Postgraduate learning in optometry: developing training now and in the future
Professor Barbara Ryan, director of WOPEC, and deputy head, School of Optometry and Vision Sciences, Cardiff University on the growing demand for higher qualifications and what postgraduate learning could look like in the future
07 January 2023
I think WOPEC has definitely played a part in the development of the profession. If you haven’t got that education and training to support enhanced skills, it is difficult to upscale it. There might be things happening in little pockets, such as in one hospital or practice, but in order to be able to take those great ideas and roll them out to a larger group of the profession, I think WOPEC was really quite important.
Learning as postgraduates
We’ve always had the philosophy that it is about optometrists teaching optometrists. Whilst we do bring in ophthalmologists and other specialists to deliver some content, at the core of what we do we use optometrists in practice.
The majority of our CPD offering is funded by organisations and not individuals. While at the beginning most of the people taking postgraduate modules paid for themselves, now over half of people are funded by others. NHS bodies are the main funders, although some companies and other organisations are also investing in the profession’s postgraduate education.
The pandemic didn’t make a huge difference to our delivery because we did a lot online already. We definitely saw a trend in that our work and student base continued to grow, and the courses that people wanted extended. There was a feeling that people were educating themselves through COVID-19 and using any downtime they had to upskill. We continue to see growth in uptake across all higher qualifications. When we started, WOPEC’s work was mainly in continuing professional development but our postgraduate work, which is accredited by Cardiff University, the College of Optometrists and the General Optical Council, is really taking off now.
I think there are several drivers to the increased demand we are seeing. There are the waiting lists in hospitals, and where there might have been some resistance to working closely with community optometry, I think ophthalmologists are realising how valuable we as a profession can be. But also, with the birth of possible online refraction, or people buying glasses online, the business model for the profession may have to change. I think we have so much more that we could offer to the health of the people of the UK. We are an untapped resource. I think professionals having the qualifications gives a level of security to those who are commissioning the services.
I think we have so much more that we could offer to the health of the people of the UK. We are an untapped resource
We are seeing that some of the qualifications that are traditionally taught to postgraduates should be covered in the undergraduate courses. We have designed a course at Cardiff University which incorporates some of what we have been doing in postgraduate level. We’ve had it approved by the university, but we are waiting for the General Optical Council (GOC) to approve it. That in itself may drive demand for upskilling because, if we are graduating optometrists with a number of what were traditionally postgraduate or professional qualifications, then some might feel that they become the core skills.
We are starting to think about, if everybody upskills to the level that was previously postgraduate, then what does postgraduate look like now for those who are already qualified? Now that we are starting to get a better career structure and progression of clinical work, what might those practitioners of the future need?
signed up for WOPEC/LOCSU courses in 2021
We need to become better educators as a profession. One of our bottlenecks is finding people who can teach. We have all these people who want to learn, but not that many people who have the higher qualifications yet. With time, we hope that the majority of placements for optometrists in these higher qualifications will be able to happen in practice instead of hospitals, but those people in practice have to be able to educate, examine and assess.
We are also looking at what the next roles will be that optometrists undertake in the community. There is talk about optometrists possibly doing selective laser trabeculoplasty and laser treatments, and the possibility of injections for macular degeneration. We have lots of forums that we use to sound out these ideas, to check it is something the profession feels safe about and that others would want us to develop in those ways.
A lot of our time currently is spent trying to keep up with demand. We would encourage anyone who has upskilled in some of the higher qualifications to think hard about doing some teaching. It is really important for us as a profession to share that knowledge, and there are lots of people who want to learn.
Optometry is a really interesting and exciting profession at the moment. Grasp the opportunities that come and don’t be afraid of the learning.
Teach and Treat
In recent years, we’ve set up Teach and Treat clinics in Wales: providing a place for optometrists to come in and do placements, rather than going into busy hospitals. We have the NHS Wales University Eye Care Centre in Cardiff and we are looking at whether we can have similar developments in west and north Wales. It has worked brilliantly and is a really good environment for optometrists to learn in.
I think it has also forged better connections with colleagues in hospitals. We find that a lot of ophthalmologists wanted community optometrists to upskill, but they were so fraught with the concern of seeing their patients day-to-day, they couldn’t fit in the placements. We’re helping to see some of the patients from their waiting lists, yes, but we are helping them to plan for the future as well.
In those centres we share clinical records electronically. I think that for a long time, ophthalmologists had confidence in their colleagues who were perhaps hospital optometrists down the corridor, because they work closely. Having shared online records enables them to see the work that is being done and understand the level at which these practitioners can operate. It allows them to have confidence in the work that optometrists in the centre do.
Then, as those optometrists go out to work in the community, ophthalmologists are happier to discharge their patients to them. I think any resistance for optometrists to do the work has often been, at the foundation, a concern about patients – which as clinicians we would all understand. I think it’s about helping to show that we are very safe and we can do this job.
WOPEC: The journey so far
Dr Nik Sheen and I were employed by Cardiff University in around 2003. The university had won a tender to provide education for optometrists in Wales to develop an acute eye care service and low vision service. Around three or four years later we had a re-accreditation, and the scope of practice was extended a little more, funded by the Welsh Government.
Then, in 2009, the Local Optical Committee Support Unit (LOCSU) told us that it was developing extended pathways in England, and asked if we could tender to help it with providing education. It was felt that we needed to set up a slightly different entity for this, and that is where WOPEC came from. We established the centre so that we could continue what we had been doing in Wales, in England.
There has been a 10-fold increase in practitioners doing postgraduate taught modules with the School of Optometry and Vision Sciences, Cardiff University, in the last 10 years; from 67 in 2011/12 to 667 in 2021/22
In 2011, we set up the first MSc that the School of Optometry and Vision Sciences at Cardiff University had been providing. That was developed in a credit accumulation model, where people could bring some of the learning that they had already done with us, whether they were from Wales or England, and put that towards an MSc. When the College of Optometrists brought in their qualifications, we started to credit some of those modules.
It has seemed that, as we were developing, the profession was developing
One of the things that drove us forward was looking at other professions and seeing how well developed their postgraduate learning was and how, at the time, under-developed optometry’s postgraduate learning was.
We are lucky in Cardiff, that optometry is in a college with dentistry, medicine, pharmacy and healthcare. We could take inspiration from other healthcare professionals, and talk to our colleagues in optometry about what they needed.
As we got a body of people together that were dedicated to thinking about the training, education and support that the profession needed as it extended into new roles, we found that everything fed off from each other. It has seemed that, as we were developing, the profession was developing.
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