COVID-19: Remote Stage One assessments -information for trainees

Arrangements for remote Stage One assessment visits during the COVID-19 pandemic for trainees who had at least two Stage One assessment visits.

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COVID-19 Stage One assessment guidance

This guidance sets out arrangements for remote Stage One assessment visits during the COVID-19 pandemic for trainees who had at least two Stage One assessment visits before 18 March 2020, when assessments were suspended.

We will be issuing guidance for currently enrolled trainees, who did not have at least two Stage One visits before 18 March 2020, in due course.

Contents: 

                                                                                   

Overview of Stage One modifications

Background

Stage One assessments were suspended from 18 March 2020 due to government restrictions on face-to-face contact. To resume assessments and enable you to progress, Stage One assessment visits need to take place remotely. We expect that this will remain the case for some time.

Key features of the modified approach

The modified approach to Stage One assessments will involve conducting visits via online one-to-one video meetings between you and your assessor. These will be used to assess you if you are still waiting to return work/supervised practice and once you have been able to return.

This approach will also recognise that the nature of your supervised practice will be subject to constraints and limited patient contact.

The remote Stage One assessment visits will use established forms of evidence of your fulfilling the 75 competencies required. However, they have been designed so that they will not require compulsory direct observation (DO) in your practice by a College assessor, nor the use of patient records (PR).

Some of the competencies that previously involved DO, which you didn’t have assessed before lockdown, will be assessed in your Stage Two assessment.

Modified Stage One evidence requirements

This table provides a list of evidence types in Stage One

Evidence type Abbreviation Explanation
Direct observation DO The assessor observes the trainee interacting with a patient or performing a particular clinical skill on a patient or a simulated patient.
Patient record PR The trainee provides a patient record from their supervised practice for inspection by the assessor. The record is then used as the basis for discussion between the assessor and trainee.
Case scenario CS The assessor provides the trainee with a hypothetical case scenario or patient record. This then forms the basis for discussion between the assessor and trainee.
Questioning Q The assessor addresses a series of structured questions to the trainee.
Role play RP The assessor plans a role-play of a clinical scenario to enact with the trainee, with the assessor taking the role of the patient.
Field plot FP The assessor provides a field plot for the trainee to interpret and discuss how they would manage their findings.
Images I The assessor provides images for the trainee to interpret and discuss.
Referral letter RL The trainee writes a referral letter for discussion.
Prescription interpretation PI The assessor provides a prescription for the trainee to interpret and discuss.
Witness testimony WT The trainee’s supervisor or other suitably qualified optometrist (the “witness”) observes the trainee interacting with a patient or performing a particular clinical skill on a patient or a simulated patient. The witness signs a testimony detailing the episode and confirming it was performed competently.
Log Log The trainee provides a log providing information they have gathered of local services (relating specifically to low vision).
Reflective Account RA The trainee provides a written description of an experience and their actions including what went well and what did not go well, including what they have learnt for the future.

Evidence modifications

COVID-19 restrictions mean DO and PR for assessment cannot universally take place in a safe, fair way. This is because some of you are not in supervised practice and so cannot access patient records, or because assessors cannot enter the workplace for prolonged periods of time. 

At least two different evidence types will still be required for each competency to be achieved. Updated frameworks for each Stage One visit, showing the GOC 75 competencies and compulsory evidence types, can be found here.

Witness testimonies

Wherever possible, compulsory DO evidence will be replaced with a witness testimony (WT). This requires your supervisor (or, if not possible, another optometrist who has been registered with the GOC for at least two years) to sign a testimony that they have observed you demonstrate a particular competency. 

We have produced a template for the WT, plus guidance, to ensure WTs contain sufficient information on how the performance criteria for individual competencies have been assessed. {link to WT}

If you are unable to demonstrate the competency that requires a WT on a patient, you can demonstrate it on your supervisor or member of the practice team.

Witness testimonies will be used for the following competencies:

3.1.1 Keratometry
3.1.3 Direct ophthalmoscopy
3.1.6 Contact tonometry
4.1.2 Measurement and verification
5.1.3 RGP fitting
5.1.3   RGP insertion and removal

Direct observation at Stage Two

For some competencies, DO evidence will be moved (“trailed”) into Stage Two. You will still be assessed on these competencies in Stage One, but using other forms of evidence.

2.1.1 Health and Safety
3.1.2 Slit Lamp
3.1.3 part Indirect Ophthalmoscopy
3.1.7 Assessment of tear Film
3.1.9 Pupils
5.1.1 Soft Fit
5.2.1 Soft Aftercare
7.1.1 Refraction
8.1.1 Assessment of Binocular Status

Patient records

Where possible, compulsory PR evidence will be replaced by the use of structured case scenarios (CS) and related questions (Q). You can still use a PR for the basis of discussion, but you cannot use PR as evidence for a competency during remote assessment. This is due to patient confidentiality issues. You should not send any PR to your assessor. You may discuss a PR with your assessor as long as all patient-identifiable information has been removed.

Reflective accounts

A Reflective account (RA) will be introduced as a new type of evidence for specific competencies:

2.2.4 Record keeping
2.2.6 Referral Pathways
4.1.5 Dispensing a range of lens forms
8.1.3 Adult patients with Heterophoria

We have produced a template and guidance on producing RAs.

Remote Stage One assessments

All trainees currently enrolled on Stage One, who have had at least a two visits are eligible for remote assessment. You do not have to be currently employed to complete Stage One, and assessment visits can take place if you are on furlough. The modified Stage One assessment framework and your previous action plan will be used to structure your progress and define the focuses for each visit.

Scheduling your assessments

The Stage One modified assessments will be conducted via a pre-arranged video call, usually using Zoom. As far as possible, you will be assessed by your original appointed assessor. You will be given at least two weeks’ notice of your remote visit, but an assessment can be arranged sooner if you agree this with your assessor.

You should use a tablet or computer with a webcam for your visit, not a mobile phone. If you are unable to access a tablet or computer, please get in touch with the College team at education.help@college-optometrists.org.

Online assessments will take place across the week, with the date and time agreed between you and your assessor.

If you and/or your assessor are based overseas, you will need to make remote visit arrangements that take account of reasonable appointment times for each party.

Preparing for your remote Stage One assessment

Your assessor will initially contact you to determine whether you are in a position to take part in remote assessment visits. They will ask:

  • If you are working in the practice, on furlough, or currently without employment?
  • If working in practice, what is your current patient load and patient contact time?
  • If furloughed or not employed, do you have access to a practice?
  • Do you have contact with your supervisor?
  • Are you, or any members of your household shielding?
  • Are there any other exceptional circumstances meaning you can’t resume assessments/practice?

You can choose not to participate in the modified assessment arrangements during the first six weeks of assessment visits being restarted, if you have exceptional personal circumstances that prevent you from restarting. Exceptional personal circumstances may relate to ill health, loss of employment, or being based overseas. You should discuss this with your assessor in the first instance.

If a delay is proposed and agreed with your assessor, this arrangement will need to be confirmed with the College, and you / your assessor should email this to education.help@college-optometrists.org.

If you and your assessor agree to resume assessments, your assessor will send you a visit plan listing the competencies you’ll be assessed on during the remote visit. You will not need to be re-assessed on any Stage One competencies that you have previously achieved, or on evidence types that you have previously had signed off.

You will also be sent a revised action plan from your most recent previous visit. Action plans from previously unachieved competencies are likely to need modification to reflect the new evidence types required, and to take account of the individual circumstances of each trainee.

You will need to return the visit plan to indicate your agreement. You’ll also be required to confirm that you will not record or share any aspects of your online assessment visit, or any of the materials used in it.

Helping you prepare for your remote assessment

  1. Look at the competencies that will be assessed in your next visit. Pay particular attention to the type of evidence required and the indicators for each competency.
  2. If any WTs are required, arrange to complete these with your supervisor or another qualified staff member. Remember to practise your technique first.
  3. Complete the RAs in advance of your visit, if required for any outstanding competencies
  4. Read through the revised action plan sent by your assessor from your most recent visit. Action plans from previously unachieved competencies will be modified to help ensure that you are prepared for the new required evidence types, and to take account of your individual circumstances.
  5. Send the signed visit plan, logbook numbers, witness testimony and reflective account through to your assessor a week before the visit.
  6. Ensure that your supervisor knows the time and date of your visit and ask whether they want to join you for the feedback at the end of the visit.

This video Q&A should answer your questions on preparing for a remote stage one assessment

On the day

  1. There will be no DO elements to the assessment. The entire assessment will take place over an online platform
  2. Make sure that you have your logbook and hospital logbook available, if possible
  3. Find a quiet space to complete the assessment.
  4. Your remote visit should take no more than one hour and 45 minutes. If more time is required, an additional one hour and 45 minutes can be booked on the same day, with a minimum of 15 minutes’ break between sessions. The total assessment time should be a maximum of four hours. Your assessor will make this clear to you when scheduling visits.
  5. Your assessor will work through the agreed competencies. Remember that the standard has not changed.
  6. Feedback will take place on the same day and your supervisor will be invited to join you.
  7. Your assessor will complete the online reporting tool within a week after your visit.

Once a remote visit has taken place, you will either be signed off from Stage One, or have a further remote visit scheduled.

The time between remote visits will be in line with the normal scheduling of visits (i.e. there should be a minimum of two weeks between visits).

Cheating and misconduct

Cheating and misconduct during remote assessments will be treated as any other form of cheating and misconduct as set out in the Scheme for Registration Regulations.

In addition to the steps already in place to minimise cheating and misconduct, the following will take place in all remote assessment visits:

  • Your assessor will ask you to show them a form of photo ID prior to starting the assessment
  • Your assessor will ask you to confirm that you are alone in the room when undergoing a remote assessment visit. If appropriate you can use your video camera to show that you are alone.
  • You must keep your video camera on at all times. If you deliberately choose to turn off your video camera without prior agreement from your assessor, your assessor has the right to terminate your assessment.
  • You will be required to sign a declaration when returning your visit plan to your assessor that you will not cheat or engage in misconduct, and that you will not record or share elements of your assessment with others.
  • You will be required to sign a separate declaration when submitting a Reflective Account, declaring that it is all your own work and has not been plagiarised. These will be regularly and randomly sampled by assessors and senior assessors.

 

Hospital experience

If you have not completed your ten sessions of hospital experience, you will need to complete a set of online virtual hospital experience modules before sitting the OSCE. This is currently in development and will be finalised as soon as possible.

If you have completed your hospital experience since your last visit, you will need to show your assessor your completed hospital logbook for sign-off.

Patient experience requirements

The patient numbers have changed to align with the GOC requirement of 350 refractive examinations, 200 dispenses and 30 contact lens episodes (these can be fits or aftercares). However, rather than having to complete these numbers by the end of Stage One, you will have until you complete the OSCE to do this. You should be prepared to share your logbook with your assessor so they can update your experience numbers.

Stage Two and the OSCE - future plans

Stage Two will be conducted in two stages: assessment of the overarching competencies and the DO of routine eye exams and contact lenses. Further information will follow when available.

Quality assurance arrangements

With the exception of the use of Reflective Accounts (RAs) for specified competencies, we are not introducing any new assessments methods or standards. Assessors are thoroughly trained in assessing trainees against the competencies using all of the evidence types listed above. Assessors will be supported in integrating  RAs into their approach.

Assessors have attended a virtual training session and been issued with College guidance ensuring a consistent approach to conducting remote assessment visits.

Assessors’ plans for remote assessment visits for individual trainees will be signed off by College senior assessors on a regional basis (senior assessors report to the Lead/Deputy Lead Assessor).

The College will continue to conduct observations of assessors with senior assessors joining the virtual assessment, conducting interviews with trainees and inspections of assessors’ written assessment reports. This is in line with our established quality assurance processes.

The College will undertake a review of progress following the first round of Stage One remote assessment visits and identify any refinements or additional information needs.

Monitoring, review and evaluation arrangements

The College will put in place arrangements for the active monitoring, review and evaluation of arrangements for the remote assessment visits, their conduct and emergent issues relating to trainees’ progression.

Emergent issues, learning and good practice arising from the implementation of the modified assessment arrangements in Stage One will form a focus of College meetings with its senior assessors. 

The College’s temporary oversight group for the changes made to the Scheme will receive regular reports on emergent issues, trends and learning.

The College’s Scheme Performance Review Panel will receive reports on broader issues emerging from the temporary changes and trainee progression.

 

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