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Designing clinical experience

University of Manchester academics share their views on the GOC's latest ESR consultation findings

06 Jul 2018 by Andrew McClean

As the General Optical Council (GOC) publishes its latest findings from the Education Strategic Review (ESR), optometry programme director, Will Holmes, and professor of clinical optometry at the University of Manchester, Chris Dickinson, ponder what clinical experience really means

Following the latest ESR consultation, chair of the GOC, Gareth Hadley, has said that the regulator believes that “earlier, more varied and frequent clinical experience for students can help further build professional confidence, effective communication skills and professionalism."

It is our view that it is important that ‘clinical experience’ and ‘patient episodes’ are not defined too narrowly. Clinical experience should not only mean a student interacting with real patients in a real clinical environment as simulation has many advantages over real experiences.

Guaranteed exposure to key pathologies 

A major weakness of ‘real experience’ is a reliance on the type of patient who happens to present. This makes it more difficult to ensure that all students are exposed to key pathologies. The use of paid volunteers/actors who present with particular pathologies guarantees that all students can receive the necessary exposure.

More effective learning

A further problem with relying on the ‘real patient lottery’ is the timing of experiences. Ideally, students would have the opportunity to apply the theory that they have learned within a clinical environment shortly afterwards. This can be more easily guaranteed if simulation is used. This ability to design the clinical experience a student receives is also useful in other ways. For example, it can be ensured that early on students are exposed to simple and common clinical scenarios with the complexity increasing towards the end of the course. 

More effective teaching

Supervisors in real optometric environments have twin responsibilities. The first is to the patient (who must be their overriding concern) and the second is to student learning. The burden of the first responsibility is considerable. Some real patients can present with very considerable clinical challenges, leading to much of the supervisor’s intellectual energy being spent on ensuring that they are put first. This can be to the detriment of time spent focused on student learning. Simulation means that supervisors already know the status of a patient and are thus able to be more focused on student learning.

Freedom to make mistakes

In a real clinical environment there are skills which are impossible to practise fully because the cost of making a mistake is too high. For example, if a patient becomes angry with a student it would be unacceptable for a supervisor to allow them to ‘practise handling an angry patient.’ However, in a simulation it would be perfectly appropriate for an actor to simulate anger and for a supervisor to allow the student to practise how to communicate in such a scenario.

Simulation more easily allows for patient feedback

In a real clinical scenario, the role of giving feedback to the student is primarily the responsibility of the supervisor. In a simulated environment, actors can give specific and expert advice to students – particularly in the area of communication skills and professionalism. 

Simulated clinical experience should not replace real clinical experience since only real clinical experience allows students to be exposed to a large volume and variety of patients.  This volume and variety is particularly important during the pre-registration year. 

It is our hope that when the ESR is completed, the framework that is produced defines clinical experience in a broad way. This will then allow educators to select the most appropriate type of clinical experience required to achieve a desired learning outcome. 

Will Holmes is an AOP councillor, optometry programme director at the University of Manchester and co-chair of the Optical Confederation education committee.

Professor Chris Dickinson is professor of clinical optometry at the University of Manchester and a member of the GOC education committee.

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