“In any healthcare occupation, I believe you are constantly learning”

What is Health Education and Improvement Wales’ (HEIW) new support and mentoring service?

Dr Nik Sheen (NS): HEIW was established in Wales a year ago and it is an equivalent body to NHS England or NHS Education for Scotland. It is designed to educate and transform the workforce. There are multiple professions in the building: pharmacy, dental and medicine. I’m on secondment as an eye care lead and am the only optometry representative here at the moment.

The support and mentoring service launched in November and is for newly-qualified optometrists in Wales who want to offer enhanced services. The idea is to provide the tools to support them in their newly-qualified roles. It will support newly-qualified optometrists with their clinical decision-making, improve skills and increase understanding of what career options are open to them.

Who will newly-qualified optometrists be supported by?

NS: Newly-qualified optometrists will be assigned a one-to-one mentor who are from the same area as they are practising in. We have put seven optometrists through a coaching, mentoring and learning course and each one of them will be assigned a student to look after.

We held an introductory webinar with all of the newly-qualified optometrists, established a WhatsApp group, showed them the online system and asked them to upload a couple of cases so that we could have a peer review session. They will have two one-to-one coaching sessions and one big group peer review session. There are also monthly update meetings between the mentor and the optometrist.

It will support newly-qualified optometrists with their clinical decision-making, improve skills and increase understanding of what career options are open to them

How is support provided?

NS: The service includes support on day-to-day stuff as well as clinical queries. We are encouraging newly-qualified optometrists to upload cases to the online system so that they can be discussed in groups, but we also want to support them in their career and make sure they are aware of what options are available to them in terms of further enhanced services. We’re hopeful that it will improve their reflective practice as well.

How was the service developed?

NS: We had been thinking about the concept for a while. With the General Optical Council’s Education Strategic Review steering in this direction we thought it would be a good time to launch it. With the advent of HEIW and being able to tap into other professions and the work that they are doing, it all came together.

We spoke to Optometry Wales and ask for its feedback. It preferred for the service to be a voluntary process with the idea to offer it everyone if it was successful. If the results show that it makes a difference to clinical practice then we’d consider making it mandatory, as long as it is in line with that the profession wants.

We are encouraging them to upload cases to the online system so that they can be discussed in groups

Why is this service important?

NS: David Parkins did a study recently which found that newly-qualified optometrists are more likely to be risk averse and refer more patients into secondary care. This is because they don’t have the support anymore and are alone when gaining experience. We’re looking at whether we can make an impact for newly-qualified optometrists by giving them the tools to make better clinical decisions and be less risk averse where appropriate. For example, there could be an individual who is working in a team with their supervisor next door, then they qualify and might change jobs and be a lone practitioner without any support. Understandably, that’s a daunting process and you are probably more likely to be risk averse and just refer in case.It seems like a lot of practitioners drop out in the early years after qualification. We’re keen to highlight that there are other avenues open to the profession as a whole in terms of training. They can explore different areas via optical committees or working in a hospital, for example, which I don’t think newly-qualified optometrists know about. We need to make them aware that once they’ve qualified, every day practice isn’t the end of their career. There are alternatives and they can have that career progression if they chose to.

What’s next for the service?

NS: It’s a proof-of-concept process at the moment, so at the end of a six-month period we will evaluate it with qualitative feedback from all those involved and review the referrals they’ve made in that time. We’ll assess whether it has been useful in terms of their clinical decision-making skills and their reflective practise. If we find it to have been a positive and worthwhile experience, then we will look to secure funding to roll it out for newly-qualified optometrists coming to work in Wales.

We’re looking at whether we can make an impact for newly-qualified optometrists by giving them the tools to make better clinical decisions

What are your expectations of being a newly-qualified optometrist?

Hannah Jones (HJ): I am looking forward to putting everything that I have learned over the past four years into practice. However, making decisions without anyone else present to reassure me is very daunting.

What reflections can you make on your pre-reg year?

HJ: Personally, I found pre-reg year very stressful and exhausting. It’s important to maintain a work/life balance to keep you motivated. I attempted to work and revise during weeknights and have free-time on weekends. Working consistently like this throughout the year made me calmer prior to the Objective Structured Clinical Examinations as my notes were prepared and I knew that I just had to work on communicating my knowledge and understanding quickly and concisely to the assessor.

I completed my pre-reg year at an independent practice that had never had a pre-reg before. While completing applications at university, several optometrists and supervisors warned me against independents because, in their opinion, they were unlikely to have the resources available to facilitate my pre-reg year. However, I had a very supportive practice that actually allowed me to see a whole range of pathology to aid my competencies and experience. I was also able to attend a practice OSCEs course that proved very useful.

I had a very supportive practice that actually allowed me to see a whole range of pathology to aid my competencies and experience

Throughout the year, my supervisors would show me patients’ conditions and talk me through how they came to the diagnosis and management. This really helped my learning process as I feel the university notes and textbooks can only give you the baseline knowledge and patients often present in slightly different ways.

My practice also made sure I was practising various techniques from the start. For example, I would complete Perkins tonometry daily instead of non-contact tonometry. When Visit 3 came and I had to perform tonometry in front of the examiner, I had done it so many times that I felt very confident.

What areas do you want to develop in?

HJ: I need to continue to develop my time management. I am looking forward to completing Eye Health Examination Wales training in order to offer emergency appointments. In the next year, I am also very interested in pursuing a further professional glaucoma or medical retina qualification.

Having a mentor will allow me to see other optometrist’s mode of practice and create my own

Why is further support from a mentor important to your career progression?

HJ: In any healthcare occupation, I believe you are constantly learning from new research and people’s experiences. Having a mentor will allow me to see other optometrist’s mode of practice and create my own. I think this support could be very beneficial to future optometrists.

Why did you decide to use the mentor service?

HJ: The transition between pre-reg to newly-qualified optometrist is very daunting. It is reassuring to have a mentor who you can approach to talk through your decision-making and ask how you could improve in the future. I am looking forward to getting some advice on how I can progress my future and gain further qualifications.

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