Dr Shehzad Naroo reports on the latest meeting looking at a unified approach to optometry qualification in Europe
The European Council of Optometry and Optics (ECOO), in conjunction with the Association of European Universities, Schools and Colleges of Optometry (AEUSCO) and the International Association of Contact Lens Educators (IACLE) met recently in the beautiful Polish City of Krakow.
The meeting was aimed at the harmonisation of optometric and optical education in Europe. Representatives of training institutions and professional bodies (including observers) were present from Austria, Belgium, the Czech Republic, Denmark, Finland, France, Germany, Hungary, Ireland, Italy, Latvia, Luxembourg, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey, UK and US.
ECOO president Dr Robert Chappell (College of Optometrists) started the proceedings by suggesting that governments in Western Europe realised the benefits of a pan-European primary eye care system that was complementary to ophthalmology. He introduced the presidents of the other bodies, Gloria Ricco (France), president of AEUSCO and Judith Morris (City University), European president of IACLE.
training recognition
The secretary general of ECOO, Richard Carswell (Association of Optometrists), gave further details of the how professional qualifications would be recognised by member states of the EU. Currently, this type of recognition exists, but the host state (ie the county where an individual wishes to travel to for work purposes) can ensure a certain level of training and apply compensation measures.
These measures can be either in the form of an aptitude test or a period of supervised practice. However, there is a directive from the EU to have a common platform. This would be based on agreement by two-thirds of the member states and must be proposed by a professional body such as ECOO. Suppose ECOO proposed a European Diploma of Optometry (EDO) and the EU accepted this, this EDO would become a standard of entry-level competence throughout Europe. However, member states would be able to decide the scope of practice and training within their own states. For example, some EU countries do not allow diagnostic drug use by optometrists. ECOO or the EU or the fact that the person was an EDO holder would not necessarily grant them the right to use diagnostics. This would be a matter for the professional bodies within that member state to decide with their own governments depending on the needs of that state.
Another example of this would be the use of therapeutics, where it would be decided by individual member states if this would be permitted. However, not being able to perform therapeutic work would not stop an individual from migrating to a country where it was permitted. It may mean that the individual would need to undertake compensatory measures to be able to practise in the host state.
Carswell explained that this type of harmonisation started many years ago. The World Trade Organisation put into action a General Agreement on Trade and Services (GATS), and the EU has signed up to GATS. The EDO proposed by ECOO is based on three parts of a four-part global model of optometry. The four parts are:
1 Optical technology services
2 Vision function services
3 Ocular diagnostic services (this would include parts 1 and 2)
4 Ocular therapeutic services (this would include parts 1, 2 and 3).
These four parts collectively fit the global competency-based model of the scope of practice in optometry, approved by the World Council of Optometry (WCO). Part 4 of this system is outside the scope of the ECOO-proposed EDO but will soon be a part of the model proposed for optometry in the UK. In the longer term the WCO international assessment agency would aim to harmonise optometry on a more global scale, but still there would be provision for each country to decide which competencies apply to the needs of that nation.
Wolfgang Cagnolati, chairman of the board of examiners of ECOO EDO, said that in 1988 at the Venice meeting of ECOO the members of ECOO accepted the structure of the EDO. However, there was a slow uptake - in 2004 only eight EDOs were awarded. The exam itself consists of a practical element, a station exam and multiple-choice questions. ECOO will apply accreditation visits to all institutions that offer the EDO. There will be two levels of accreditation available to universities, colleges and schools. The first will be full accreditation, whereby students from that institution will be awarded with the EDO upon graduation from that institution. Alternatively, ECOO may award partial accreditation to an institution whereby upon graduation the students will get the qualification of that institution, but will need to take extra modules to achieve the EDO. The timescale envisaged would be that by 2006 the standards and competencies would be set, by 2008 the accreditation panel of ECOO would be in place and by 2010 institutions would be awarded accreditation.
qualification process
Dr Adrian Jennings (University of Manchester) detailed the process involved in becoming an optometrist in the UK. He started by discussing the history of ophthalmic optics and ended with details of the Masters degree in Optometry (MOptom) programme in Manchester, which is the only UK programme where students can register directly with the General Optical Council (GOC) from university.
This programme is offered to the best four students at the end of the second year of the normal three-year Bachelor of Science (BSc) programme. These students then have an accelerated third year in one semester, followed by six months of hospital experience and six months of routine practice experience. This takes them into a fourth year and the four students return to the university for a final semester in this fourth year and upon completion have a MOptom degree that allows them to apply for GOC registration.
Dr Jennings informed the audience that the Spectacle Makers Company (SMC) came into being in 1629 and in 1898 set up examinations for new members. In 1895 the British Optical Association (BOA) was established and set a syllabus and examinations for new members. These two organisations finally merged in 1980 to become the College of Optometrists.
In 1958 the GOC was formed by an Act of Parliament - the Opticians Act. This was the first time that the profession of ophthalmic optics had been formally recognised by the government. The GOC sets criteria for registration and decided to accredit the existing examinations of the SMC and the BOA. Nowadays it is the College of Optometrists' examinations that are accredited by the GOC.
Originally, these examinations were in two parts. Part 1 would be examined at the beginning of the period of supervised practice and Part 2 examinations (split into parts A and B) were taken at the end of the one year of supervised practice. In 1965 when ophthalmic optics became a BSc level of study, students who attained a BSc were exempt from Part 1 of these accreditation examinations. The GOC still visits the training institutions and also inspects the Professional Qualifying Examinations (PQEs) of the College of Optometrists. Currently the GOC accredits all the UK optometry courses, a total cohort of around 600 new students per year. Plus, the GOC accredits the optometry course in Dublin, Ireland and Utrecht, Netherlands.
To qualify for Part 2 examinations (PQEs) the GOC requires that candidates achieve a minimum of a 2:2 BSc degree. (This equates to an average mark of 50 per cent, the mean average mark for BSc students is approximately 60 per cent.) The student must have seen 70 patients including routine, dispensing and contact lenses patients. During the pre-registration year the candidates must perform 500 eye examinations, 350 dispensing appointments, keep a log of all patients seen and visit a hospital eye department. In February 2005 the GOC published schemes for overseas candidates.
fast-track to optometry
Professor David Whitaker (University of Bradford) gave details of the conversion course at his university that allowed registered dispensing opticians who held a contact lens fitting qualification to undergo a fast-track system and achieve a BSc degree in Optometry. This system enabled the DOs to have a period of recognised practical experience before they started the full-time element of the course. The full-time element was 12 months' duration (broken into three semesters). Previously DOs would have to undertake the full three years of the BSc programme and the full pre-registration requirement of the GOC and would only be exempt from one of the 10 Part B PQEs (in dispensing).
The Intra-Professional Forum (IPF) decided that when persons from one profession were being retrained, then acquired prior learning (APL) must be considered. The University of Bradford recognised APL for DOs who had the contact lens qualification. The learning objectives for the fast track system are identical to the main three-year Optometry BSc programme. In 2003 the first cohort of students were enrolled, a total of 24 persons aged between 24 and 59 years old (mean age of 35 years). This first cohort were awarded degrees in 2004, half of whom achieved first class honours compared to around 12 per cent of the students on the regular three-year BSc programme. Professor Whittaker hinted at the possibility of career progression beyond optometry, perhaps into ophthalmology?
Professor Frank Buijs (Netherlands) pointed out that many European optometry teaching institutions, including his, worked towards the BSc and MSc (Master of Science) structure as agreed by the Bologna Declaration. This agreement puts in place the European Credit Transfer (ECT) System, where one point is awarded for 28 hours of study.
Professor Peter Moest (Germany) discussed how the optometry course at his university not only complied with the Bologna Declaration but also worked on a system of competency-based learning.
The five German optometry universities work on a seven-semester system. To pass a certain core competency, candidates are required to show one of three levels - safe, good or specialist. Everyone must be at least safe, as a basic entry level, and a high proportion would also be at the good level. It is not necessary for everyone to have the specialist level - for example, not every optometrist would have the specialist skill required to fit contact lenses for keratoconus.
Mirjam van Tilborg (Netherlands) said that optometric education needed to incorporate various skills, including clinical skills that were problem- and case-based. Students should get an all-round education and it was helpful if a large proportion of the educators were themselves optometrists.
Dr Miguel Angel Munoz (Spain) gave details of how the optometry course was developing in Spain, and how institutions were collectively lobbying the Spanish government to give a degree status to optometry education.
It would appear as though there are many challenges ahead if the reality of the harmonisation of optometric and optical education in Europe is to be seen, but certainly there are strides being made in that direction. The fact that 26 countries were represented by the 130 delegates (including 27 from the UK) can only be seen as a positive sign.
Dr Chappell expressed his disappointment that there were institutions in Spain that were aligned with the Pennsylvania College of Optometry (PCO) to administer the MSc programme of PCO at their own Spanish institutions when these resources were available in other parts of Europe, such as in the UK. He would prefer to see European links of this type being developed.
It would appear as though there are many challenges ahead if the reality of the harmonisation of optometric and optical education in Europe is to be seen, but certainly there are strides being made in that direction. The fact that 26 countries were represented by the 130 delegates (including 27 from the UK) can only be seen as a positive sign. Other UK professional bodies were represented at the meeting including Peter Coe (GOC), Bob Hughes (AOP), Paul Carroll (FODO), Bryony Pawinska (College of Optometrists), Jim Russell (ABDO) and Jo Underwood (ABDO).
Shehzad Naroo is a lecturer at the School of Life and Health Sciences, Aston University. He is an examiner for the College of Optometrists, the treasurer of the British Society for Refractive Surgery and the editor-in-chief of Contact Lenses and Anterior Eye
A follow-up piece on the role of IACLE will appear in a future issue