Recruiting newly-qualified optometrists to work in domiciliary settings has long been a major problem for OutsideClinic but a plan to improve awareness among students aims to change that.
Simon Raw, optometrist at OutsideClinic, is having conversations with universities to deliver a lecture and live-streamed domiciliary eye examinations for future practitioners.
‘When OutsideClinic offered me a job 14 years ago and said, do you want to do domiciliary? I said, “No, why on earth would I want to do that? I know nothing about it.” At university, no one ever mentioned domiciliary in three years. It wasn’t part of the curriculum. There was no lecture on it,’ he says.
As a result, Raw adds, there are lots of myths about what domiciliary services do and do not involve and what the equipment is like. ‘A lot of optoms, I think, feel the same. They just don’t know anything about it and so when they get approached, a lot of them reject the idea straight away because they’re just going on myths and they don’t actually know what it involves.’
OutsideClinic has made efforts to dispel those misconceptions across the profession. Raw’s project with universities is about teaching students how it differs to working on the high street.
An increased demand for services has created job opportunities at OutsideClinic, but the company has found it difficult to recruit the right people because they do not necessarily know what the job involves. ‘There’s probably hundreds of optoms out there who are going to be perfect at domiciliary but don’t know that they are and don’t know what it involves, so that’s the plan,’ Raw says.
He says by teaching students about the specific considerations of the setting, it opens their minds to think about working in domiciliary as they would the high street or hospital.
A complete role
Sight test demonstrations have been set up for universities to watch live via Zoom. When Raw visits a patient who is willing to have the visit observed, students can watch a domiciliary examination being carried out live. A question and answer session is then arranged at a later date for students to quiz Raw on equipment, diagnosis and communication. As Covid-19 restrictions have eased, Raw has been able to do these Q&A sessions face-to-face and let students get hands on with the equipment he uses.
Raw says during the Zoom session, he is able to demonstrate a complete eye examination, including symptoms and health checks, fundus camera examination, plus dispensing and discussion about low vision aids.
‘We talk about lighting and trip hazards in the home that you just don’t get to do on high street because you don’t get to see the patient’s environment. It’s all very well prescribing the perfect pair of reading glasses, but if they’re sitting in a dark room with inappropriate lighting, they’re not going to use them. You get to see how the patient lives and more of a complete role rather than just the eye test.’
Live demonstrations can be daunting because Raw never knows what he is going to walk into and how co-operative the patient will be. Patients are not pre-selected and have not been tested before to make it as authentic as possible.
‘We’ve had patients who are quite deaf and a gentleman who was really keen to involve students at every opportunity. He wanted to get them closer and look at his eyes and for them to choose his glasses,’ Raw shares.
Utilising skills
A lecture was created to watch via YouTube, which is being reworked to deliver in person and create more interaction between OutsideClinic and prospective practitioners. It explains what domiciliary is, showcases parts of the sight test, as well as the type of personality a practitioner needs to be to work in that environment and what kind of patients are encountered.
‘For a lot of students, it is the first time they’ve ever thought about it or seen it and they’re quite shocked at what we can do. A lot of them expecting us to do a very basic eye test and have not very good equipment as it was probably 30-40 years ago in optometry.’
Raw hopes the lecture and Zoom demonstrations helps students realise domiciliary utilises a lot of the skills they learn and inspires them to explore it as a career option. OutsideClinic has also started to look at offering placements in partnership with the universities in areas where it can be facilitated.
Real time results
Gareth Whatley, senior lecturer in optometry at the University of the West of England, explains how OutsideClinic’s lecture and Zoom session has helped students.
How aware of domiciliary were students before OutsideClinic’s sessions?
Before the sessions, the cohort’s awareness of domiciliary care varied a lot across the year group. All of the students were aware it existed through the learning achieved in their enhanced clinical skills module. However, most were unsure of what a domiciliary eye exam would look like.
What insight does the live sight test on Zoom provide students with?
The live sight test exposes them to more complex cases to consider, helping them see the topics they have learned being applied in real time to an actual scenario, which positively re-enforces the value of our teaching. It also enables them to see an optometrist at work making management decisions, which is invaluable for their development into practitioners.
Domiciliary is a great example of the adaptability and ingenuity required of optometrists to enable them to carry out clinical tests in changing conditions. Seeing an eye test outside of the controlled environment they are accustomed enables the students to visualise how they can test patients’ visual function and eye health despite challenges like patient mobility and altered cognition.
How has interest in domiciliary services increased among students?
The students’ awareness is definitely far greater and I am sure they are more likely to consider domiciliary as a career path than they would have previously. Particularly, Simon highlighted the benefits of getting to spend more time with his patients and the enjoyment he gets from the varied work domiciliary offers.