A Global Competency-Based Model of Scope of Practice in Optometry

1. A Global Competency-Based Model of Scope of Practice in Optometry Anthony F. Di Stefano, O.D., M.Ed., M.P.H.

2. Committee • Dr. Norman Wallis, Chair • Dr. Robert Chappell • Dr. Patricia Kiely • Dr. Thomas Lawless • Dr. Leon Gross (Consultant) • Dr. Anthony Di Stefano (WCO)

3. Introduction • WTO and GATS • MRAs • Optometric initiative • ARBO and WCO collaboration • WCO and ARBO committee • International Advisory Group on Optometric Competencies (IAGOC) (December 2003)

4. WCO Concept of Optometry Statement Optometry is a healthcare profession that is autonomous, educated, and regulated (licensed/registered), and optometrists are the primary healthcare practitioners of the eye and visual system who provide comprehensive eye and vision care, which includes refraction and dispensing, detection/diagnosis and management of disease in the eye, and the rehabilitation of conditions of the visual system Developed Paris 1992 Approved Venice 1993

5. Background/Prior Work • Do not “reinvent the wheel” • Model must address variations in scope of practice • Controversial topic for some • ECOO European Diploma recognized diversity in region with 3 stages

6. ECOO’s European Diploma Structure • Optical Technology (lab work and dispensing) • Vision Care (refraction, BV, CLs) • Ocular Disease (& systemic) (detection/diagnosis and management) • Different words used for political reasons

7. 10 years later • Global vs. Regional • Therapeutic use of drugs now common in some countries (Australia, Canada, Nigeria, UK, USA, etc) • Need an additional stage • Evolutionary approach

8. Categories of Service • Optical Technology Services • Visual Function Services • Ocular Diagnostic Services • Ocular Therapeutic Services

9. Optical Technology Services • Management and dispensing of ophthalmic lenses, ophthalmic frames and other ophthalmic devices that correct defects of the visual system

10. Visual Function Services • Optical Technology Services and/plus • Investigation, examination, measurement, diagnosis and correction/management of defects of the visual system

11. Ocular Diagnostic Services • Optical Technology Services and/plus • Visual Function Services and/plus • Investigation, examination and evaluation of the eye and adnexa, and associated systemic factors to detect, diagnose and manage disease

12. Ocular Therapeutic Services • Ocular Technology Services and/plus • Visual Function Services and/plus • Ocular Diagnostic Services and/plus • Use of pharmaceutical agents and other procedures to manage ocular conditions/disease

13. Competency Statements • Work in Australia, Canada, UK, California • IAGOC recommended Australian competency statements and system • Allocate across 4 stages

14. Optometrists Association Australia • Developed system of competency statements (1993, 1997, 2000) • Tracked evolution of profession in one country • Has been applied in other countries, e.g., Norway

15. The System • Units – 6 major components of activities within profession • Elements – sub-divisions of units • Performance criteria – accompany elements, evaluative statements • Indicators – measurable and observable features of performance criteria (refinement for more specificity and assessment)

16. The Units 1 – Professional and clinical responsibilities • 2 – Patient history • 3 – Patient examination • 4 – Diagnosis • 5 – Patient management • 6 – Recording of clinical data

17. Unit 1 – Professional and Clinical Responsibilities Elements • Ensures that optometric knowledge, clinical expertise and equipment remain current. • Practices without the need for supervision • Acts in accordance with the standards of behavior of the profession. • Provides advice and information to patients and others.

18. Unit 2 – Patient History Elements • Communicates with the patient. • Makes general observations of patient • Obtains the case history. • Obtains and interprets patient information from other professionals.

19. Unit 3 – Patient Evaluation Elements • Formulates an examination plan • Implements examination plan • Assesses the ocular adnexae and the eye • Assesses central and peripheral sensory visual function and the integrity of the visual pathways. • Assesses refractive status. • Assesses oculomotor and binocular function.

20. Unit 4 – Diagnosis Elements • Interprets and analyses findings to establish a diagnosis or diagnoses.

21. Unit 5 – Patient Management Elements • Designs a management plan for each patient and implements the plan agreed to with the patient. • Prescribes spectacles • Prescribes contact lenses • Prescribes low vision devices.

22. Unit 6 – Recording of Clinical Data Elements • Ensures that data is organized in a legible, secure, accessible, permanent and unambiguous manner. • Maintains confidentiality of patient records.

23. Allocation to Categories • Prefixes for each each Stage • Optical technology -OT • Visual function - VF • Ocular diagnostic - ODx • Ocular therapeutic – OTx • Denote specific meaning of performance criteria • When meaning common across stages, arrow • When no comparable meaning, blank

24. The System • Units – 6 major components of activities within profession • Elements – sub-divisions of units • Performance criteria – accompany elements, evaluative statements • Indicators – measurable and observable features of performance criteria (refinement for more specificity and assessment)

25. Example Allocation of System UNIT 3: PATIENT EXAMINATION Element 3.3 Assesses the ocular adnexae and the eye. Performance Criterion 3.3.1 The structure and health of the ocular adnexae and their ability to function are assessed. Indicators Assessment of skin lesions, conjunctiva, lids, lashes, puncta, Meibomian glands. Screening for disease; macro-observation, slit lamp biomicroscopy, loupe, interpupillary distance, lid eversion, photography, diagnostic pharmaceuticals, tear dynamics.

26. Example – 1

27. Example – 2

28. Example – 3