Optimising outcomes in education

As the General Optical Council (GOC) consults on updating its requirements and processes for optometry and dispensing optician pre-registration education, Helen Gilbert looks at the rationale for the move. 

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The College is urging eye health professionals and other stakeholders to submit their views on the General Optical Council’s (GOC’s) plans to update its requirements and processes for approving qualifications that lead to optometrist registration or as a dispensing optician (DO).

“The College holds a huge amount of expertise and we could and should have an important role to play in continuing to deliver the Scheme for Registration in an updated format, working closely with universities and employers,” says Sally Gosling, Director of Education at the College. “As the UK professional body, we can also contribute to the detail of how the new GOC outcomes are implemented, including to ensure the quality of practice-based learning and assessments.”

The consultation, which opened on 27 July and closes on 19 October, forms part of the regulator’s Education Strategic Review (ESR). It makes recommendations on how pre-registration education should evolve to prepare future optometrists and DOs for changing roles and models of patient care. 

Under the plans, the existing Quality Assurance Handbooks for optometry (2015) and ophthalmic dispensing (2011) will be replaced by three documents: Outcomes for registration, Standards for approved qualifications, and Quality assurance and enhancement method (see Views needed below).

The proposals herald a shift to an outcomes-based approach to defining pre-registration education requirements with a singular journey and point of accountability for routes to registration. This means a move away from the current competency-based approach and the GOC defining requirements for two stages of pre-registration education. 

What might the role of the College look like under the new proposals?

Sally Gosling, the College’s Director of Education explains.

“There is the possibility for the College to secure Ofqual recognition to act as the single point of accountability for some routes to registration. Under this model, the College would quality assure the delivery of complete routes to registration. While obviously not the current model in optometry, the equivalent arrangements exist for some other professions. As the professional body, we would also have a view on the wider development of, and quality of, optometry education.

 “At present, we’re commissioning a joint piece of work with the GOC and the OSC to establish the level at which optometry pre-registration education should be set. This will directly influence how the new outcomes are finalised and implemented to ensure that future optometrists have the level of knowledge, understanding and skills required for the profession’s evolving scope of practice, contribution to models of care/service delivery to meet population/patient needs.”

The College has been engaging members on the ESR consultation and will be consulting members on the College’s draft consultation response early in October.

Keeping up

So what are the reasons for the change?

Leonie Milliner, the GOC’s Director of Education, says the existing system is at risk of “becoming out of date”. 

Sally agrees. She says the existing model of optometry education is “out of kilter” with those of most other healthcare professions, including nursing and the allied health professions, which operate a singular pre-registration journey from post-A-levels through to registration. Other professions that currently have a staged approach are due to move in the same direction. 

Sally also believes that the current 75 competencies through which the GOC  defines the threshold for full registration as an optometrist are at risk of holding back the profession.

“Competence-based approaches to education tend to be prescriptive and grounded in what can be observed and technical proficiency, whereas outcomes-based approaches focus more on professional capability that melds critical thinking, clinical-reasoning and decision-making, taking responsibility for decisions and actions, and responding to changing needs. These are all key to engaging in up-to-date, effective and research-informed clinical practice, in addition, obviously to scientific understanding and technical skill.”

According to Leonie, an outcomes-based approach to specifying the knowledge, skills and behaviours expected of a day-one registrant is a model used frequently by other healthcare regulators and one that is widely understood within higher education. 

“Our proposals require providers – who we are calling ‘single points of accountability’ – to measure students’ achievement of the outcomes leading to the award of the approved qualification, which must be either an academic award (such as a degree) or a regulated qualification (Ofqual, SQA, and so on),” she says.

“The strength of a provider’s assessment strategy, coupled with our increased expectations for greater engagement with patient and public stakeholders, optical professionals, students, employers and commissioners in the design and delivery of the approved qualifications, is an important safeguard, encouraging innovation and greater responsiveness to patient and service-user need.”


Long overdue?

Sally says this outcomes-based approach has been a long time coming.

“For the profession to optimise its contribution and potential to meeting patient care needs through an expanded scope of practice, medical and other colleagues need assurance that optometrists have the knowledge, the skill and the understanding to manage complexity and risk, and engage in clinical governance, clinical audit and evidence-based practice, all as key parts of their day-to-day practice,” she says. “We need to ensure that these attributes and skills are developed in pre-registration education, in addition to the clinical and technical proficiency that are fundamental to optometry practice.”

Will Holmes, Chair of the Optometry Schools Council (OSC), describes the existing GOC education model as input-centred and one that encourages a “tick-box” approach as students collect various competencies at different stages.

“From a professional perspective, a move to being less input-based and having higher-level registration outcomes will enable education to be more flexible and respond to changes in practice,” he says. “From a teaching and learning perspective, we will have greater freedom to be innovative in our activities and be able to facilitate learner thinking in terms of global goals rather than discrete ‘abilities’.”


Clinical is crucial

In its earlier call for evidence, the GOC heard that students and their employers desired earlier and higher-quality clinical experience that is more firmly integrated into their education and training.

“For both optometrists and DOs, we are proposing that at least 48 weeks of professional and clinical experience must be integrated within the approved qualification in one or more ‘blocks’ of time in more than one sector of practice,” Leonie says. 

However, the Association of British Dispensing Opticians (ABDO) has expressed concern about a possible “one-size-fits-all approach” and questions why the GOC wishes to impose “the same root and branch changes on dispensing opticians, given that nearly all student DOs already combine academic study with working in practice.”


Areas of concern

Arguably, there are other elements that still need to be fleshed out in the review. Both ABDO and the College raise concerns about a “lack of detail” around the clinical skills and knowledge required of both optometrists and DOs in the Outcomes for Registration, while the absence of exploration of funding to support implementation of the ESR is also raising concern.

“The key unknown is how a different model of optometry education can or will be funded,” Sally says. “This urgently needs to be explored, especially now in the very uncertain context created by COVID-19.”

So, what’s the solution? “A longer lead-in period to enable a full exploration of how models of education can appropriately evolve safely, building on what already works well for producing safe, effective practitioners,” she says.

Will agrees. “We believe that more work is needed to fully understand the financial viability of the proposals. It is imperative that what the GOC approves is financially sustainable if they are to fulfil their core duty of public protection.”

It’s a point acknowledged by the GOC. “We are working with experts in the field of higher and further education funding to understand these [financial] impacts, and welcome information from stakeholders on this and other aspects of our proposals.”

Academic teams across the UK will also need to put significant work into revising their programmes to fit with the new model, Will adds, which would not only involve internal processes but the establishment of new external relationships in order to provide clinical experiences.

“It is essential that the timescale for implementation is realistic and begins at a point where we have learned what the long-term effects of COVID-19 will be.”

The Education and Training Requirements for GOC-approved qualifications consultation is seeking views on the following:
  • Outcomes for registration, which describe the proposed knowledge, skills and behaviours a DO or optometrist must have at the point they qualify and register with the GOC.

  • Standards for approved qualifications, which explain the expected context for the delivery and assessment of the outcomes leading to an award of a GOC- approved qualification.

  • Quality assurance and enhancement method, which describes how the GOC proposes to gather evidence to decide whether a qualification designed to lead to registration meet its Outcomes for registration and Standards for approved qualifications.


The COVID conundrum

This raises a question: is now, given the extra pressure placed on the professions, universities and employers in this COVID-19 climate, really the right time to be progressing this work and the review?

 “On the one hand we need to wait until there’s more stability in the system; conversely, the pandemic is raising the need for change,” says Sally. “Optometry needs to be supported to develop so that its contribution to meeting rapidly changing needs in how patient care is delivered is optimised. This is why it’s so important members engage in the ESR consultation.” 

Have your say

The consultation closes on 19 October 2020Have your say here.


Helen Gilbert