The Clinical Blog - All Comments

re: Introduce the option to become an Accredited CET Provider

billharvey — Thu, 17 May 2012 06:33:14 GMT

I could not agree more on the need to protect CET from "dumbing down' however sadly maybe we have lost that battle. MCQs with playback for answers on video content does not really promote high standards. Nor does emailing answers to MCQs nationwide on a rotation basis.

There are a minority of people that want quality CET. Example, I no longer do CET in the press (just gain my points and focus on CPD instead), I read books "how to read a paper- trisha greenhalgh" at the moment ...etc. because I want to be better at reading research. The other day I downloaded Ivan trial. It was a struggle but after some research I found issues with GCP and also big difference between how we designed IVAN here and how the NIH (NEI) in the USA backed CATT trial.

However, training and education in these areas is limited within our profession and you need to go outside to get it. The core competencies may restrict in some cases very useful knowledge transfer from other sectors. For example imagine CET on Health Ethics? or GCP?

The general lack of engagement from the majority should actually lead to some sample bias is GOC consultations. You would expect under such consultation process for tougher CET/CPD provisions to be passed?

However, it is not like that as key stakeholders take hold. That is because bodies like the AOP fight for rational arguments (as they see them) "you cant call us a low risk profession, and have high CPD and CET requirements". They have a point (but the wrong one, as they could be pushing for better risk profiles to be applied to optometry- that factor in HES supply vs ageing population and visual loss and its links to falls and hence cost and so on- which may place optometrist in better position in the future). Sure a risk assessment that has as much rationale as homeopathy and behavioral optometry is still a risk assessment just a bad one. So lets all go with it seems the mantra- few we are low risk and so on.

I do want change. However, there is lack of discourse in our profession that goes anywhere past NHS fees or locum rates. So, good luck with CET meeting. I will try and attend more meetings at the GOC.

I attended the GOC re-validation consultation where I tried to argue about the flawed risk assessment, poor CET standards and questionable audit trails for education. I proposed the GOC grade CET. So simple CET had fractional grading, hence low brow CET would need so much reading you would need prism glasses. Yet CET that was difficult, robust say grade AAA would receive higher points with classification units. I also tried to push peers to see tougher CET would be better absorbed by quality outlets.

So 36 AAA grade points a year would allow some professional recognition for example. We would be able to then promote some form of market credit to knowledge (which at present is thin on the ground). Such credits may help people enter hospital optometry without experience or several year MSc. It may look good on a CV allowing them access to work with GPs or commissioning groups in the future. Help outlets display quality mark of CET and so on. I never thought this would be accepted but wanted to show there is sadly little incentive to do quality CET because it is devalued by the majority of, I cant think of a word. You can do good CET if you find it. However, why not just do other learning without points so you do not have to look through lots of questionable content that is depressing? Then do your 12 CET points a year in something you been 'educated' in before like why x cl is better than cl y, because research shows it but you cant see the research, its 11.99 a month. (drama)

Then I also suggested randomized MCQs from a data bank for online courses. To reduce remote cheating (I really wanted someone to create an experiment that would present different MCQs to different people all over the UK for a online module. Do that a few times and you have some indicator into how many people actually do CET or just get emails with answers, delegate the task etc).

CET hoarding is not uncommon either. In general CET does not for the majority promote knowledge (sadly) anymore than annual GOC registration makes us better optometrists. However, for a considerable number of people quality CET including support on how to read papers may just be the thing they need to open doors. So maybe we can all ignore the GOC low bar (which I would put money on) and create a platform for high quality rich source CET from speakers ranging from Ben Goldacre to Janet Radcliffe? A brand even without GOC stamp, that provides CET that is tough and sort of gives you a little headache, but ophthalmologists support etc. Then we may be on the road to pushing standards. There is something embarrassing when your peers raise the bar so high, it has an anchor effect.

There will always be a market (however small it maybe) for high quality CET/CPD yet no single body is providing that platform. Sometimes peer pressure can be used for innovation in good ways.

Good luck with the CET meeting. If I can do anything to help please let me know.

re: Is an OCT needed?

billharvey — Wed, 22 Feb 2012 14:01:59 GMT

Saw a patient over the weekend at the City clinic who had disc asymmetry but full fields on threshold testing. The RNFL values were clearly anomalous and warranted referral. Not sure that this would have been piucked up without OCT (will be running it as a case record in a future issue of Optician). Primary care is not anything like the AMD service Chong writes about - the argumnet for OCT in practice for optometrists has, in my view, been won. Still think Chong's view on AMD monitoring is well worth a read. He knows what he is talking about.

re: Is an OCT needed?

Nick Rumney — Wed, 15 Feb 2012 20:05:41 GMT

Couldn't disagree more. What rubbish.

re: Pinhole vision and lack of vision

Chris Bennett — Tue, 06 Sep 2011 14:14:42 GMT

It's true Google ads for all manner of things appear on our pages from time to time. While we can have specific advertisers blocked we can only do this retrospectively so alas rouge ads do make it throughl.

Editor

re: At last - a doctorate - just £98 so the cheapest yet!

billharvey — Thu, 25 Aug 2011 16:14:45 GMT

I am a truly humbled community optometrist

re: At last - a doctorate - just £98 so the cheapest yet!

SydBush — Mon, 22 Aug 2011 21:23:09 GMT

I am grateful to Bill Harvey for exposing his true position vis-à-vis his opinion that Optometrists should remember their places and not aspire to be equal at least to those in other countries

Optometrists like Bill Carlyle (Optician 12th Aug) are right. We have pursued an arcane lonely path. I consulted the General Dental Council recently, telling them my plans for an Optometric Professional Doctorate and found concord, cementing our views.

Bill Harvey knows very well the difference between a PhD entirely research based degree and a courtesy Professional Doctorate but he speaks for the 'Establishment' and its narrow view in seeking to maintain, at great cost to the profession, the 'difference' between MCOptom PhD and DOptom.

It is made very clear that the DOptom does two things. (1) It is the passport to higher education in a part research part taught doctorate in CardioRetinometry for those who aspire to be autonomous consultants in Nutritional Preventive and Therapeutic CardioRetinometry, only available to DOptoms as members of the Institute (supporting the Institute's aims and objectives) and (2) Belated recognition of the training and responsibilities for people's eyesight and health that is assumed by UK Optometrists in exactly the same way as is the responsibility of Optoms in other countries with minor variations.

Disparaging remarks about the professional Doctorate in Optometry can only boomerang on BH for seeking to demote and keep demoted, the advancing profession of Optometry increasingly recognised now World-Wide through high profile Cardioretinometry, as poised to enter the supremely important field of public health through prevention of cardiovascular disease and heart bypasses to put it at its least.

Optometrist are destined to become the leaders, and as I say in my encyclopaedia (700 Vitamin C Secrets - and 1,000 not so secret for doctors!) "the war with PharmacoMedicine will decide whether or not Optometrists prevent disease or doctors get rich treating it." It is a pity that Bill has never been paid £650/year for his expertise in this area but thinking people are now doing so and any Optometrist who thinks this can never happen should wake up to what HAS happened! I now care for people in other countries and with extra training he might too. Optometry can then emerge as more trusted in prevention, than medicine, physicians having all to lose and nothing to gain.

re: Excellent education, missed political opportunity

Lofty — Wed, 23 Mar 2011 16:56:52 GMT

The profession has to vote with its feet if it really wants change. No one is going to do it for us.