The Transition...Secrets to a Successful Pre-registration Year

Eshmael Palmer BSc MCOptom

Outline The pre-registration period

The Scheme for Registration (SfR)- college logbook / monthly reviews

- work-based assessments (stages 1 & 2)

- final assessment (OSCE’s)

Qualifying / registration

Sources of support and the AOP

Example questions

Pre-registrationPrimary care sector

Secondary care sector

College logbook How to get the best out of your logbook

- initially everything seems to be peculiar

- numbers

- evidence

- reflect on each patient experience – how can you use each patient to demonstrate a particular competency

- some cases may illustrate more than one competence

- more than one patient record?

- review and reflect weekly

Example record

Example record

Monthly Reviews How to get the best out of your reviews

- discuss progress/problems with your supervisor

- remember to collect the evidence

- remind yourself (and supervisors) about competency definitions and what patient episodes are required

Know yourself Where are your weaknesses regarding clinical and

subject matter ?

Who around you is strong in those areas?

Common reasons for failure:- binocular vision- dispensing- incorrect patient episodes

Try not to waffle on answers! … avoid “carrying over” competencies because you run out of time

Communication CRVO

Wet AMD

UV light damage

POAG

Describe in lay terms

Know your assessor What are they looking for ?

They are not trying to fail you!

They can be a mine of information!

Safe / unsafe?

Work-based assessments

How to get the best out of your assessments- collect evidence- consider the use of ‘witness statements’- have everything ready for the assessor - do plenty of revision- make sure you have patients for the exam if needed- ensure you are familiar with your records

Assessment timeline

Stage 1

75 of the GOC’s 82 competencies assessed over 3-4 visits (provide your own patients)

Visit 1 (after 1 month) – 10 competencies including...- pupil assessment- focimetry- keratometry

Work-based assessments

Question!!

CompetencyThe ability to advise on the use of and to dispense complex spectacle lens forms

Measurements Patient advice

Stage 1 75 of the GOC’s 82 competencies assessed over 3-4 visits

(provide your own patients)

Visit 2 (after 3 months) – 31 competencies including...- full eye test- soft lens aftercare- indirect ophthalmoscopy

Work-based assessments

Question!!

CompetencyThe ability to manage the aftercare of patients wearing soft contact lenses

Management- smile stain- neovascularisation- GPC- SEALs

Stage 1 75 of the GOC’s 82 competencies assessed over 3-4 visits

(provide your own patients)

Visit 3 (after 6 months) – 34 competencies including ...- RGP aftercare- soft lens fitting (soft and RGP)- contact tonometry

Work-based assessments

Question!!

The ability to manage a patient presenting with a red eye.

Competency

Taking a history from the patient

Stage 1 75 of the GOC’s 82 competencies assessed over 3-4 visits

(provide your own patients)

Visit 4 (after 8 months) – any remaining competencies

Deadline for stage 2 - third week of March

Work-based assessments

Question!!

Signs Diagnosis

Management Treatment Patient explanation

CompetencyThe ability to recognise, evaluate and manage diabetic eye disease and refer accordingly

Stage 2

Carried out by a second assessor, in one visit with paid patients

provided by College (but unknown to assessor)

‘Over-arching’ competencies will be assessed (to ensure you have

kept your ‘broader based’ knowledge and skills up to date)

Routine eye examination will be assessed

Fitting and aftercare of soft contact lenses will be assessed

Deadline for July OSCE - third week of May

Work-based assessments

Applying for the Objectively Structured Clinical Examination (‘OSCE’)

Pass all competencies in work based assessments

Minimum 350 ‘refractions’ and 250 dispenses

Application deadline – late May

First feasible sitting takes place early July

Next sitting takes place in September

OSCEs Take place in Manchester

14 stations (+1 rest +2 pilot) Pass=10

1 minute to read the instructions outside.

Five minute for each station involving either;- actor playing a patient- anatomical model- case record and viva

In stations involving ‘patients’ the examiner will observe you (and will not intervene unless your patient is at risk of harm!)

OSCEs

Each station will assess ability in the following:

- clinical examination and practical skills

- communication with patients, colleagues and carers

- data interpretation

- history taking

You may be assessed in any area of the 82 GOC stage 2 competencies

Wash hands – there is usually alcohol gel outside

Look at the title of the station it may give you a clue of what is expected of you

Use the equipment provided

Disinfect all equipment

Introduce yourself to the patient!

Focus equipment - slit lamp & keratometer

Thank the patient and ask if they have any questions

OSCEs – hints and tips

Be confident – if you are acting like you don’t think you’re safe why should the examiner think you are?!

Don’t just look at the obvious!! assess the eye from front to back – don’t miss the wood for the trees!

Say what you see – even if you are not sure of the diagnosis you need to have safe management.

Differential diagnosis - go through the differential diagnosis and explain your reasoning...don’t just jump to your answer.

OSCEs – hints and tips

Question!!

Competency

Patching discussion with the parent of a four year old child with right eye amblyopia

- what is amblyopia?- why patch now?- reasons for patching?

An understanding of the management of a patient with an anomaly of binocular vision

Revision Revision courses are expensive, but so are re-takes.

There are good ones around.

Get organised:- dates are fixed- use competency lists to break the work down- set your targets- use undergraduate notes- remember the AOP questions

Reasons for failure

Fundamental errors in patient management

Compromised the safety of the patient

Showed a deficiency in technique leading to

inappropriate patient management

Outside tolerances / major errors +/- omissions

Failed to detect or act upon significant signs,

symptoms or pathology

Sources of support

Your supervisors Your colleagues Each other! hospital AND high street Your assessor College PR forum Websites

- www.college-optometrists.org.uk- www.aop.org.uk- www.optometry.co.uk

Free membership during the pre-registration year

OT fortnightly – good articles for revision

Access to newly updated OT website

Model questions and answers (excellent!)

Suggested reading / tips for the OSCEs.

Legal and professional advice

Lots of people will qualify at once

Download AOP application form (insurance) and post or fax to AOP.

- you can pay over the phone to speed things up.- you need this number to register with the GOC!

Fill in your GOC form

Optional – College membership

Health board registration – contact early – April

Qualifying

Job hunting

When?

How?

Where?

What?

Take-home points

Make a list of the competencies required for each visit

You are just trying to pass and prove your competence (are you safe to practice independently ?)

Timing is everything!

Self motivation and management is essential

Example questions

Colour vision assessment

Dendritic ulcer

Pupil assessment

Ocular motility

Cataract detection

Non-tolerance of spectacles

Red eye differential diagnosis

Malingerer

Wet AMD detection

BVD Calculation

Soft / RGP lens selection

Safety spectacles

CRVO / CRAO

Cause of headaches

Questions - practical

Colour vision assessment- when is it required?- types of tests- testing conditions- results- management- communication

Questions – data interpretation

Visual field plot- describe plot- differential diagnosis- associated conditions- management- referral? How soon?- communication

Questions – clinical knowledge

Blurred disc margins- presenting symptoms- signs- differential diagnosis- investigations- management- referral? How soon?- communication

Thank you for your attention!

Any questions?