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Friday / August 19.
HomemistoryThe New Kids on the Block…

The New Kids on the Block…

In 2009 Flinders University announced it would offer an optometry course in South Australia. Three years later Deakin University launched its own condensed optometry program enabling students to emerge with a Bachelor of Vision Science/Master of Optometry in just three and a half years. Ever since, the profession has been abuzz with concerns over the quality of learning being offered and the prospects for the 110 students who will emerge fresh and eager to practise in 2015.

Flinders University says its course is unique, with its focus on integrated teaching, problem and case-based learning, and an emphasis on ensuring students receive direct experience across all models of optometry practice.

Deakin University also claims its optometry course is unlike any other with its accelerated program of study and case-based teaching style. It’s certainly something that appealed to 77 students who enrolled in the first cohort.

“The idea of finishing in only three and a half years compared with five while studying the same amount of content was very appealing,” said third year student Marc Eskander who graduated from the Bachelor of Science course at Deakin University in March 2014 and recently commenced his Masters of Optometry with the same institution. “It not only means an extra one and a half years of income – it also means we’ll have a head-start in pursuing our interests or career directions, be it opening a business, further education, or corporate optometry just to name a few… this is vital in what is fast becoming a very competitive industry,” he said.

While Flinders offers the traditional five-year course… there’s nothing traditional about the approach to content delivery

Condensing five years into three and a half has obvious ramifications when it comes to student workload, but Professor Alex Gentle, Director of Optometric Pre-Clinical Studies and Associate Head of School Teaching and Learning, says the course’s first cohort of students has coped “remarkably well”.

“There is no doubt that the student body in general feels under pressure through years two and three of the course and this is exacerbated by our weekly assessment tasks, which are designed to ensure students consolidate their learnings from the previous week, rather than cramming for end of trimester exams,” Professor Gentle told mivision. He said an extra exam period and extra pre-exam study period add further pressure to the course by reducing downtime between trimesters.

“We never expected it to be any other way as you can’t expect to cover a ‘five-year curriculum’ in three and a half years without increased workload. However, in the main, the students have coped remarkably well with the pressure,” he said.

Mr. Eskander felt the workload grow “exponentially” in his second year as the first of 50 cases were introduced, however he said the case-based teaching methods employed at Deakin University made the content manageable.

He wasn’t alone. “Anecdotally, I have the sense that a few more students have struggled to cope with the rigours of study in this fashion, however student drop out from the course has not been remarkable and these events have often occurred for all of the usual reasons seen in other universities,” he said.

Corporate Conflict

Some in the eye health profession have questioned the influence that key sponsors, such as Specsavers and Luxottica, may be having Deakin’s course content. This has been strongly denied by the University.

“We have support from across the entire profession and industry, from a wide variety of sources and taking a wide variety of forms,” said Professor Gentle. “It is important to note that the academic team sets the curriculum consistent with the requirements of OCANZ (Optometry Council of Australia and New Zealand) and the OBA (Optometry Board of Australia) and our contributors in no way influence this.”

However Mr. Eskander said “it is impossible to deny” the impact that Specsavers and Luxottica have had on the Deakin course, adding that “many other” industry members also leave an impression.

“Although not involved directly with the teaching side of things, as this must be driven by the OCANZ guidelines and requirements, they have been vital in the setup of our pre-clinical training facility at the Australian College of Optometry,” said Mr. Eskander.

“Specsavers and Luxottica, along with other independent groups and stakeholders are represented on the advisory board of the course, which seeks to give guidance and knowledge and different matters surrounding the training and work-readiness of Deakin’s optometry students,” he added.

Flinders University has never received financial support from corporate providers of optometry services. “To the best of my knowledge, we are the only school in Australia that has not received any funding from the major optometry corporates. We’re neither pro-independent nor pro-corporate. We don’t want to do anything to affect our neutrality,” said Professor Konrad Pesudovs, Foundation Chair of Optometry and Vision Science
at Flinders University.

However, the school does welcome involvement from corporate and independent practice in its clinical placement program. “We welcome involvement in terms of placements, we want our students to see all practice models. It is inappropriate to exclusively see only one model.

“Our six week placements are partly to provide students with the variety of clinical experiences, including the philosophy of practice – so at least one six week placement will be spent in a commercial setting and one in an independent optometric practice.” He said that’s because “I want to give the students an opportunity to make their own minds up about the type of optometry they want to practice. I see this as an improvement on the old model of students training in a university clinic, then ending up staying in whatever type of job they first take because they don’t know what else is out there”.

Managing Student Placements

Professor Pesudovs said students interests in mode of practice seem to be influenced by where they do their training. “While our students are exposed to a variety of placement settings including corporate, independent, metropolitan, rural, therapeutic, specialty and a combination thereof, the majority of our placements occur in independent practices. This seems to have influenced student preferences, with the majority indicating they would like to work in an independent practice setting.

“Our students do six, six-week placements where they conduct eye examinations in our partners’ practices. Our first cohort has completed four of their six placements and have on average, performed 247 eye examinations, observed a further 448 examinations and performed 72 optical dispenses. We expect these numbers to increase by a bit more than 50 per cent through the last two placements.”

Deakin University is putting the final touches on its clinical placement program, which students will commence mid-November.

Professor Harrison Weisinger – Deakin’s Foundation Director of Optometry and Chair in Optometry – said the clinical placements program designed for students at Deakin offers students a realistic window into the way they are most likely to practise.

“One great thing about the course at Deakin is that we give students experience at the College of Optometry first – they see around 30 patients at the College before they move into the community.

The Australian College of Optometry provides clinical placements for students from Deakin as well as students from the University of Melbourne, University of New South Wales and a small number from Flinders University.

“Students all have organised programs for clinical placements, where they see ACO patients under the supervision of our optometrists,” said Jane Trevaskis, Senior Manager Teaching and Quality at ACO.

“The ACO offers a unique clinical experience for students, giving them the opportunity to work in a public health setting. Our patients tend to be older and with that comes more complex presentations. We feel that this is preparing students to work with an ageing population. Many of our patients are also from non-English speaking backgrounds, so students also develop important non-clinical skills from our clinics.”

Residential Placements

Professor Weisinger acknowledges the high level of learning students get from the College but says it’s just the beginning. “The College of Optometry is really important – that’s where they refine skills and see how important it is to assess and examine carefully, then (during the Masters Program) they get out in the community where they get a taste for what it’s going to be like when they graduate. It’s designed to set up a very smooth transition (into the workforce).

“Our Clinical Residential Placement Program is all about putting the students where optometry actually occurs as opposed to bringing optometry to where the students occur – other universities predominantly do their clinical education on campus in the staff/ student clinic. This is a flawed model because it gives a very skewed population – so you generally either get to work with staff and students or you get very lower socio economic groups, with a predilection for the rare and complex.

“There’s a whole other set of skills that cannot be developed in that environment – our community needs community optometrists. The majority of work an optometrist will do will be servicing healthy middle-aged people that need a screening eye exam and optical solutions,” he said.

Each Deakin student will undertake a residential clinical placement that extends for a total of 26 weeks, 30 hours a week. Students’ experiences will be closely monitored with an online log and, Professor Weisinger says, if the course co-ordinators find the experience they’re getting is lacking in a particular area, the student will be remediated or moved to another placement.

“Everyone will be adopting this model in time – they will have to because university-run clinics are expensive to run and they don’t give the students the broad grounding they need to be work ready,” said Professor Weisinger.

Will the Bar be Raised?

Just as the approach Deakin and Flinders are taking to clinical placements is innovative, so too is the approach to teaching the curriculum. As Professor Weisinger says, “we all have a more or less prescribed number of hours of education that we have to deliver for any given subject – we’re bound by the national framework – but how we deliver it is up to us. It can be self-directed, clinical teaching, symposia, team-based, tutorials, or problem based learning.”

While Flinders offers the traditional five-year course made up of a three year Bachelor of Medical Science (Vision Science) followed by a two year Masters in Optometry, Professor Pesudovs says there’s nothing traditional about the approach to content delivery. He said there are many reasons that make the course stand out – among them problem-based learning, case-based learning, a clinical placement model (that focuses on diversity, supervisor training and infrastructure with debrief weeks), high level clinical skills training incorporating simulation, evidence-based optometry, research and topics such as ophthalmology and communication skills.

“Integrated teaching is at the core, so clinical skills, case-based learning and ophthalmology or ocular therapeutics are taught in an integrated way. This allows for immersion teaching; students are continually working in one content area for a block of time. This has been shown in other disciplines to be much more effective in developing a deeper understanding than is achieved by bouncing students from one learning topic to another each hour.”

However, he said, there are two aspects that define how good the graduates are: one being the learning methods, the other being the assessment criteria upheld. “You have to assess to a very high standard and have the courage to fail people who don’t meet those standards. If you pass everyone, there’s no point in having all those fantastic learning methods in place. So we work very hard to encourage students to aspire to the highest standard.” He said only 16 of the 40 students who commenced the first year of Flinders optometry course are still in the lead cohort. “That reflects the high standards we set.”

While this may be contrary to the typical university model of large student numbers and solid pass rates, Professor Pesudovs said it’s the only way forward. “We’re graduating registered health professional and we can’t take any shortcuts,” he said.

At Deakin, out of 77 students who enrolled in the first year of the course, 69 students graduated with the Bachelor of Vision Science degree this year in March. Some of the initial intake chose to defer for a year and have now joined the second cohort. Professor Gentle said only one of the graduating students chose not to commence the Masters degree in Optometry (he entered a post-graduate medical program).

The three-and-a-half year course is delivered in three parts: three trimesters of prevocational studies; five trimesters of optometric Problem-Based Learning (PBL) and Team-Based Learning (TBL) units that integrate health, vision science and clinical optometry practice; and two trimesters of workplace-based clinical placements.

Professor Gentle said the doubts raised over the quality of learning that can be achieved within this condensed time frame simply reflect the non-traditional structure of the program and that the end results will speak for themselves.

“If you were to read through the case studies driving PBL in our course you would see they are driven by functional disorders of vision, ocular pathology and systemic disorders which also affect vision,” said Professor Gentle. “While optical dispensing and business are also taught within these cases, you’ll see they are primarily focussed on the functional and ocular conditions.

“What is indeed an artefact of the PBL process is that the pathology is covered as the cases demand it, thus some observers may not think our students have covered a particular condition, however the reality is that they just haven’t yet studied the case in which that particular pathology is covered yet.

“As I would expect we are currently getting anecdotal feedback that our students know a lot about certain medical conditions and very little about others at present. This is as I expect it to be until they have completed the entire course,” he said.

Course Accreditation

Both Deakin University’s Bachelor of Vision Science and Master of Optometry and Flinders University’s Bachelor of Science (Vision Sciences) and Master of Optometry were approved by the Optometry Board Australia in September 2013 under section 49 of the National Law until 31 December 2015 with 51 conditions in the case of Deakin and nine conditions in the case of Flinders.

The imposition of conditions is not unusual, in fact they were expected. “The presence of the conditions is an unavoidable consequence of the OCANZ accreditation guidelines, which provide no other option to the Assessment Team but to accredit a new program with conditions. If I was in their shoes
I would do exactly the same as it is very important for the profession and the public that new courses are watched very closely until they are proven in the quality of their graduates,” Professor Gentle said.

Will the Needs of Rural Optometry be Fulfilled?

Both Deakin and Flinders Universities established the optometry courses with an aim of meeting the gap that exists between demand and supply of optometrists in rural and regional Australia. Professor Pesudovs said this is something that Flinders has achieved.

“The Flinders optometry school was established because there hadn’t been a new school of optometry in Australia for 40 years; there hadn’t been a school outside the eastern seaboard – so it was traditionally hard for optometrists in SA, Western Australia, Northern Territory, and country Australia to recruit graduates,” said Professor Pesudovs. “Flinders addressed this in an Adelaide context; the initial philosophy was to address rural and remote Australia – through a twin pronged attack of recruiting students from rural areas and also conducting clinical placements in rural Australia – and this has been manifest in the results. Half of our places are made available for rural students, and a lot (approximately one third) of clinical placements are conducted in rural Australia – we’ve done it.

As to whether the Flinders students will eventually find themselves working in rural Australia, Professor Pesudovs said he expects that, in line with experience from other universities in Australia and around the world, where graduates end up working will largely mirror where they have come from. “Most of the students from a rural background – their long term goal is to settle in country Australia, have a family and their own practice. So they will largely work in independent practice. Students recruited from the city will largely stay in the city.”

He said contrary to industry talk, there will not be an oversupply of students emerging from Flinders in 2015. “We’ve deliberately designed our program for national sustainability of the optometry profession – that’s why we only have 40 students – in fact it would be easier to have 80 students a year. We can sustain 15–25 into Adelaide each year, you can model sustainability – attrition, the age of the profession that flows in and out. The remaining 15–25 grads will need to go into rural areas nationally.

“That’s why we’ve targeted those numbers, we try to recruit broadly so that we’re not flooding the Adelaide market.
I believe this is part of my responsibility as the head of an optometry program.” he said.

Professor Gentle agrees that the career prospects for students coming through are promising, especially in rural Australia.

“I would anticipate that our students’ career prospects remain strong if they fulfil Deakin’s vision for them to graduate as effective, skilled and work ready optometrists and are willing to work and live in regional and rural Victoria and Australia. There remains a great need for optometrists in these areas. This was always the expectation when Deakin started and, to date, data continues to suggest that many new graduates are unwilling to move to regional and rural areas and stay there to serve the communities, leading to the situation we find ourselves in now,” he said.

Professor Gentle said the challenge to attract and keep optometrists working in rural and regional Australia is not one Deakin can take on alone.

“Although Deakin hopes to help address this, it is a problem for the entire profession to solve. In the long term I think you’ll find that the government’s predictions regarding the geographical distribution of the ageing population and their increasing need for eye care services will mean an increasing need for optometrists in regional and rural areas.”The New Kids on the Block…

Not Hard to Find Supervisors

It’s all very well sending students out into the community but according to some optometrists the job of supervising means a basic patient examination can be extended by up to half an hour and then there’s all the private tuition that needs to be provided every hour of the practice day.

Both Professor Weisinger and Professor Pesudovs say they have plenty of optometrists signed up to supervise clinical placements and while Professor Pesudovs doesn’t deny that the role takes time and energy, he says the Flinders clinical placement program is designed for minimum impact on the practice business.

“We have designed our placements based on the parallel clinical consulting model – the presence of a student in the practice is neutral on the number of consultations in that practice – so the impact on the business model should be neutral.

“That doesn’t mean it’s not hard work for the supervisor – it is. They have to spend a lot of time explaining things to the student so it’s not effort neutral. However, the supervisors are generally high quality practitioners, they want to share their view of and approach to optometry – and we’re delighted about those arrangements.

“We have many more placement providers than we need – we work hard to spread the workload among them, we try not to overburden them… and if they feel overburdened, we give them a break.” He said the University was able to attract the majority of supervisors through Commonwealth Government Infrastructure Grants – which enables 26 consulting rooms to be built into practices in Western Australia, New South Wales, Victoria, South Australia and Northern Territory. “With that model there is a contract with the provider that will provide a certain number of placements over a period of time. They form the core of our placements but we have other placement partners as well,” he said.

At Flinders, there are direct benefits for supervisors who take on students and rural practitioners, especially, recognise those benefits.

“Rural practitioners are very keen to be involved, they are looking to employ students when they graduate, they’re looking for succession planning, so there is a real benefit in being able to promote their practice and meet potential employees,” said Professor Pesudovs.

Similarly at Deakin, Professor Weisinger says there are plenty advantages for those who take on the role of supervisor. “I’d draw the parallel to GP practices taking students in final year – what they get out of it is currency. They get a person into their practice who is educated in the latest thinking, techniques, technology – a young energetic excited optometrist-in-training, who is keen to learn and soak up all the knowledge; they get alumni status at Deakin – so they can access the library and online resources; and an extra pair of hands – a student in the practice for 30 hours every week who is not paid but expected to undertake the full gambit of activities – customer service, answering the phone, tightening a screw, visual field testing, instructing on how to insert contact lenses. They perform all the functions that a staff member would, but they’re not paid.

“The last benefit is that this presents the ideal opportunity to recruit future optometrists – they get to work with the person, see what they’re like; and they’re free to make offers,” he said.

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