A new way of assessing optometry students and their clinical competence in practice was presented by the University of Manchester’s Will Holmes during a session at the AOP’s Hospital and Specialty Optometrists Conference (HSOC) in September.
The academic’s educational talk, entitled How do you know Messi is a good footballer?, aimed to shine a light on the way in which the clinical competence of optometry students is assessed currently during, what Holmes, described as single, high-stake assessments.
He emphasised: “The core message that I was trying to draw out was that we don’t judge Messi, or any footballer, on the basis of a single, or even multiple, penalties. We judge them on the basis of watching them over a period of time, playing in a number of games, and we form a judgement about them.”
Using this analogy, Holmes explained that the current assessment process for optometry students sees their clinical competency judged on a single penalty, such as an Objective Structured Clinical Examination (OSCE) or a worked-based visit.
“We set up some penalties and we see if they can convert them in a way that is somewhat artificial, and we then say you are competent or you are not,” he said.
As an academic, Holmes finds himself asking, ‘Is this a good way of doing things? Does that make sense?’
As a result, in 2015, Holmes sent a survey to pre-reg supervisors across the UK, in which he asked them to identify from a list of university signed-off competencies, what skills trainees had when they first arrived in practice.
The results, Holmes said, demonstrated that the high stakes assessments that universities are doing do not seem to be guaranteeing a student’s ability to perform clinical tasks in the workplace.
Offering an alternative approach to the assessment of optometry students, Holmes explained the concept of Entrustable Professional Activities (EPAs).
EPAs refers to “a unit of professional practice that can be entrusted to a trainee once he or she has demonstrated sufficient competence to be able to do a particular thing,” he told OT.
“In lay terms, it’s a thing that you do professionally that you can entrust to someone else,” he added.
Relating EPAs to the training and assessment of optometry students, Holmes shared that when a student undertakes a clinical activity within a practice, because they are doing the job of an optometrist, they automatically take part in EPAs.
“The idea is that every time they perform EPAs, the person who is supervising them gives them a trust score,” he explained, with level one being that the trainee is only trusted to watch a task, through to level four, when the trainee can perform the task unsupervised.
Holmes believes the EPA model translates well to optometry because “practitioners make trust judgements all the time instinctively.”
By transitioning to such a model “all we are doing is asking something to record something that they are already doing,” he said.
Explaining the EPA model in detail, Holmes highlighted: “When we talk about signing off whether a student can be trusted in a particular entrustable activity, it is never on the basis of an individual’s judgement.
“You will always have a group of practitioners, eight or 10, supervising the student over an extended period of time, on different days, and in different clinical situations giving those trust scores.”
Holmes emphasised that the model provides fairness in assessment, which is key. “At the moment, if someone has what you would call a bad day of on a high stakes assessment like an OSCE, even if they are competent, that will stop them from progressing,” he shared.
He continued: “That’s not a problem when using EPAs as you are looking holistically across the piece.
“Equally, and perhaps more importantly, you can’t get people passing EPAs by chance. It’s possible that you might be quite weak in a particular clinical area, but you get lucky on the high stakes assessment and it doesn’t come up on the OSCE in a way that would highlight the weakness, but it is very difficult to escape that when looking longitudinally over a period of time.”
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