Explaining Stage One evidence

Your guide to the types of evidence you will need for your Stage One visits.

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Assessors use a range of evidence to assess each competency. You will need to provide at least two types of evidence per competency. You can find the evidence types you will need for each competency in our assessment framework downloads.

Below is an explanation of the evidence types needed in Stage One:

Evidence type
Direct observation
Your assessor observes you face-to-face in practice performing a skill on a patient or a simulated patient. Find more information on direct observations below this table.
Patient record
You provide a patient record from your practice. This happens face-to-face. The record is used as the basis for discussion. Find more information on patient records below this table.
Anonymous patient record*
You present an anonymised record to your assessor during a remote visit. This would have the patient’s name and other personal details anonymised.
Before the assessment, your supervisor must sign a statement saying that the records have been checked and fully anonymised, identified only by patient number.
During visit three, your assessor will ask to check a sample of your anonymous patient records.
Find more information on anonymous patient records below this table.
Case scenario
Your assessor gives you a hypothetical case scenario. This forms the basis for discussion.
Trainee led case discussion* TCD

You present a real case verbally to your assessor, and then have a case discussion based on the record.

You do not need to present the record to your assessor, but some records may be sampled at visit three/four.

Your assessor will be looking for evidence of your thought process and actions (e.g. in investigation of symptoms, management planning and some dispensing elements).

Find more information on trainee-led case discussions below.

Questioning Q A series of structured questions.
Role play RP A role-play of a clinical scenario, with your assessor taking the role of the patient.
Field plot FP A field plot to interpret and discuss.
Images I Images for you to interpret and discuss.
Referral letter RL You will present a referral letter you have written for discussion.
Prescription interpretation PI A prescription to interpret and discuss.
Witness testimony* WT Your supervisor or other suitably qualified eye care professional observes you interacting with a patient or performing clinical skill. The witness signs a testimony detailing the episode and confirming it was performed competently.

Find more information on witness testimony, including templates, below this table.
Log Log You provide a log on your patient encounters or with information you have gathered on local services relating to low vision.
Reflective account* RA You provide a written description of an experience and your actions.

Find more information on reflective accounts below this table.

*New evidence types for 2020-21

More on direct observation (DO) evidence

During face-to-face visits, your assessor will need to see you doing the following:

•    history taking;
•    communication with the patient;
•    interpreting and investigating presenting symptoms;
•    refraction;
•    assessing binocular status;
•    assessing the external eye and adnexa;
•    slit lamp examination;
•    direct ophthalmoscopy;
•    indirect ophthalmoscopy;
•    contact tonometry;
•    Soft lens fitting.

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More on patient record (PR) evidence

You must review any patient record evidence you want to be assessed with your supervisor.

Patient records must be original, include patient consent and be contemporaneous (Contemporaneous means the record that was completed at the time of the examination or dispense). 

If you are in the Hospital Eye Service, an original, contemporaneous record is one that is kept in your HES logbook/notebook, and signed by the supervisor at the time of the consultation.

Dispensing patient records must be the complete record and not the printed patient order. A complete dispensing record outlines the patient’s requirements, and the advice and specifics of the device ordered.

Do not alter patient records in any way. 

If your visit happens at a different practice to where the original records are kept, you can present your assessor with copies. Copies will only be accepted if each one is individually signed off by your supervisor as an exact copy. 

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More on anonymised patient record (APR) evidence

All patient records used in remote visits will need to be anonymised. You should present an anonymised patient record in the same way you would present a patient record at a face-to-face visit.

There is no requirement to anonymise records that are shown to your assessor during a face-to-face visit, even if a competency with anonymous patient record as compulsory evidence has been carried forward from visit two.

How to anonymise and present your records

You must not alter the patient record in any way, beyond anonymising. Changes to patient records are considered a form of cheating.

In your place of work, remove:
•    the patient name,
•    address,
•    date of birth,
•    GP details,
•    telephone number,
•    any other patient identifiable details from the record.
You need to duplicate the record before anonymising. You can either redact records electronically or cross the details out with black ink so that details cannot be seen. 

You must do this while in your place of work. You must never take patient records with identifiable features out of your work premises.

You can record the age and ethnicity of the patient on the record if it is clinically significant.

Once a record has been anonymised, store it electronically so that you can screen share it during your visit.

Your supervisor must then sign a separate declaration (below) confirming that your anonymised patient records have been checked, and appropriately anonymised.

Be prepared to share the record on screen with your assessor during your visit. The record must be clearly visible to the assessor.

The anonymised record should not be sent to the assessor ahead of a visit, or ever held by the assessor.

You must keep a record of the actual patient record from which each anonymised patient record is taken, in case your assessor needs to cross-check it.

Record checking

At visit three, your assessor will check a minimum of three, and not normally more than ten records across the categories of anonymised patient records, reflective accounts and trainee-led case discussions that you used at visits one and two.

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More on witness testimony (WT) evidence

We have produced witness testimony templates below.

When demonstrating a skill for a witness testimony, the following can be performed on either a patient or your supervisor/other practice staff member:

•    Keratometry,
•    Measurement and verification,
•    RGP fitting, insertion and removal,
•    Management of anterior uveitis.

These are the skills that you must demonstrate on a real patient:

•    Management of a child under two years of age
•    Management of incommitant deviation.

Witness testimony templates


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More on reflective account (RA) evidence

You must produce a reflective account as evidence for the following skills:

•    Understanding patient expectations,
•    Communication with patients who have poor or non-verbal communication,
•    Management of patients with additional clinical or social needs,
•    Record keeping,
•    Referral,
•    Non-tolerance in dispensing.

We have produced a template and guidance for completing reflective accounts:

Reflective accounts are in addition to your reflective portfolio.

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More on trainee-led case discussion (TCD) evidence

Trainee-based case discussions (TCD) are discussions, led by you, and based on a real record of a patient you have seen.

Trainee-based case discussions are used to assess competencies where patient records alone don’t give enough information on your thought process, decisions and actions (i.e. in relation to investigating symptoms, management-planning and some dispensing elements).

When presenting your record to your assessor, you should cover the following information:

•    Your patient's age, gender and any other relevant information such as ethnic background,
•    Relevant presenting symptoms and history,
•    Investigations and findings,
•    Clinical decision and management,
•    Advice given to patient. 

You must not submit any case information to your assessor before your visit.
You must keep a record of the actual patient record on which each trainee-led case discussion was based, in case the assessor needs to cross check it. 

Record checking

At visit three, your assessor will check a minimum of three, and not normally more than ten records across the categories of anonymised patient records, reflective accounts and trainee-led case discussions that you used at visits one and two.

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