as a joint venture between rs scan and the 3D printing company Materialise from Leuven, the staff have given guest lectures and presentations to many educational institutions and have been invited to many conferences throughout the world. "In the beginning the reactions where a mix of skepticism and surprise, but nowadays the acceptance is growing," says Tom Peeters, Brand Manager for Phits Insoles, the brand of 3D-printed orthopedic insoles brought to market by RS Print. "The idea of ​​translating dynamic data directly into a digital design that is 3D-printed has attracted the attention from people in the field of medicine, but also from researchers and lecturers."

In only 4 years, RS Print managed to build a substantial network of providers, the focus of the orders is in Belgium, the Netherlands and the US, but South Korea, the UK and the Scandinavian countries are currently hopping on board. It proves that the sector is ready to embrace a new technology.

From the beginning, the lecturers at Thomas More's Department of Orthopedics closely monitored the developments in Phits’ technology, giving RS Print the opportunity to introduce their technology to students, the students came to visit the company in Paal -Beringen and since the beginning there have been very good contacts with Mobilab, Thomas More's biomechanical lab.

This convinced them that the combination of digital dynamic data acquisition and digital production methods with 3D printing is the future. And so, the lecturers decided to include footscan and Phits in their curriculum. This is a milestone for a young company like RS Print. Tom Peeters: "It shows that we're considered a reliable service partner who provides added value to orthopedic technologists." 

Bert Laermans and Tom Van den Eynde were the driving forces behind the decision to include the new technology in the program.

Bert Laermans first studied as a physiotherapist and later as an orthopedic technologist. Tom Van den Eynde obtained his degree as an orthopedic shoe-technician after completing a bachelor's degree in mechanics. Both have a lot of practical experience which they bring to the table when teaching students - the practical experience of the teachers is invaluable. Within the department, Tom is also responsible for the workshop and student's internship coordination. Both still work in private practice as well and Tom is even a certified Phits Expert.

During our conversation, students walk in and out with their questions. A student has a question about a foam box for taking footprints. We all saw the irony of the situation. It seems that in a few years this method will definitely be replaced with digital measurements.

 

If you compare the curriculum in 2017 with the courses you had back when you were a student, what evolution do you see?

Bert: The curriculum has evolved so that there's much more science being used now then back when I was in school. Back then it was more trial and error, while today it has to be much more evidence based, that's a real difference. As a scientist, I welcome this with open arms because I think it will benefit the program. As someone who's firmly rooted in practice, I have to admit that the work in the field often involves a lot of trial and error. You can develop models for the human body, but for a pathology this is more difficult. A pathology is always individual, the gait patterns of individuals suffering of a certain pathology don’t necessarily resemble each other. Digital measurement, however, helps to determine the pathology and it is an important advance which allows us to work more analytically. We may have studied measurement techniques in our courses back then, but now there are more advanced resources at the students' disposal.

Has this changed the students' profile from trial and error and craftsmanship to another type?

Bert: Definitely, in the past, we mostly saw the handy, more technical profiles, and nowadays we also see a lot of other profiles: people who are more interested in analysis of the human body and people who are real problem solvers. The job has changed. You'll see that shift in the field as well, orthopedic technicians don’t all come into the workshop anymore. There's a lot of technicians who finish their education here and then evolve to a front office role: measurement, orthotic measurements and fitting, where production is no longer a part of their activity. That's a landslide change. Whether this only has positive effect, ‘m not sure yet. I still think that it’s important that an orthopedic technologist knows how to make things better to apply them to patients. I think you should know the background of your repertoire on devices to be able to apply them to a pathology.

What's the content of the 3-year program?

Bert: The first year is general, where you get acquainted with the profession and from the second year you have to make a choice between orthopedic technologist and orthopedic shoe technologist. In the first year, you will learn practical skills that you apply from the second year, including practical internships with companies. In the third year, you are working on a case to case basis and the internships are expanded until they take up about half the curriculum.

How do the students experience that?

Bert: Much depends on their internships, but generally the students are happy to learn in practice. The courses are also very diverse because the field is very diverse. In my view, a student cannot see everything in those three years - too much has changed and diversified over the last years. Ideally, our curriculum would be 4 years instead of 3.

Where do they end up in their professional career, are there any shifts?

Bert: I do not see that many shifts, most of them end up in an orthopedic company. Most of them grow into higher positions within those companies, which can be as a sizing professional, but also in managerial, coordinating positions. We also see more and more alumni starting their own business. We try to prepare them for this as well and make sure that they can do this - as in every bachelor program, our education also includes a portion of accounting and business management. In itself, that is not enough, but in some cases, our students have to gain experience in an orthopedic business before they can start independently. Over that period, they will have learned a lot.

How do you determine what kind of innovations you make available to the program?

Bert: We are not beholden to anything, we are free to make choices, and these often reflect the interest of the teachers and the requirements of the field. We look at what's new on the market and we look at whether it's feasible for us, both financially and in terms of time investment. We are looking closely at the marketplace and trying to quickly respond to new technologies, this doesn't mean we'll be the first to integrate an innovation, but we will certainly not be the last. A course is always coordinated among several teachers, and if we're convinced of the use of an innovation after consulting with the others and we believe in its potential, we are quickly inclined to include it in the package.

What do students make of it?

Bert: The advantage of our students is that they are always very open to innovations and we try to shape them to critically evaluate new technologies. In themselves, they are often pleased to receive the latest new technologies, but it is often less important to them now what is new and what is now an outdated technique.

For me, the switch to digitalization is perhaps more difficult than for the students. I'm trained to use plaster and my natural reflex is to use that approach while digitalization is becoming the norm. For our students, digital thinking is evident.

Tom: For me as well it's an adaptation and a continuous learning process, I was used to using plaster for everything as well. I like the challenge of mastering new technologies ourselves to pass them on to our students.

CAD CAM has come into the field in the last 15 years, how did your professional environment change?

Tom: It is a completely different interpretation, in the past, our profession was really a craft. It was craftsmanship, both the sizing and crafting of the product, but now it's evolving more towards CADCAM as digital scanners are becoming more commonplace. It requires another way of thinking when you see a limb digitally on your computer screen, another way of thinking about how to make certain corrections, how heavily are you going to correct? You do sort of lose feeling with the foot or the limb. It turns us into professionals who spend more time behind a computer screen than people who used to spend a lot of time in the workshop. The difference between the current situation and 10 to 15 years ago is enormous.

At present, digital milling is still the most common form of CADCAM, but 3D printing is also on the rise. How do you estimate the chances of 3D printing relative to milling?

Bert: I think 3D printing will be a bigger success story than milling. You can print prostheses which have better finishing, with CADCAM, you were milling the shape and creating your device on top of it, I think it won't take long before you can print a finished device. That greatly reduces your production time. A lot will depend of course on the price change, but you have to look at the total package and not just the printing cost.

You also have footscan, what are the strengths of footscan according to you?

Bert: We have not had it for very long, we've been instructing the students in the use of 2D scanners and how they could produce insoles with those and that gave good results in the past, but how it's going evolve right now we'll only probably be able to tell after next year.

What convinced you to start using Footscan and Phits?

Bert: We believe it is a good product and that there is a market for it. We also want to present our students with the most recent evolutions. Too often, insoles are made under static load while they have to do their work under a dynamic load, which is just common sense. The same also applies to prosthetics which are also made to ensure that people can move.

Our students have enough biomechanical background, but it is a matter of translating those biomechanics into a product. We hope to be able to do so with these soles because the translation of dynamic parameters into the final product is integrated into the program. The dynamic aspect is one of the most important reasons for choosing this system.

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