Our proposed changes are explained below. We will provide further information on the Scheme for Registration for 2020/21 as soon as we can.
A move to ‘patient encounters’
We have proposed a shift from mandatory minimum number requirements to ‘patient encounters’. This is to ensure that trainees gain a breadth of experience across patient groups and conditions that reflect modern optometry practice.
‘Patient encounters’ refer to the following:
- interactions with individual patients (and their carers)
- patient interactions through face-to-face and remote consultations
- provision of patient services and/or assessment of patients’ eye health
- provision of patient and carer advice in response to presenting problems or issues (underpinned by history-taking and the exercise of clinical-reasoning)
- appropriate referrals, in accordance with individual patient needs.
Our proposal to the GOC on patient encounters covered the following:
- Trainees should continue to meet the GOC’s current total for patient experience requirements, but through activity that reflects contemporary optometry services, rather than just in relation to refraction, dispensing and contact lens care.
- Elements of refraction in supervised practice should be recognised, and there should be an increased emphasis on contact lens care and enhanced optometry roles, and less emphasis on dispensing
- Trainees should gain exposure to clinical variation in terms of the age of patients, presenting conditions, and types of optometry practice and service delivery.
- Involvement in phone triage and remote consultations should be recognised in trainees’ supervised practice, in line with changing models of care and taking a risk- and needs-based approach to meeting patient care.
- Trainees should be supported to engage in critical reflection on their patient encounters, as well as the practice environment created by COVID-19.
- Trainees should be supported to develop clinical efficiency and the ability to manage a realistic caseload, safely and with efficacy.
Fulfilment of GOC requirements
Trainees, including those who secure part-time placements during the COVID-19 pandemic, would need to accrue an average of 12 patient encounters per week of supervised practice over 12 months (allowing for four weeks out of practice).
Under our proposals, assessors would continue to monitor individual trainee’s accrual of patient experience. They would also continue to use structured action plans to enable trainees (and their supervisors) to identify specific areas of practice where they need to gain more experience in order to develop their competence.
While COVID-19 has created difficult circumstances for optometry practice, changes arising because of the pandemic should also provide positive opportunities for trainees’ learning and development.
A greater emphasis on taking a risk-based and needs-led approach to meeting patient needs should enable trainees to develop their competence and prepare for registered practice, and allow for greater reflective practice.
Our proposals focus on trainees being supported to do the following:
- engage in ‘deliberate practice’ and ‘rational testing’; i.e. thinking critically about knowledge and skills acquisition, and ensuring they have a clear rationale for each procedure that they undertake
- record their patient encounters in a reflective portfolio and articulate their learning from each experience
- build a conscious understanding of their evolving competence as their range of patient encounters increases.
We will continue to require that a named optometrist (qualified for at least two years) is fully accountable for each trainee’s supervisory arrangements.
We have also proposed that other suitably qualified members of practice teams could contribute to trainees’ supervision experience. This includes other registered optometrists, dispensing opticians, and wider members of the multi-disciplinary team. All supervisory arrangements should be relevant, safe, and comply with legislation.
Our rationale for proposing more flexible supervision arrangements is that:
- it should increase the feasibility of practices providing placements, and reduce the supervisory burden on individual practitioners
- it should provide professional development benefits for individual trainees and those contributing to their supervision, as well as for multi-disciplinary working and patient care.
We also plan to modify the College’s requirements for trainee supervision, so that registered optometrists can supervise more than one trainee at a time. This reflects changing circumstances in optometry practice/service delivery and reduced placement availability. It should be offset by the proposal that other members of a practice team can contribute to individual trainees’ supervision (but with a named optometrist remaining fully accountable for arrangements).