The Top: Clinical & Business Graduates

When Professor Neville McBrien arrived in Australia over a decade ago to take up a post at the University of Melbourne, he found the Department of Optometry and Vision Sciences there delivered a “very good teaching program”, but was under resourced, with few academic staff and a need to increase research output.

Prof. McBrien had come from an established career in Optometry and Vision Sciences in the U.K. and the U.S. and knew that if the Department was to reach the world’s highest standards, things would have to progress…and progress they have.

The Department is now more than twice the size with over 30 academic and Professional staff. The number of students, including undergraduate students completing a Bachelor of Optometry and post graduate students studying for research higher degrees, has more than doubled in size. There are now more than 260 effective full-time students.

The University of Melbourne Optometry and Vision Sciences Department is set to change that by improving student knowledge of practice administration and modern optometry practice cost management, and by creating a more product aware graduating optometrist

Those are serious changes, but there are others now taking place which will mean that University of Melbourne graduates will not only be the best trained optometrists in the land, but they will also have an improved knowledge of the business side of running a practice.

Previously, the most significant teaching initiative was that University of Melbourne were the first (optometry) Department to integrate ocular therapeutics into the undergraduate curriculum and move from a four to a five year program incorporating therapeutic management of ocular disease. It moved to the five year degree in 2001 and now other Australian universities are following or planning to follow. The University of Melbourne is currently the only Australian University Optometry Department graduating therapeutically endorsed optometrists.

Five Year Course

“At the moment, those optometry graduates coming out of the University of Melbourne are trained to the highest level in the country because they study for five years allowing them to use therapeutic agents to treat and manage ocular disease,” Prof. McBrien explains.

Whilst the addition of therapeutic training is invaluable, there has been a growing concern in the industry that new graduates still won’t be fully prepared for the real world of modern optometry.

The Department of Optometry and Vision Sciences at the University of Melbourne is starting to change that by improving student knowledge of practice administration and retail cost management, by creating a more product aware graduating optometrist.

In the past, University of Melbourne Optometry students accessed the clinics of the Victorian College of Optometry to gain their main clinical experience with patients. This public health institutional clinic provides low cost eye care for the State of Victoria, which means that the vast majority of patients the students were examining were over the age of 65. This demographic is not typical of a normal private practice patient demographic. There was also very limited exposure to active ocular disease in this clinic.

Professor McBrien said: “The University of Melbourne Optometry and Vision Sciences Department wanted students to gain experience on a broader diversity of patients, in both age range and socio-economic status, but also wanted students to get the additional experience of a more real world practice environment and not just an institutional clinic base. Thus, at the start of 2008 the University of Melbourne established a full-scope optometry teaching practice, which is just like a normal retail professional practice that encompasses all aspects of modern optometry, but with a few more consulting rooms. The University of Melbourne EyeCare practice has a modern frame and dispensing area, with all frame types available, from the budget end of frames right up to the top-end designer frames, complimented by the latest dispensing technology aids such as the Essilor Vision Print system and the Rodenstock ImpressionIST terminal. This was another issue we were trying to address because students were not getting sufficient experience with the high-end ophthalmic lens technology such as the latest free-form progressive lenses or of the high-end frames. In particular the Department wanted students to gain experience in day-to-day management of a modern practice. The University of Melbourne EyeCare practice has made everything in the practice electronic, from patient records to the practice management system. Sunix has generously donated their Vision practice management system to support our teaching initiative,”.

The students are now exposed to a more modern optometry practice environment and gain exposure in the pricing of both frames and lenses to assist in the procedures required for the running of a modern practice.

Eyetalk Consultants, the company that publishes recommended costing for ophthalmic products have supported our teaching initiative by donating subscription to the University of Melbourne EyeCare practice of the Eyetalk Reference Guide, both electronic and hard copy. Students are now familiar with this guide giving them much better product knowledge of the ophthalmic industry products and how they work.

As well as initiatives to give students broader and more diverse clinical experiences, the University of Melbourne are also giving Optometry students experience in running an optometry business. The Department listened to feedback from practitioners and what we learned was that whilst Melbourne students were very knowledgeable about examining eyes and their conditions, their product knowledge and practice management could be stronger. The Department has addressed this in the new University EyeCare teaching practice by exposing students to Clinical Teaching Instructors who are experienced optometrists from a diverse range of practice management environments. In addition the Department are now bringing in experts in practice management to lecture the students including the highly respected chair of the newly established Optometrists Co-operative Emmanuel Calligeros.

The Latest Technologies

The teaching initiative of the University of Melbourne Optometry and Vision Sciences Department has received overwhelmingly positive support from the ophthalmic industry. One form of support has been in the form of donating or subsidising ophthalmic equipment. University of Melbourne EyeCare now has the latest technology and equipment in each of the consulting rooms and additional ocular diagnostic equipment including Digital Fundus camera, Cirrus Ocular Coherence Tomographer, Corneal Topographer and anterior eye cameras.

The university has received generous support from BOC Instruments, Luxottica, Designs for Vision and Optical Manufacturers in equipping the consulting rooms. In addition Carl Zeiss have supported the teaching initiative subsidising the purchase of a digital Fundus camera, two digital anterior eye cameras and software, two sets of field equipment, a Humphrey Visual Field Analyser, Matrix screener and they have just installed the latest technology ocular adherence thermographer. In addition Medmont has supplied computer vision charts and a Field Screener for the pre-clinical training rooms.

The University practice has some of the latest technology equipment of any practice in Australia. What we’re doing is making sure that we take digital records of everything so that not only are all the practice records electronic, but we take digital images of patient’s eyes and fundus and we store it in the electronic practice management system.

In addition, the University has partnered with some of the leading ophthalmic and contact lens suppliers to obtain preferential supply deals and in particular to deliver technical information support to the students. Both Bausch & Lomb and CooperVision are preferred suppliers of soft contact lenses, while ACL and Gelflex are preferred RGP lens suppliers.

Essilor and Rodenstock have partnered with the University of Melbourne for ophthalmic spectacle lens supply. These companies are providing technical dispensing aids such as the Vision Print system and Impressionist system as well as lectures to further improve the product knowledge of University of Melbourne optometry students.

The University has also received good support from spectacle frame companies Safilo, L’Amy, European EyeWear (who also supplied Low Vision Aids for the practice), Healy Optical and Rodenstock.

“The University of Melbourne EyeCare teaching practice has strived to give its later year students exposure to the diverse aspects of the profession, with support from the various ophthalmic companies mentioned, from corporate optometry support by Luxottica and private practice optometry, with all students attending rural placements with therapeutically qualified private practitioners. The University of Melbourne EyeCare practice is also an inaugural member of the Optometrists Co-operative so that students gain exposure to independent optometry practice viewpoints as well as corporate practice viewpoints.

“The students are exposed to the very latest equipment that the profession has to offer … as well as information and technology on the business operation side of a professional practice. The Department rosters four students, one to each of the consulting rooms to examine patients and two students are on practice administration duty every session. They assist with the patients calling into the practice and they assist with the ‘back room’ operation of the practice, such as finishing lenses ordered by tracer, stock analysis and ordering and marketing information. They are also involved in dispensing. We send all our orders off electronically and the lenses come back so we can finish the edging and fit into the frames. The students are involved in all these processes,’ Prof. McBrien says.

Other Initiatives

The Department of Optometry and Vision Sciences now send all of their final (fifth year) students overseas. The students get bursaries from the University of Melbourne as part of the growing esteem strategy, can access interest free loans and the Department has secure additional bursary support from donations secured by the Department from CooperVision and Rodenstock to financially assist student travel and accommodation costs. The Department has set up an ophthalmology private practice placement program in 2008 so that students spend time with practicing ophthalmologists observing active ocular disease and its management.

This year, the Department has also arranged for optometry students to provide services in aged care facilities and provide school screenings, giving students experience of delivering eye care in a community setting.

Prof. McBrien said “when students qualify, they not only have the theoretical knowledge, but can ably manage equipment and utilise the latest technology. We are giving them a lot of contact lens experience and companies like Bausch & Lomb, CooperVision, Gelflex and ACL have given us excellent support.”

Professor McBrien considers that the new cohort of final year students will graduate with not only greater knowledge but will also be better equipped to know how to contribute to the successful operation of a modern optometric practice.

The students are now aware that the patient’s first impression is not in the consulting room, but out in the practice reception area. They better understand the costs and cash flow in operating a practice and they have a much better understanding of the products by name.

“The University of Melbourne Department of Optometry and Vision Sciences has committed a significant amount of financial resources to acquire the space and fitting it out to the highest standards. This investment is important because at the end of the day you are providing professional eye care to the patients, as well as running a teaching clinic and everything should be to the highest standards possible. The University of Melbourne are really trying to make students aware of what it’s like to be out there operating a practice in the real world from both a professional health provider perspective and a business point of view. This is fundamental objective of the new Melbourne Model , training students to be better prepared for the professional workforce” says Prof. McBrien.

The Practical Results of the Departments Initiatives

Patient Type 2006 2007 2008 General Consultation Patients (First consult + and subsequent visits) 97 + 34 86 + 31 91 + 26 Contact Lens Patients (Fits and After care) 29 27 35 Ocular Disease Patients (including Therapeutics) 75 71 196 Pediatric Patients 23 20 23 Days Rostered at Rural Private Optometry Practices 5 5 10 Days Rostered in Private Ophthalmology Practices 0 0 8 Percentage of Students undertaking 4 Week International Externship 26% 47% 100% Number of Hours of Rostered Practice Administration 0 0 52 Days Rostered for School Screening and Aged Care Visits 0 0 2 Number of Technical Information Sessions Given by Ophthalmic Industry 1 1 8 How effective have the initiatives undertaken in 2008 by the Department of Optometry and Vision Sciences at the University of Melbourne been in improving training for real world optometry practice? Information supplied by the Department of Optometry and Vision Sciences at the University of Melbourne (Table 1) shows that Comparison of Patient Types, Patient Numbers and Practice Experience obtained by Bachelor of Optometry Students of the University of Melbourne in 2006, 2007 and 2008 How effective have the initiatives undertaken in 2008 by the Department of Optometry and Vision Sciences at the University of Melbourne been in improving training for real world optometry practice? Information supplied by the Department of Optometry and Vision Sciences at the University of Melbourne (Table 1) shows that despite significant increases in the exposure to active ocular disease, something which is increasingly required for our therapeutically endorsed graduates, there are no reductions in general consultation patients, paediatric patients and improvements in contact lens patient experience and dispensing.” Another observation from Table 1 is that all students now get to complete an overseas externship. This gives them, not only additional clinical experience in a different eyecare system (such as Nepal, South Africa, Fiji, China, Mexico, North America, Singapore and India) also develops maturity in living for four to six weeks in a different environment. New initiatives brought in for 2008 also include a private ophthalmology practice placement system, where final year students sit in with an ophthalmologist in a one-to-one setting managing their patients. “In 2008 each final year student has actively observed and in some cases assisted in the management of over 100 active ocular disease cases. In addition to these initiatives, a major new focus has been to give students a more practical insight into how a modern optometry practice operates at the newly established ‘University of Melbourne EyeCare’ practice which opened in April on one of Melbourne ‘s major thoroughfares, in Swanston Street opposite the University of Melbourne entrance. From the data supplied by the Department it can be seen (Table 1) that in 2008 each final year student was rostered for 52 hours of practice administration. All final year students are now capable of working with the Sunix practice management software, knowing how to cost up and bar code spectacle frames, manage a practice appointment book, do minor adjustments, maintain an inventory stock of contact lenses and frames as a minimum. Students have also been given substantially more product knowledge exposure from the start of 2008 with talks on technical aspects of single vision aspheric lenses, progressive lenses from Essilor and Rodenstock, and contact lens ranges from Bausch & Lomb, CooperVision and CibaVision. Another major improvement that has occurred in 2008 as a consequence of opening the new practice is a markedly better age demographic for the patients seen by students (see Table 2). McBrien concludes by saying: “previously, when most clinical training was attained solely at the clinics of the Victorian College of Optometry, due to the predominantly pensioner concession card holder patient group, 74 per cent of patients examined by students were over 65 years of age, which is not representative of the ‘real world’. It can be seen from Table 2 that the age demographic of patients examined by University of Melbourne students in 2008 was a lot more balanced and representative of the ‘real world’ practice environment.” Age Range 0-17yrs 18-35yrs 36-50yrs 51-65yrs >65yrs Year 2006 12% 7% 2% 5% 74% 2007 13% 8% 2% 5% 72% 2008 15% 25% 10% 10% 40% TABLE 2. Age Demographics of Patients Managed by Bachelor of Optometry Students of the University of Melbourne.