COVID-19: Stage Two remote assessments – information for trainees

This guidance is designed to respond both to the COVID-19 pandemic and the GOC’s Education Strategic Review.

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The guidance sets out arrangements for Stage Two assessment visits during the COVID-19 pandemic for trainees who:

  • were enrolled on the Scheme on 18 March 2020, and had completed visit two.
  • have completed Stage One.
Contents:

 

Overview of Stage two modifications

Background

On 18 March 2020 Stage Two assessments were suspended due to COVID-19 and government restrictions on face-to-face contact. To resume assessment and enable you to progress, your assessment visits now need to be both face-to-face and remote.

Key features of the modified approach

Structure
The structure of the revised Stage Two direct observation takes government restrictions and College guidance into account, and has been agreed by the GOC. Contact time for you, the patient, and the assessor has been reduced where possible. All parties will need to wear suitable PPE during the Stage Two direct observation.

The modified Stage Two assessment is divided into two parts:

  1. Direct observation (DO) - the practical elements, made up of a modified eye examination and soft contact lens aftercare, observed and assessed face-to-face.
  2. The overarching assessment (OA), delivered remotely.

To provide flexibility in arranging visits, you may have a different assessor for the two components. The two parts will not have to take place on the same day.

Location
The Stage Two direct observation can take place in your workplace, providing that you have access to a room of at least 2.5m in length. If you cannot sit the assessment in your workplace, we are working towards arranging a number of regional locations (such as HEI clinics).

Your employment status
Stage Two includes a practical assessment. In order to support your preparation you must be regularly working clinically, as regular rehearsal of skills will support the development of your ability and confidence.

Logbook checks
Please make sure that you have your logbook with you for your stage 2 assessment. During the direct observation assessment, your assessor will assessor check your logbook numbers. They will also check your logbook to confirm that you have seen a child of seven years or under. This is a new GOC requirement. Your logbook numbers do not need to be complete to pass Stage Two. Another check will be done by the College team ahead of the OSCE.

During the direct observation assessment, your assessor will also check your Hospital Eye Service logbook. If you have completed virtual HES experience, this will have been noted by College staff.

Direct Observation – Eye examination

Eye examination

The eye examination assessment will last 40 minutes in total. If you require reasonable adjustments to this time, contact us. Below is an outline of the content.

Section

Content

History and symptoms

You will take history and symptoms from a presbyopic patient (supplied by us) and record your findings on a record sheet. History and symptoms are taken respecting social distancing, or remotely via phone from another room. If taken in the same room, you and your assessor must wear appropriate PPE. The patient should wear a mask.

You will be given the unaided visions of the patient: distance and near.

 

If history and symptoms are taken remotely, you and the assessor then enter the consulting room wearing appropriate PPE.

Face-to-face examination

You will be instructed to carry out a modified eye examination on the patient and record the results on the record card.

The eye examination must include:

  • Unaided Cover test distance and near
  • Motility
  • Pupils
  • Retinoscopy to both eyes
  • Subjective on one eye only including near add (your assessor will give you the subjective for the second eye). You can use a trial frame or refractor head.
  • Indirect ophthalmoscopy on one eye only

 

The patient leaves the room and practice. You and your assessor stay in the room, respecting social distancing.

Final conclusion

You write your conclusions and further management on the record sheet and sum up with the assessor.

 

The eye examination will be modified in the following ways:

Section

Modification

Clinic room

The room length must be a minimum of 2.5m to allow for social distancing.

History and symptoms

You should take history and symptoms, respecting social distancing.

If you wish, you can take history and symptoms remotely using a speakerphone or video call from another room. Your assessor will remain with you.

Subjective refraction

You should carry out subjective refraction on one eye only. Your assessor will choose the eye with the better acuity. The other eye is to be occluded during subjective. Near add should be carried out on one eye only. Your assessor will give you a simulated result for the second eye. The simulated result will be based on the patient’s prescription.

Ophthalmoscopy

You should carry out indirect ophthalmoscopy on one eye only. Your assessor will choose which eye. You must not carry out direct ophthalmoscopy.

Binocular tests following refraction

Not to be included as only one eye is being refracted.

Advice to patient

The patient leaves when clinical tests are completed. Give your advice verbally to your assessor and write your findings on the record sheet.

 

Following the assessment, you should clean the clinic room ahead of the soft contact lens aftercare assessment.

Direct observation – Soft Contact Lens Aftercare

The Soft Contact Lens Aftercare assessment will last 35 minutes in total – 25 mins for the soft lens aftercare and 10 mins for the soft lens fitting. If you require reasonable adjustments to this time – contact us.

Section

Detail

History and symptoms

You will take history and symptoms from a contact lens aftercare patient (supplied by us) and record findings on a record sheet. History and symptoms are taken respecting social distancing, or remotely via phone from another room. If taken in the same room, you and your assessor should wear appropriate PPE. The patient should wear a mask.

Record keeping

You will be given the VA and over refraction achieved by the patient wearing the contact lens.

 

If history and symptoms are taken remotely, you and your assessor then enter the consulting room wearing appropriate PPE.

Slit lamp examination

You will perform an aftercare including fit assessment and slit lamp examination on one eye of a contact lens wearer. The aftercare should include a fluorescein check and lid eversion.

You will write your results on the record sheet.

 

The contact lens patient leaves the room. You and your assessor stay in the room respecting social distancing.

Final conclusion

You will write conclusions and further management on the record sheet and sum up to your assessor.

Fit Assessment

You will be shown a video of a soft contact lens fit by the assessor and will write an assessment of fit and the details of the next lens that will be tried or ordered.

Total assessment time: 35 minutes - includes time for watching video of fit

 

The soft contact lens assessment will be modified in the following ways:

Section

Modification

Clinic room

The room length must be a minimum of 2.5m to allow for social distancing.

Soft lens fitting section

Assessed using a video of a soft lens fit

This is timetabled at the end of the assessment, but could be adjusted to earlier if a patient is late.

History and symptoms

You should take history and symptoms, respecting social distancing.

Where social distancing is not possible, you should take history and symptoms remotely using a speakerphone or video call from another room. Your assessor will stay with you.

Soft lens aftercare

Visual acuity is given to you as 6/5 and N5. Over refraction is given as Plano. Your assessor will check the corneal integrity of the patient once you have finished this part of the assessment.

Advice to patient

The patient leaves when clinical tests are completed. Give your advice verbally to your assessor and record it in the patient record.

 

Direct Observation –  Assessment schedule

The assessment will last up to two hours, following the schedule below:

9.15

Your assessor will check your eye examination patient.

9.30

Eye examination assessment of a presbyopic patient (40 mins).

10.10

Fifteen minute break, clean your clinic room.

Your assessor will check your contact lens patient.

10.25

Assessment of soft contact lens aftercare (25 mins) and soft lens fitting with video (10 mins)

11.00

Assessor checks your logbook and hospital logbook if applicable.

11.15

Assessment ends

Feedback

You and your supervisor will be sent the outcome of the assessment via email once you have completed both the direct observation and overarching parts of Stage Two.

Overarching Assessment

The overarching assessment will be conducted remotely and last up to two hours in total.

Patient Records (PR) will no longer form the type of evidence as you may not have access to your records, and sharing them remotely is not secure. Instead, you will be assessed via a series of case scenarios. Other recognised forms of evidence such as images, field plots, role plays and prescription interpretation will also be used.

Preparing for the overarching assessment

You’ll find a bank of over 100 case scenarios here. You have access to all of these in advance for preparation. 60 minutes before your scheduled assessment, your assessor will contact you to let you know which eight of these scenarios will be used in your assessment.

You’ll also find a matrix that illustrates which overarching competency element is covered by each scenario. You will be assessed in 13 different elements of competence. The elements of competence are the same as at Stage One.

We recommend that you familiarise yourself with the format and content of the case scenarios by selecting a range from each unit to revise.

Your assessor will introduce each scenario in turn, ask if you have read it and then ask you to describe the case or test your understanding of it with questions. You may not get through all eight cases in the assessment.

Before the assessment starts

Your assessor will check your ID and ask you to show a sweep of the room to ensure that you are on your own and no reference books or phones are in the room. If you turn off your screen it is assumed you are cheating and the assessment will stop. Tell your assessor if you need a break – you will need to leave your screen on throughout the break.

On the day

Once you know been informed which eight scenarios will be used for your assessment, read each scenario and highlight the key points. Make yourself aware of what competencies are covered by the record according to the matrix. Consider:

  • What other questions would I ask the patient?
  • What other tests would I do to investigate further?
  • Are the results what I would expect?
  • How would I manage the patient?
  • How would I communicate the findings to the patient?
  • Is the scenario complete and are all details recorded fully?

Remember that, when discussing any scenario, your assessor can ask you questions beyond those competencies listed in the matrix. For example, if a scenario covers 5.1.1 (SCL fit), you could also be asked how you would approach a spectacle dispense for this patient.

Competencies will be assessed using at least two forms of evidence. One form will be a case scenario, but field plots, additional images and questions may also be used.

Book your Stage Two assessments

You will need to opt in to Stage Two assessments via the booking form. Priority will be given to those who were waiting for a Stage Two assessment at the time of lockdown.

We can no longer guarantee that your will be able to have be able to have a Stage Two visit within 6 weeks of completing Stage One. We will also no longer be able to guarantee a Stage Two resit within 6 weeks of your last Stage Two visit.

You won’t be able to choose the order or time of your overarching or direct observation assessment. We will aim to book these as close together as possible, but this will be dependent on assessor and practice/venue availability. Also the timing may be impacted by local lockdowns.

 

Your direct observation assessment – next steps

We will book your Stage Two Direct observations. Visits are expected to last a maximum of 2 hours and 15 minutes.

Important information on the booking of assessments
Overarching and Direct Observation Assessments will be booked separately.

Due to an issue with our booking system, the automated mail that confirms the direct observation assessment currently says that the overarching competency assessment will also take place. Please ignore the information relating to the overarching competency section of the assessment. The assessment that booked for you is a direct observation assessment only. The notification of an overarching assessment will be done and sent separately.

Your remote overarching assessment – next steps

We will book your Stage Two Overarching visit separately. Times for the Overarching assessment will be scheduled at either 10.00, 13.15 or 16.30. Your assessor will contact you 60 minutes ahead of the scheduled assessment time with Zoom details and the case scenarios that will be used.

If you have not received your email with the assessment details by 50 minutes before your assessment please contact us.

If you need reasonable adjustments, these will be implemented as before. You can apply for reasonable adjustments here.

Your employment status

You don’t have to be employed to complete Stage Two overarching assessment, however, the Stage Two direct observation is a practical assessment, so you must be working clinically on a regular basis in order for a visit to go ahead, as regular rehearsal of skills will support preparation.

Cancellations

We may need to cancel a direct observation at short notice due to local lockdowns, or one of the parties needing to isolate.

If you are exhibiting symptoms of COVID-19 ahead of a scheduled direct observation, you must follow government advice on self-isolation here and let the College know as soon as possible. At the time of writing, the main symptoms of the virus are:

  • a high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
  • a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
  • a loss or change to your sense of smell or taste – this means you've noticed you cannot smell or taste anything, or things smell or taste different to normal

Most people with coronavirus have at least one of these symptoms.

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 assessment visits as applicable:

  • 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 you opt into Stage Two that you will not cheat or engage in misconduct, and that you will not record or share elements of your assessment with others.

Passing Stage Two
If you do not pass Stage Two after three attempts, you’ll be contacted by the Lead or Deputy Lead Assessor to review your feedback.

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