After an opening welcome from chair Gareth Hadley, the format and objectives for the meeting were introduced by GOC director of strategy Alistair Bridge who explained the GOC has already consulted widely on education reform and the 55 detailed and thoughtful responses had been distilled into 11 themes.
Education Strategic Review project director Claire Herbert then took the group through the 11 themes as follows:
Concept 1: Standards for Education Providers
Currently the GOC imposes a level of detail on educators that it acknowledges as counterproductive in terms of innovation, flexibility and adaptation to changing needs of patients and healthcare systems. It is exploring the idea of a single set of high level standards for all education providers which may include: the content of optical and optometric programmes; course design and delivery; student support; policies and procedures; quality assurance; learning outcomes to be achieved on registration.
Concept 2: Education Standards and Professionalism
The GOC is considering linking education standards directly to standards of practice to ensure professional standards are central to the entire process of optical education. Conversations in the side-lines indicate that many feel this is a good idea reflecting a previous time within the memory of practitioners in the second half of their careers when professionalism, ethics, law and management were all considered important.
Concept 3: Learning Outcomes
How the GOC accredits training institutes is currently rather input driven. It is proposed that educators will be required to deliver specific learning outcomes to enable flexibility to adapt to changing patient demographics and emerging diagnostic and therapeutic technologies.
The system at the moment for optical education including CET is competency driven. The necessity to assess every minute competency and map where and when each candidate was deemed competent is seen by many educators as counterproductive as it can lead to a box ticking ‘learn and forget’ approach especially if competencies critical to real world practice are assessed early on in the student’s programme of studies then forgotten.
Concept 4: Links to Continuing Education and Training
The competencies that registrants cover within each three-year CET cycle are identical to those covered by students in order to register as an optician. An advantage of this is that registrants must ensure they retain a level of skill equivalent to a newly qualified practitioner and adopt any new competencies added to the syllabus.
If there is a move away from a competency based approach for education then there will be consequences for CET which will require careful thought. The proposal is that CET is linked to Standards of Practice rather than educational competencies.
It is not clear how the GOC might address the current issue of only having to get points in high level competencies rather than a more detailed approach. For example, at present there is no requirement for supervisors of trainee dispensing opticians, pre-registration optometrists, or non-registered staff carrying out restricted and regulated functions to gain CET relating to supervision, any old ‘standard of practice’ will tick the box. Likewise because the optometrist competency ‘optical appliances’ includes low vision even those that supervise unregistered dispensers do not need to do any CET relating to ophthalmic dispensing.
The consultation so far suggests that a majority of the 55 responses (out of 30,000 registrants) hold that CET is not fit for purpose. While it may have its shortcomings the process of prior accreditation, and an electronic means of monitoring compliance making it easy for registrants and regulator alike is the envy of other professions.
The CPD certified scheme used by other professions is prohibitively expensive to providers, and is unable to properly accredit ad hoc self-directed learning. CET must reflect changes to the competency of newly qualified opticians. Indeed when the syllabus changes it could be argued that existing registrants should be compelled to bring themselves up to date as they had to with the new Standards of Practice during the current cycle.
Concept 5: Educational content
The GOC is likely to review the content of education and training courses that lead to registration as an optometrist or dispensing optician. Key drivers for this are changing technologies, new services and increased use of different models of service delivery such as domiciliary care.
Concept 6: Enhanced clinical experience for students
There is a move more generally in healthcare to ensure students are exposed to practical clinical experience from the start of their studies that is in line with the move towards blended learning and apprenticeships.
Concept 7: National registration examination
The GOC states that it wishes to explore retaining the principle of a national standardised examination or assessment, yet it is only in recent years it has allowed a handful of Manchester students each year to register without doing the College of Optometrists Scheme For Registration.
Similarly, and in greater numbers, distance learning students on the Anglia Ruskin Foundation Degree ophthalmic dispensing programme have not been required to take FBDO exams that for over 20 years were the national standard. Professional bodies may welcome the idea, presuming they remain preferred providers, but educators looking for new models of learning and assessment may be less enthused.
Concept 8: Multi-disciplinary education
The concept of embedding a multidisciplinary ethos into education programmes is something the GOC is exploring the feasibility of. Some educators are already doing this, for example Glasgow Caledonian University educates dispensing opticians, optometrists and orthoptists together in first year.
A number of CET providers have held joint sessions, reportedly with great success, with other disciplines such as pharmacy, orthoptics and sight loss rehabilitation. Research shows patients are much more likely to go somewhere other than the opticians if they have an eye problem and it is interesting to consider the number of practitioners involved in primary eye care.
Patients might consult a GP, registrar, physician associate, triage nurse, or pharmacist, as an alternative to a dispensing optician or optometrist. GOC registrants are also involved in secondary and tertiary eye care alongside ophthalmologists, sight loss rehabilitation workers, orthoptists, ophthalmic nurses, eye clinic liaison officers and screening personnel. It seems inconceivable that effectiveness and efficiency cannot be improved in both eye related education and eye healthcare by developing inter-professional collaboration and understanding with the patient at the heart.
Concept 9: Duration of education and training programmes
The current minimum duration periods for education and training of optometrists and dispensing opticians are under consideration, however, Claire Herbert made the point that programmes are unlikely to reduce in duration as there is considerable demand to put additional learning outcomes into programmes rather than take them out.
That however would appear to fly in the face of initiatives proposed by the Government in its recent consultation ‘accelerated degrees: widening student choice in higher education’ which ran from December 10, 2017 to February 11, 2018. It seems reasonable, given most current programmes operate for under eight months a year, that the same number of learning hours could be compressed into a shorter calendar period for students who prefer to have less downtime and qualify quickly.
Government figures suggest the average graduate would be £25,000 better off given the savings in education costs, and the extra time earning money in the workplace. This argument similarly applies if the professions move to an apprenticeship model of qualification funded by employers and the apprenticeship levy tax.
Concept 10: UK educational routes to registration
The idea here is to properly accredit prior learning to allow people to pursue different careers when they want to and also to look at new educational routes to registration such as degree level apprenticeships. Co-education of different eye care disciplines, especially for underpinning scientific knowledge, may make sense as optometry, dispensing optics, orthoptics and sight loss rehabilitation share many skills and areas of common knowledge.
Concept 11: Proportionate quality assurance
Eventually, once the other concepts of the review have been crystallised into firm recommendations and policy, a new system of quality assurance will no doubt be needed.
Question Time?
After the process for consultation was explained there was a question and answer session. Lesley-Anne Baxter, former chair of the British and Irish Orthoptists Association was curious as to why the GOC had made significant comparisons to professions such as pharmacy and dentistry when there are other professions more allied to eye health.
The GOC responded that they felt because both dentistry and pharmacy have undergone significant regulatory and educational reform in recent years there were very valuable lessons to be learned. This prompted this author to suggest as part of the review the eye health education content of other programmes such as medicine and physician associate should be compared in terms of learning hours and topics versus expected learning outcomes and competencies.
Paul Carroll (pictured) of Specsavers urged the GOC to ask itself where the profession and industry needs to be in the future. Phil Ambler of the Thomas Pocklington Trust made the point that there needs to be new patient focused ways to get on the register with the ultimate aim of ensuring that we learn to work together to ensure people stop losing their sight needlessly as a result of blockages in the system.Claire Herbert (cherbert@optical.org) urged interested parties to get in touch directly with any questions they may have and also stressed that the GOC is keen to have bilateral talks with any organisation that wishes to have a face to face meeting.
If you are interested in the future of your profession, especially what it takes to qualify and join the register, then make a date in your diary – March 16, 2018 – as this is the deadline for expressing your views to the GOC about the future of education for optometrists and dispensing opticians at https://www.optical.org/en/get-involved/consultations/index.cfm. You can answer just one or all 21 questions so it need not be time prohibitive. If you have a view, now is the time to express it.