July 2025 - Simulated clinical learning in optometry education 

June's Topic of the month looked at the increasing use of Artificial Intelligence (AI) in optometry education. This month we are taking a closer look at simulated clinical learning which uses various techniques to replicate real-world patient scenarios, and enhance the development of clinical skills. These simulations allow optometry and ophthalmic dispensing learners to practice clinical techniques in low-stakes environments, make mistakes without patient harm, receive feedback on their performance and circumvent the traditional constraints of time, space and varying geographical locations.  

As with anything new, an awareness of the potential disadvantages should also be considered. Simulators can lack realism [1] and the integration of simulation requires time and effort to learn and administer the software. However, when used correctly, simulated clinical learning can significantly enhance optometry education, leading to improved learning experiences:

Practice and repetition: allows students to practice and repeat clinical skills until they are comfortable and proficient. 

Safe learning environment: creates a safe and controlled learning environment where students can develop their skills without the pressure of a real patient encounter. 

Cost-effectiveness: can be a cost-effective alternative to traditional patient encounters, particularly for exposing students to rare or complex cases. 

Individualised learning: can be tailored to the individual learning needs of students, allowing them to focus on specific areas of interest or weakness. 

Exposure to diverse cases: can expose students to a wider range of patient conditions and clinical scenarios than would be possible in a traditional clinic setting. 

These benefits of simulation based activities are why optometry educators are increasingly seeking to embed them into their curricula. 

Extended reality can incorporate competence indicators, peer review, prompts and self-reflection, as well as more effectively prepare learners for their professional lives than traditional placements. [2]

Dr Sheila Rae PhD, BSc (Hons), BA (Hons), Programme Leader, Principal Lecturer, Master of Optometry, School of Health, Medicine and Life Sciences

For many years, later stages of learning in healthcare has involved interaction with ‘real’ patients, such as in a public optometry clinic or on hospital wards. Here, communication, clinical and diagnostic skills learnt in ‘practice’ environments such as lab settings are taken to the next level as a step towards fully autonomous practice. The jump from the practice lab to ‘real’ patients can be daunting for the student [trainee]. 

In more recent years there has been a move to simulated experience as a step in the learning journey. In an optometry clinic setting, this can involve the use of simulated or surrogate patients. In a public clinic setting the patient’s condition and needs are not known before the learning session begins. This adds variability to the learning experience for the student and anxiety about the ‘difficulty’ of the patient case. The duration of a student examination often results in patient fatigue towards the end. It can be difficult to ensure a particular range of patient types has been experienced. In addition, clinical supervisors have the challenge of overseeing the learning experience of the student whilst being responsible for the eyecare of the patient.

The introduction of simulated patients to this stage of the learning journey offers many benefits. The simulated patients are drawn from a pool whose clinical characteristics are already known. The complexity of the patient case can be selected as appropriate for the student stage, with a year two student being presented with more straight forward cases than a year three student. Clinical supervisors are familiar with the patient characteristics therefore can tailor the supervision to the particular case. Students can be provided with a broader range of clinical experience. The simulated patients can be used for ‘full’ examinations such as a primary care sight test or contact lens examination but also to enhance specific clinical skills or communication. Sub-sections of an examination can be simulated such as explaining an ocular condition or its management, or the care and compliance with contact lenses. Thus, a broad range of experience which is appropriate to the stage of the students learning can be provided. The use of simulated patients is an important stage in the learning journey between the practice lab and the real clinical setting and can ensure that an appropriate range of patient interaction is experienced.

Brian McGill BSc(Hons) MCOptom DipTp(IP) FHEA, Lecturer, Department of Vision Sciences, School of Health and Life Sciences Glasgow Caledonian University

Utilising the Eyesi Slit Lamp to improve diagnostic clinical skills in the Vision Science students

The Eyesi Slit Lamp is a high-fidelity, simulation based, diagnostic training system that is currently used within the Department of Vision Sciences at Glasgow Caledonian University (GCU). It simulates a range of different ocular health scenarios for students to explore and experience in a controlled environment.

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The primary aims of using the Eyesi Slit Lamp simulator in clinical teaching sessions is to improve: 

  1. Student Engagement in the clinical setting
  2. Support Development of their clinical and diagnostic skills

The Eye-Si Slit Lamp provides an environment where the students will be asked to practice their diagnostic and investigation skills. This will be through real life experiences and in a safe environment, without compromising patient safety. [3] This can both help reduce anxiety associated with ‘real patient episodes’ and encourage them to work more independently but learn from mistakes.[4]  Each patient scenario that the students are presented with will have pre-defined learning objectives and outcomes (eg Examine, Diagnose and manage a patient: Acute Anterior Uveitis). This has the further benefit that teaching staff can select and target key disease or pathology that will enhance the students clinical experience.

In a typical session, the students will firstly be briefed on the use of the Eyesi Slit Lamp equipment. The students will then be given an outline of the patient scenario, including key notes on the clinical presentation of the patient. Students can then interact with and view the simulated patient eye using the Biomicroscope, Fundoscopy lens, or Gonioscopy lens. The library of scenarios available hosts an extensive range of both anterior and posterior pathological presentations to be covered in an immersive simulation environment. All students taking part in the session can observe and be exposed to pathology that they may not get the opportunity to experience in an everyday clinic. 

This simulation training provides a true-to-life learning and teaching environment, that mirrors real life work scenarios that can be delivered consistently to a whole cohort, providing parity in the learning experience of the Vision Science students at GCU.

Sahal Patel, Lecturer in Optometry & Ophthalmic Dispensing and Rupal Lovell-Patel, Academic Lead for Vision Sciences UCLan

What does simulation add?

  • Moving towards simulation – giving every student a standardised experience, but remove stress/real-life pressure of clinical decision making ‘within the moment’ with a real patient
  • Increasing comfort for student of repeated exposure before experiencing in a live clinical setting
  • Enhance clinical experience for less common/unique cases which can occur in practice

What is different in preparation for sim session?

To effectively design and deliver the session, it is important to establish a clear structure that outlines the intended learning outcomes and demonstrates how the session will meet these objectives. Emphasis should be placed on the added value of incorporating simulation into the learning experience. This approach will require increased preparation time, as more hours will be needed to plan and execute the session effectively.

A thorough technology check is essential to ensure that all necessary resources are available and functional. Staffing should be appropriate for the session, with personnel possessing both the theoretical understanding and practical expertise required. In addition, technical support must be in place to address any issues that arise during the session.

Achieving a balance between simulation and discussion is key to enabling students to benefit from both interactive and reflective learning opportunities. At the end of the session, feedback should be collected to evaluate what aspects were successful, what did not work as intended, and what improvements could be made for future sessions. It is also useful to consider what additional experiences students may wish to have in a simulated setting.

Following the session, a debrief among staff should take place to reflect on the delivery and identify potential changes for subsequent implementations. Furthermore, with technology constantly evolving, staff must consider whether updates or upgrades are necessary and assess the associated cost implications.

Examples of technology currently used at the University of Central Lancashire in simulation teaching:

Optometry

  • EyeSi (hardware and virtual reality combination)
  • Sim clinical case records which can be used for discussions as alternative to patient testing
  • Tonometry model eyes – feedback on training, pressure of probe, technique on SlitLamp
  • OptoSim (hardware and software combination)
  • Ophthalmoscopy model eyes
  • Retinoscopy model eyes
  • ThingLinks – virtual only
  • Articulate Rise – virtual only

Ophthalmic dispensing:

  • Anatomically correct paediatric model heads – different for teaching and exams
  • VisuFit – cases given, could be linked to SFC/High Rx, then dispense with technology and compare technology vs human judgment
  • LV Sim specs – real world scenarios completed
  • 3D printing

As these examples show, simulated clinical learning is an effective tool for enhancing the development of clinical skills in optometry. By providing students with safe, controlled, and engaging learning experiences, simulations help them to develop the skills and confidence they need to succeed as future optometrists. 

Keep updated 

SPOKE's Topic of the month will no longer be published on a monthly basis but watch this space for future features under the new SPOKE contract starting in August 2025. Furthermore, if you would like to be kept up to date with the work of SPOKE, please email spokehub@college-optometrists.org to be added to our Advisory Review Group. 

References and bibliography