A Global CompetencyBased Model of Scope of Practice in Optometry

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A Global Competency-Based Model of Scope of
Practice in Optometry

• Anthony F. Di Stefano, O.D., M.Ed., M.P.H.

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Committee

• Dr. Norman Wallis, Chair
• Dr. Robert Chappell
• Dr. Patricia Kiely
• Dr. Thomas Lawless
• Dr. Leon Gross (Consultant)
• Dr. Anthony Di Stefano (WCO)

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Introduction

• WTO and GATS
• MRAs
• Optometric initiative
• ARBO and WCO collaboration
• WCO and ARBO committee
• International Advisory Group on Optometric
  Competencies (IAGOC) (December 2003)

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WCO Concept of Optometry Statement

• Optometry is a healthcare profession that is
  autonomous, educated, and regulated
  (licensed/registered), and optometrists are the
  primary healthcare practitioners of the eye and
  visual system who provide comprehensive eye and
  vision care, which includes refraction and
  dispensing, detection/diagnosis and management of
  disease in the eye, and the rehabilitation of
  conditions of the visual system
• Developed Paris 1992
• Approved Venice 1993

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Background/Prior Work

• Do not reinvent the wheel
• Model must address variations in scope of
  practice
• Controversial topic for some
• ECOO European Diploma recognized diversity in
  region with 3 stages

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ECOOs European Diploma Structure

• Optical Technology (lab work and dispensing)
• Vision Care (refraction, BV, CLs)
• Ocular Disease ( systemic) (detection/diagnosis
  and management)
• Different words used for political reasons

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10 years later

• Global vs. Regional
• Therapeutic use of drugs now common in some
  countries (Australia, Canada, Nigeria, UK, USA,
  etc)
• Need an additional stage
• Evolutionary approach

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Categories of Service

• Optical Technology Services
• Visual Function Services
• Ocular Diagnostic Services
• Ocular Therapeutic Services

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Optical Technology Services

• Management and dispensing of ophthalmic lenses,
  ophthalmic frames and other ophthalmic devices
  that correct defects of the visual system

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Visual Function Services

• Optical Technology Services
• and/plus
• Investigation, examination, measurement,
  diagnosis and correction/management of defects of
  the visual system

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Ocular Diagnostic Services

• Optical Technology Services
• and/plus
• Visual Function Services
• and/plus
• Investigation, examination and evaluation of the
  eye and adnexa, and associated systemic factors
  to detect, diagnose and manage disease

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Ocular Therapeutic Services

• Ocular Technology Services
• and/plus
• Visual Function Services
• and/plus
• Ocular Diagnostic Services
• and/plus
• Use of pharmaceutical agents and other procedures
  to manage ocular conditions/disease

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Competency Statements

• Work in Australia, Canada, UK, California
• IAGOC recommended Australian competency
  statements and system
• Allocate across 4 stages

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Optometrists Association Australia

• Developed system of competency statements (1993,
  1997, 2000)
• Tracked evolution of profession in one country
• Has been applied in other countries, e.g., Norway

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The System

• Units 6 major components of activities within
  profession
• Elements sub-divisions of units
• Performance criteria accompany elements,
  evaluative statements
• Indicators measurable and observable features
  of performance criteria (refinement for more
  specificity and assessment)

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The Units

• 1 Professional and clinical responsibilities
• 2 Patient history
• 3 Patient examination
• 4 Diagnosis
• 5 Patient management
• 6 Recording of clinical data

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Unit 1 Professional and Clinical
Responsibilities

• Elements
• Ensures that optometric knowledge, clinical
  expertise and equipment remain current.
• Practices without the need for supervision
• Acts in accordance with the standards of behavior
  of the profession.
• Provides advice and information to patients and
  others.

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Unit 2 Patient History

• Elements
• Communicates with the patient.
• Makes general observations of patient
• Obtains the case history.
• Obtains and interprets patient information from
  other professionals.

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Unit 3 Patient Evaluation

• Elements
• Formulates an examination plan
• Implements examination plan
• Assesses the ocular adnexae and the eye
• Assesses central and peripheral sensory visual
  function and the integrity of the visual
  pathways.
• Assesses refractive status.
• Assesses oculomotor and binocular function.

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Unit 4 Diagnosis

• Elements
• Interprets and analyses findings to establish a
  diagnosis or diagnoses.

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Unit 5 Patient Management

• Elements
• Designs a management plan for each patient and
  implements the plan agreed to with the patient.
• Prescribes spectacles
• Prescribes contact lenses
• Prescribes low vision devices.

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Unit 6 Recording of Clinical Data

• Elements
• Ensures that data is organized in a legible,
  secure, accessible, permanent and unambiguous
  manner.
• Maintains confidentiality of patient records.

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Allocation to Categories

• Prefixes for each each Stage
• Optical technology -OT
• Visual function - VF
• Ocular diagnostic - ODx
• Ocular therapeutic OTx
• Denote specific meaning of performance criteria
• When meaning common across stages, arrow
• When no comparable meaning, blank

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The System

• Units 6 major components of activities within
  profession
• Elements sub-divisions of units
• Performance criteria accompany elements,
  evaluative statements
• Indicators measurable and observable features
  of performance criteria (refinement for more
  specificity and assessment)

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Example Allocation of System

•  UNIT 3 PATIENT EXAMINATION
• Element
• 3.3 Assesses the ocular adnexae and the eye.
• Performance Criterion
• 3.3.1 The structure and health of the ocular
  adnexae and their ability to function are
  assessed.
• Indicators
• Assessment of skin lesions, conjunctiva, lids,
  lashes, puncta, Meibomian glands. Screening for
  disease macro-observation, slit lamp
  biomicroscopy, loupe, interpupillary distance,
  lid eversion, photography, diagnostic
  pharmaceuticals, tear dynamics.

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Example 1
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Example 2
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Example 3