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

Transcription

1 A Global Competency-Based Model of Scope of Practice in Optometry Introduction On April 8, 2005, the General Delegates Meeting of the World Council of Optometry (WCO) formally adopted the Global Competency-Based Model of Scope of Practice in Optometry. This model provides a rational framework for addressing the challenges of increased practitioner mobility across international borders and the need to promote greater harmonization in optometric education around the world. In addition, the model responds to the challenges of the World Trade Organization (WTO) and its General Agreement on Trade in Services (GATS), whose intention is to allow for mobility of professional services across international boundaries through Mutual Recognition Agreements (MRA s) that would be negotiated between states (countries). In 2003, the World Council of Optometry and Association of Regulatory Bodies in Optometry (ARBO) jointly appointed a Planning Committee on Optometric Competencies (Appendix A). The Committee was charged with developing an acceptable global competency-based model of optometry. The model should allow objective comparisons of optometric scope of practice between states that could be used for international practitioner mobility while still assuring the safety and welfare of the public, according to immigration rules and health care needs of local jurisdictions. The final Global Competency-Based Model of Scope of Practice in Optometry has been built on the recommendations and historic work of the Planning Committee on Optometric Competencies. Background In approaching the development of a global model, the Committee recognized the importance of the WCO Concept of Optometry statement as the basis for a global competency-based model of scope of practice in optometry. Developed in 1992 and approved by the WCO in 1993, this valuable, unifying statement about the profession is accepted by all member associations of WCO. It recognizes the historical development of optometry and the cultural and legislative differences in the optometric scope of practice around the world. Moreover, it reflects optometrists commitment to achieve appropriate patient care outcomes aimed at maintaining and improving their patients quality of life. The WCO Concept of Optometry statement is: 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. 1

2 The Committee recognized and evaluated the significant work that had already been carried out in a number of countries to develop statements of expected optometric competencies. In addition, it recognized that a wide variation in the scope of practice and levels of education of optometrists exists throughout the world, and that any system adopted should be able to address this diversity even in the face of internal or external political opposition to the concept of practitioner mobility across country borders. The Committee recognized that the ultimate decision for an MRA will be between two sovereign countries ( or legal jurisdictions), and that the existence of a pragmatic model to aid in this mutual recognition will benefit everyone regulators, professional associations, educational institutions and the public. The resultant Global Competency-Based Model has been built largely on the competency statements and model developed over the past decade by the Optometrists Association Australia (OAA). These competency statements have the added strength of having been developed through support received from, and then recognized by, the Australian government. The categorical structure of the model parallels the structure developed for the European Diploma in Optometry by the European Council of Optometry and Optics (ECOO) in the mid-1990s, but also embraces the legal authority of optometrists to treat ocular disease with pharmaceutical agents in several jurisdictions (Appendix B). The Planning Committee also benefited by the input of an International Advisory Group on Optometric Competencies (Appendix C). The following model should be used in conjunction with the World Council of Optometry s Case Statement entitled World Optometry Enhancing Vision, Protecting Health. The latter describes the global public health challenges and optometry's role in primary care, its educational underpinnings, and its integral role in interprofessional relations and research. It underscores the responsibilities of primary care optometry in prevention, health education, health promotion, health maintenance, diagnosis, treatment and rehabilitation, counseling, and interdisciplinary consultation. Its purpose is to provide health professionals, government agencies and the general public with an overview of the practice activities of the optometrist and how they relate to the global needs of the public. It underscores the fact that although the scope of practice of optometry may vary from country to country due to different regulations, today s optometrists are educated and trained to provide the full range of services thereby enhancing vision and protecting health. Thus, the Global Competency-Based Model will help regulatory bodies assure practitioner competence as part of their responsibility to protect the public when faced with future migration of optometrists across jurisdictional borders. It will also act as stimulus for creating greater uniformity in optometric practice worldwide by being applied to teaching syllabi and statutory definitions of scope of practice. The Model Framework In response to the globalization of the health professions, the World Council of Optometry (WCO) has developed the following Global Competency-Based Model of Scope of Practice in Optometry to assist states and countries around the world to reconcile the variations in the scope of optometric practice internationally. This competency model includes four categories of services which also provide a vertical career ladder for individuals seeking to expand their scope of clinical responsibility. As such, each category requires a set of competencies which includes the previous category. The four categories of service are: 4

3 1. Optical Technology Services Management and dispensing of ophthalmic lenses, ophthalmic frames and other ophthalmic devices that correct defects of the visual system 2. Visual Function Services Optical Technology Services, plus Investigation, examination, measurement, diagnosis and correction/management of defects of the visual system 3. Ocular Diagnostic Services Optical Technology Services, plus Visual Function Services, plus Investigation, examination and evaluation of the eye and adnexa, and associated systemic factors, to detect, diagnose and manage disease 4. Ocular Therapeutic Services Optical Technology Services, plus Visual Function Services, plus Ocular Diagnostic Services, plus Use of pharmaceutical agents and other procedures to manage ocular conditions/disease Using the Australian methodology for identifying core competencies needed for the safe practice of optometry, the model includes a hierarchy of steps (Appendix D): 1. Units - major components of the activities within a profession 2. Elements - sub-divisions of units, the lowest logical, identifiable and discrete subgroupings of actions and knowledge, which contribute to and build a unit 3. Performance criteria - accompany elements, evaluative statements specifying the required level of performance ; can be used by an assessor to determine whether a person performs to the level required for the profession. 4. Indicators - measurable and observable features for each performance criterion can assist in determining whether a competency is achieved. Units and Elements in the Competency Model The units and the elements in each unit define the professional responsibilities and functions of the primary care optometrist. The following listing thus becomes the foundation for the model: Unit 1 Professional and Clinical Responsibilities 3

4 Element 1.1 Element 1.2 Element 1.3 Element 1.4 Element 1.5 Element 1.6 Element 1.7 Element 1.8 Element 1.9 Element 1.10 Element 1.11 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. Utilizes resources from optometry and other organizations to enhance patient care. Understands the principles of the planning, establishment, development and maintenance of an optometric practice Understands the legal obligations involved in optometric practice. Provides for the care of patients with special needs. Ensures emergency optometric care is available. Promotes issues of eye and vision care to the community. Understands factors affecting the community's need for optometric services. Unit 2 Patient History Element 2.1 Element 2.2 Element 2.3 Element 2.4 Communicates with the patient. Makes general observations of patient Obtains the case history. Obtains and interprets patient information from other professionals. Unit 3 Patient Evaluation Element 3.1 Element 3.2 Element 3.3 Element 3.4 Element 3.5 Element 3.6 Element 3.7 Element 3.8 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. Assesses visual information processing Assesses the significance of signs and symptoms found incidental to the ocular examination in relation to the patient's eye and/or general health. Unit 4 Diagnosis Element 4.1 Interprets and analyses findings to establish a diagnosis or diagnoses. Unit 5 Patient Management Element 5.1 Element 5.2 Element 5.3 Element 5.4 Element 5.5 Element 5.6 Element 5.7 Element 5.8 Element 5.9 Element 5.10 Element 5.11 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. Prescribes pharmacological treatment regimens. Dispenses optical prescriptions accurately. Manages patients requiring vision therapy. Treats ocular disease and injury. Refers the patient. Co-operates with ophthalmologist in the provision of pre- and post operative management 4 of patients. Provides advice on vision in the workplace.

5 Unit 6 Recording of Clinical Data Element 6.1 Element 6.2 Ensures that data is organized in a legible, secure, accessible, permanent and unambiguous manner. Maintains confidentiality of patient records. The global model presented in Appendix E is a matrix with two dimensions: the four categories, and within each of which are Units, Elements, and Performance Criteria and Indicators, which are recognized as necessary statements for the assessment of individual practitioner competence. The structure of the model reveals that while all Units and Elements apply to all four categories, Performance Criteria could apply to one, two, three, or all four categories. Also, while the language of each Performance Criterion might be common to all or some of the categories, it could have a different interpretation depending on the category in question. Consequently, the model established prefixes to each Performance Criterion to identify its application specifically for that category. The prefixes chosen were: For those Performance Criteria that could apply to more than one category, the method chosen to identify this was an arrow pointing to the next category. Where no Performance Criteria could be applied to any category, the cell was left blank. This system results in a table with each cell representing a Performance Criterion for the Element and Unit for that category. The complete model is presented in Appendix E. The ultimate utility of this model will only be determined with its use by individual states aligning their statutory scope of practice against the model. In doing so, the assumption is made that the boundaries between categories will be found to be porous, and the outcome of such an exercise with will result in a profile for each state across the whole model. As such, this then could become a template for comparing educational preparation and practice scope of migrating practitioners, and for curriculum design and test development. The model underscores the essential role that education must play in preparing an individual to meet the competencies included in the model. In conclusion, the model can be a stimulus for creating more uniformity of optometric practice worldwide, through its application to teaching syllabi and statutory definitions of scope of practice. Further, this model will help regulatory bodies assure practitioner competence as part of their responsibility to protect the public when faced with future migration of optometrists across state borders. Assuring the Quality and Standards of Optometric Education and Competence Assessment The Global Competency-Based Model does not address directly the quality and standards of optometric education and the quality and standards of the assessment of competence. It is quite 5

6 possible that country A could argue that a practitioner from that country who has completed a prescribed course of study and passed certain examinations has the same competence as an optometrist of country B based solely on the evaluation of curricula and transcripts of education and assessment against the model. However, there would be no guarantee from such a paper analysis using this model that the optometrist from country A was educated to the same level as the optometrist from country B ; and, similarly, that the quality of the assessment of the individual competence of the optometrist from country A was as rigorous as that of the optometrist from country B. From this, the Planning Committee recognized that for this global model to have credibility when operational, a mechanism had to be developed and implemented to assure that the quality of education and assessment for each competency statement must meet certain standards to assure global equivalency. In response, the World Council of Optometry has established the Global Accreditation Council on Optometric Education (GACOE). This body has been designed to offer accreditation services for both the quality and standards of optometric education and the validity and reliability of the assessment of competence for all countries using the WCO model for international recognition of credentials in optometry. These services can be in the form of consultation to such entities as educational institutions, regulatory groups, and ministries of education and health. In addition, the GACOE can play a role in harmonizing accreditation policies and practices across countries and regions. 4

7 APPENDIX A Planning Committee Norman Wallis, Ph.D., O.D., D.Sc. (Hon), FCOptom, Chair, is the Executive Director of the National Board of Examiners in Optometry (NBEO), USA, and former President of the Pennsylvania College of Optometry. He chaired and facilitated the 1992 Paris Think Tank that created the WCO s Concept of Optometry statement. Robert Chappell, O.B.E., M.Phil., D.Sc. (Hon), FCOptom, is Chair of the WCO L&R Committee, President Elect of the European Council of Optometry and Optics (ECOO), Treasurer of the College of Optometrists (U.K.), and a member of the General Optical Council (U.K.). Patricia Kiely, Ph.D., B.Sc. (Optom), is Research Officer of the Optometrists Association Australia, and the principal investigator and author of the 1993, 1997, and 2000 national efforts to develop competency statements for Australian optometry. Thomas Lawless, O.D., is Chair of the ARBO International Affairs Committee, Chairman of the Board of Trustees of the Illinois College of Optometry, and former Chairman of the Illinois Optometric Licensing & Disciplinary Board. Leon Gross, Ph.D., is Associate Executive Director/Director of Psychometrics & Research of the NBEO, USA, and an internationally recognized expert in the assessment of practitioner competence in the health professions including optometry, and serves as a consultant to the Planning Committee at the invitation of WCO and ARBO. Anthony Di Stefano, O.D., M.P.H., FAAO, is the Executive Director of the WCO, and Vice President and Dean for Academic Affairs of the Pennsylvania College of Optometry, and acts as an expert staff resource for this committee. 7

8 APPENDIX B Resource Documents 1. European Diploma in Optometry; Candidate Guidelines, pp 1-5, 2002, Examination Structure, European Council of Optometry and Optics 2. Kiely P, Chakman J., Horton P. Optometric therapeutic competency standards 2000, Clin Exp Optom 2000; 83: 6: The critical competencies and underpinning skills and knowledge arising from the Core Curriculum for the Pre-registration Period (Ophthalmic Dispensing), 2003, General Optical Council 4. High, medium and standard competencies arising from the Core Curriculum for the Preregistration Period (Optometry), 2003, General Optical Council 5. Blueprint of the Canadian Standard Assessment in Optometry, Section 3 i-iv, 2003, Canadian Examiners in Optometry 6. Licensed Optometrist: Validation Report, pp 6-23; 2001, Office of Examination Resources, California Department of Consumer Affairs 4

9 APPENDIX C International Advisory Group on Optometric Competencies (December 2-3, 2003) R. Norman Bailey, O.D., M.B.A., M.P.H., FAAO, Houston, Texas Wolfgang Cagnolati, M.S., MCOptom, FAAO, Duisburg, Germany Robert Chappell, OBE, M.Phil., D.Sc. (Hon), FCOptom, London, United Kingdom Sherry L. Cooper, St. Louis, Missouri Susan Cooper, O.D., Bramalea, Ontario, Canada Roger S. Crelier, dipl. Augenoptiker, M.S.Optom., FAAO, Olten, Switzerland Donovan L. Crouch, O.D., Storm Lake, Iowa Kjell Inge Daee, M.Sc., Kongsberg, Norway Anthony Di Stefano, O.D., M.P.H. Elkins Park, Pennsylvania Rosie Gavzey, B.Sc., MCOptom, London, United Kingdom Feike Grit, B.Sc., D.Sc. (Hon), FCOptom, FAAO, Gouda, The Netherlands Leon J. Gross, Ph.D., Bethesda, Maryland Ian Hunter, OBE, B.Sc., FAAO, FRSA, FinstD, London, United Kingdom Russell W. Jones, O.D., Flagstaff, Arizona Patricia Kiely, B.Sc. (Optom.), Ph.D., Carlton, Victoria, Australia Gary W. Lasken, O.D., Peoria, Illinois Thomas Lawless, O.D., Dixon, Illinois Keith Masnick, B.Optom., M.Optom., M.B.A., FAAO, Woollahra, New South Wales, Australia J. Martin McDowell, O.D., FAAO, Stouffville, Ontario, Canada 38

10 Kovin Naidoo, O.D., M.P.H., Bayview Chatsworth, South Africa Robert W. Smalling, O.D., Warren, Arkansas Damien Smith, AM, M.Sc. (Optom), Ph.D., Camberwell, Victoria, Australia Ellen Svarverud, M.Sc., Kongsberg, Norway Alan Tomlinson, M.Sc., Ph.D., D.Sc., FCOptom, DCLP, DOrth, FAAO, Glasgow, United Kingdom Daniel Valverde, O.D., Guayaquil, Ecuador Norman Wallis, Ph.D., O.D., D.Sc. (Hon), FCOptom, FAAO, Bethesda, Maryland John Wild, B.Sc., M.Sc., Ph.D., MCOptom Cardiff, United Kingdom Tim Winslade, O.D., FAAO, Wolfville, Nova Scotia, Canada 38

11 APPENDIX D Glossary (Optometrists Association Australia) Competency is the ability to perform the activities within an occupation to the standard expected in employment. Competencies are the skills, attitudes and knowledge needed to be able to practise. 1 Entry-level competency standards for the profession of optometry in Australia describe what skills and knowledge a person needs, to be regarded as sufficiently qualified to be registered to practise optometry in Australia. 2 Competencies can also be written for other aspects of optometric practice e.g. use of therapeutics or specialist practice. In Australia the competencies were divided into the following groups: 3 Units - major components of the activities within a profession Elements - sub-divisions of units, the lowest logical, identifiable and discrete sub-groupings of actions and knowledge, which contribute to and build a unit Performance criteria - accompany elements, evaluative statements specifying the required level of performance ; can be used by an assessor to determine whether a person performs to the level required for the profession. Indicators - measurable and observable features for each performance criterion, can assist in determining whether a competency is achieved. An example of this breakdown into the component parts is: UNIT 3: PATIENT EXAMINATION Element 3.3 Assesses the ocular adnexae and the eye. Performance Criterion 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. Performance Criterion The structure and health of the anterior segment and its ability to function are assessed. Indicators Assessment of cornea, conjunctiva, anterior chamber, anterior chamber angle, sclera, iris, pupil. Screening for disease; vital stains, slit lamp biomicroscopy; keratometry; keratoscopy; gonioscopy; 37

12 pachometry; tonometry; photography, diagnostic pharmaceuticals, pharmacological evaluation of pupil abnormalities; ultrasound, corneal aesthesiometry, pupil reactions, tear break-up time, corneal topography, exophthalmometry. Performance Criterion The structure and health of the ocular media and their ability to function are assessed. Indicators Assessment of the lens and vitreous. Screening for disease; direct and indirect ophthalmoscopy, retinoscopy, photography, diagnostic pharmaceuticals, slit lamp; ultrasound. Performance Criterion The structure and health of the posterior segment and its ability to function are assessed. Indicators Assessment of the retina, choroid, vitreous, blood vessels, macula and fovea. Screening for disease; direct and indirect ophthalmoscopy, retinoscopy, photography, diagnostic pharmaceuticals, slit lamp; ultrasound, visual acuity tests, colour vision tests, visual field assessment, photostress test, pupil reactions. References 1. NOOSR Research Paper No 7. A Guide to Development of Competency Standards for Professions. AGPS, Canberra, Kiely PM, Chakman J. Competency standards for entry-level to the profession of optometry Clin Exp Optom 1993; 76: NTB National Competency Standards Policy and Guidelines, National Training Board, Canberra, Kiely P, Horton P, Chakman J. Competency standards for entry-level to the profession of optometry 1997 Clin Exp Optom 1998: 81:

13 APPENDIX E Assignment of Optometrists Association Australia Competencies to the WCO Categories of practice The four categories of practice are: 1. Management and dispensing of ophthalmic lenses, ophthalmic frames and other ophthalmic devices that correct defects of the visual system 2. Optical Technology Services, plus Investigation, examination, measurement, diagnosis and correction/management of defects of the visual system 3. Optical Technology Services, plus Visual Function Services, plus Investigation, examination and evaluation of the eye and adnexa, and associated systemic factors to detect, diagnose and manage disease 4. Optical Technology Services, plus Visual Function Services, plus Ocular Diagnostic Services, plus Use of pharmaceutical agents and other procedures to manage ocular conditions/disease In the table below, where there is an arrow from one category across the following categories it is believed that all components of the competency to the left of the arrow apply at all other categories. The prefixes OT, VF, ODx and OTx are applied ahead of the numbering system used in the Australian competencies to indicate that only certain components of that competency apply in that category. Thus where a competency occurs for all categories but there are prefixes, certain aspects of the competency apply to Optical Technology Services. These aspects together with further components of that competency apply to Visual Function Services. All of these components with additional ones then apply to Ocular Diagnostic Services. Finally all components of that competency would apply to Ocular Therapeutic Services. If a competency is not listed in a category and there is not an arrow, it is thought that this competency does not apply to that category. Competencies have been allocated based on the interpretation of indicators that are used in the Australian Competencies. An example of how different aspects of a competency can apply at different categories of optometric practice follows: 37

14 The performance criterion Information is clearly communicated to patients, patient carers, staff, colleagues and other professionals has the indicators: Itemised accounts, referral letters, reports, written and oral instructions and information; interpreters, opportunity for the patient to ask questions; patient records; information to allow patients to give informed consent regarding their management. The components: Itemised accounts, oral instructions and information, interpreters, opportunity for the patient to ask questions, patient records would apply to. These plus further aspects of them and the additional indicators: written instructions and information, referral letters, and reports would apply to. These plus further aspects of them and the additional components: information to allow patients to give informed consent regarding their management would apply to. However although all indicators have been assigned by, this category requires different aspects of the instructions and information to be given to patients, the form of the referral letter, the contents of patient records and the information needed for a patient to give informed consent. An example of how an indicator could have different requirements across the four categorys can be seen for the indicator patients records. At the category this would require that the record card have patient details so that it is clear to whom the record belongs. Other content would include the date of the patient record and the details of the prescription and its dispensing. In the category of the results of the tests performed to investigate the visual system would need to be included eg. refraction and acuity, together with any diagnoses and management options including the treatment plan. In the category of the requirements for patient records are similar, but with the addition of the information about the additional tests performed to assess the ocular adnexae and eye. In some cases it will be necessary to provide information about the type of test used and the time of day at which the test was performed. In the category of the details of any therapeutic agent prescribed need to be recorded. Where necessary this would be accompanied by information about the frequency with which the patient is to take the medication, the method of administration etc. Where pharmacological tests are ordered the record would need to include details of tests ordered and their results. 38

15 UNIT 1: PROFESSIONAL AND CLINICAL RESPONSIBILITIES Element 1.1: Ensures that optometric knowledge, clinical expertise and equipment remain current. OT Optometric knowledge and clinical skills can be maintained and developed. VF Optometric knowledge and clinical skills can be maintained and developed. ODx Optometric knowledge and clinical skills can be maintained and developed. OTx Optometric knowledge and clinical skills can be maintained and developed. OT Developments in clinical theory, optometric techniques and technology can be evaluated for clinical practice. VF Developments in clinical theory, optometric techniques and technology can be evaluated for clinical practice. ODx Developments in clinical theory, optometric techniques and technology can be evaluated for clinical practice. OTx Developments in clinical theory, optometric techniques and technology can be evaluated for clinical practice. OT New and existing procedures and techniques are applied and adapted to improve patient care. VF New and existing procedures and techniques are applied and adapted to improve patient care. ODx New and existing procedures and techniques are applied and adapted to improve patient care. OTx New and existing procedures and techniques are applied and adapted to improve patient care. OT Clinical experiences and discussions with professional colleagues are used to improve patient care. VF Clinical experiences and discussions with professional colleagues are used to improve patient care. ODx Clinical experiences and discussions with professional colleagues are used to improve patient care. OTx Clinical experiences and discussions with professional colleagues are used to improve patient care. 37

16 Element 1.2: Practises without the need for supervision OT Professional independence in optometric decisionmaking and conduct is maintained. VF Professional independence in optometric decision-making and conduct is maintained. ODx Professional independence in optometric decisionmaking and conduct is maintained. OTx Professional independence in optometric decisionmaking and conduct is maintained. OT Possible consequences of actions and advice are considered and responsibility for one's own actions is accepted. OT Advice is sought from other optometrists, health and other professionals when the optometrist deems a further opinion is required. VF Possible consequences of actions and advice are considered and responsibility for one's own actions is accepted. VF Advice is sought from other optometrists, health and other professionals when the optometrist deems a further opinion is required. ODx Possible consequences of actions and advice are considered and responsibility for one's own actions is accepted. ODx Advice is sought from other optometrists, health and other professionals when the optometrist deems a further opinion is required. OTx Possible consequences of actions and advice are considered and responsibility for one's own actions is accepted. OTx Advice is sought from other optometrists, health and other professionals when the optometrist deems a further opinion is required. Element 1.3: Acts in accordance with the standards of behaviour of the profession. OT Optometric services provided are necessary for the care of the patient or are initiated by the patient. VF Optometric services provided are necessary for the care of the patient or are initiated by the patient. ODx Optometric services provided are necessary for the care of the patient or are initiated by the patient. OTx Optometric services provided are necessary for the care of the patient or are initiated by the patient. OT Patient interests are held ahead of self-interest. VF Patient interests are held ahead of self-interest. ODx Patient interests are held ahead of self-interest. OTx Patient interests are held ahead of self-interest. 38

17 Element 1.3: Acts in accordance with the standards of behaviour of the profession (continued). OT Advantage (in a physical, emotional or other way) is not taken of the relationship with the patient. VF Advantage (in a physical, emotional or other way) is not taken of the relationship with the patient. ODx Advantage (in a physical, emotional or other way) is not taken of the relationship with the patient. OTx Advantage (in a physical, emotional or other way) is not taken of the relationship with the patient. Element 1.4: Provides advice and information to patients and others. OT Information is clearly communicated to patients, patient carers, staff, colleagues and other professionals. VF Information is clearly communicated to patients, patient carers, staff, colleagues and other professionals. ODx Information is clearly communicated to patients, patient carers, staff, colleagues and other professionals. OTx Information is clearly communicated to patients, patient carers, staff, colleagues and other professionals. OT Liaison with other professionals is maintained. VF Liaison with other professionals is maintained. ODx Liaison with other professionals is maintained. OTx Liaison with other professionals is maintained. ODx Significant or unusual clinical presentations can be recognised and findings communicated to other practitioners involved in the patient s care. OTx Significant or unusual clinical presentations can be recognised and findings communicated to other practitioners involved in the patient s care. 37

18 Element 1.5: Utilises resources from optometry and other organisations to enhance patient care. ODx The various functions of, and resources available from, optometric and other organisations are understood and utilised. OTx The various functions of, and resources available from, optometric and other organisations are understood and utilised. Element 1.6: Understands the principles of the planning, establishment, development and maintenance of an optometric practice OT Awareness of the roles of other practice staff is demonstrated. VF Awareness of the roles of other practice staff is demonstrated. ODx Awareness of the roles of other practice staff is demonstrated. OTx Awareness of the roles of other practice staff is demonstrated. OT Maintenance of equipment in a safe, accurate, working state is ensured. VF Maintenance of equipment in a safe, accurate, working state is ensured. ODx Maintenance of equipment in a safe, accurate, working state is ensured. OTx Maintenance of equipment in a safe, accurate, working state is ensured. OT Personal and general hygiene is maintained in the practice. VF Personal and general hygiene is maintained in the practice. ODx Personal and general hygiene is maintained in the practice. OTx Personal and general hygiene is maintained in the practice. OT Patient appointments are scheduled according to the time required for procedures. VF Patient appointments are scheduled according to the time required for procedures. ODx Patient appointments are scheduled according to the time required for procedures. OTx Patient appointments are scheduled according to the time required for procedures. OT Safe access by patients and staff is considered in the layout of a practice. VF Safe access by patients and staff is considered in the layout of a practice. ODx Safe access by patients and staff is considered in the layout of a practice. OTx Safe access by patients and staff is considered in the layout of a practice. 38

19 Element 1.7: Understands the legal obligations involved in optometric practice. OT Optometric fee structures are understood. VF Optometric fee structures are understood. ODx Optometric fee structures are understood. OTx Optometric fee structures are understood. OT Familiarity with relevant State and Federal Acts can be demonstrated. VF Familiarity with relevant State and Federal Acts can be demonstrated. ODx Familiarity with relevant State and Federal Acts can be demonstrated. OTx Familiarity with relevant State and Federal Acts can be demonstrated. OT Statutory and common law obligations relevant to practice are understood. VF Statutory and common law obligations relevant to practice are understood. ODx Statutory and common law obligations relevant to practice are understood. OTx Statutory and common law obligations relevant to practice are understood. Element 1.8: Provides for the care of patients with special needs. OT Patients who qualify for subsidised eye care schemes are advised of the services to which they are entitled and these services are made available. VF Patients who qualify for subsidised eye care schemes are advised of the services to which they are entitled and these services are made available. ODx Patients who qualify for subsidised eye care schemes are advised of the services to which they are entitled and these services are made available. OTx Patients who qualify for subsidised eye care schemes are advised of the services to which they are entitled and these services are made available. OT The ability to provide domiciliary optometric care is demonstrated. VF The ability to provide domiciliary optometric care is demonstrated. ODx The ability to provide domiciliary optometric care is demonstrated. OTx The ability to provide domiciliary optometric care is demonstrated. 37

20 Element 1.9: Ensures emergency optometric care is available. ODx Emergency facilities are organised for times when the optometrist is unavailable. ODx Emergency ocular treatment and CPR can be provided. OTx Emergency facilities are organised for times when the optometrist is unavailable. OTx Emergency ocular treatment and CPR can be provided. Element 1.10: Promotes issues of eye and vision care to the community. OT Information on matters of visual health and welfare (including the need for regular eye examinations), and product and treatment developments can be provided. VF Information on matters of visual health and welfare (including the need for regular eye examinations), and product and treatment developments can be provided. ODx Information on matters of visual health and welfare (including the need for regular eye examinations), and product and treatment developments can be provided. OTx Information on matters of visual health and welfare (including the need for regular eye examinations), and product and treatment developments can be provided. OT Advice is provided on eye protection in the home and in recreational pursuits. VF Advice is provided on eye protection in the home and in recreational pursuits. ODx Advice is provided on eye protection in the home and in recreational pursuits. Element 1.11: Understands factors affecting the community's need for optometric services. ODx The demography and epidemiology of the community and the patient population are understood. OTx The demography and epidemiology of the community and the patient population are understood. 38

21 UNIT 2: PATIENT HISTORY Element 2.1: Communicates with the patient. OT Modes and methods of communication are employed which take into account the physical, emotional, intellectual and cultural background of the patient. VF Modes and methods of communication are employed which take into account the physical, emotional, intellectual and cultural background of the patient. ODx Modes and methods of communication are employed which take into account the physical, emotional, intellectual and cultural background of the patient. OTx Modes and methods of communication are employed which take into account the physical, emotional, intellectual and cultural background of the patient. OT A structured, efficient, rational and comfortable exchange of information between the optometrist and the patient takes place. VF A structured, efficient, rational and comfortable exchange of information between the optometrist and the patient takes place. ODx A structured, efficient, rational and comfortable exchange of information between the optometrist and the patient takes place. OTx A structured, efficient, rational and comfortable exchange of information between the optometrist and the patient takes place. Element 2.2: Makes general observations of patient OT Physical and behavioural characteristics of the patient are noted and taken into account. VF Physical and behavioural characteristics of the patient are noted and taken into account. ODx Physical and behaviour-al characteristics of the patient are noted and taken into account. OTx Physical and behaviour-al characteristics of the patient are noted and taken into account. 37

22 Element 2.3: Obtains the case history. OT The reasons for the patient's visit are elicited in a structured way. VF The reasons for the patient's visit are elicited in a structured way. ODx The reasons for the patient's visit are elicited in a structured way. OTx The reasons for the patient's visit are elicited in a structured way. ODx Information required for diagnosis and management is elicited from the patient and/or others. OTx Information required for diagnosis and management is elicited from the patient and/or others. Element 2.4: Obtains and interprets patient information from other professionals. OT Pertinent information from previous assessments by other professionals is sought and interpreted (with the patient's permission). VF Pertinent information from previous assessments by other professionals is sought and interpreted (with the patient's permission). ODx Pertinent information from previous assessments by other professionals is sought and interpreted (with the patient's permission). OTx Pertinent information from previous assessments by other professionals is sought and interpreted (with the patient's permission). 38

23 UNIT 3: PATIENT EXAMINATION Element 3.1: Formulates an examination plan Element 3.2: Implements examination plan VF An examination plan based on the patient history is designed to obtain the information necessary for diagnosis and management. VF Tests and procedures appropriate to the patient's condition and abilities are selected. VF Tests and procedures which will efficiently provide the information required for diagnosis are performed. ODx An examination plan based on the patient history is designed to obtain the information necessary for diagnosis and management. ODx Tests and procedures appropriate to the patient's condition and abilities are selected. ODx Tests and procedures which will efficiently provide the information required for diagnosis are performed. ODx The examination plan and procedures are progressively modified on the basis of findings. OTx An examination plan based on the patient history is designed to obtain the information necessary for diagnosis and management. OTx Tests and procedures appropriate to the patient's condition and abilities are selected. OTx Tests and procedures which will efficiently provide the information required for diagnosis are performed. OTx The examination plan and procedures are progressively modified on the basis of findings. 37

24 Element 3.3: Assesses the ocular adnexae and the eye ODx The structure and health of the ocular adnexae and their ability to function are assessed. ODx The structure and health of the anterior segment and its ability to function are assessed. ODx The structure and health of the ocular media and their ability to function are assessed. ODx The structure and health of the posterior segment and its ability to function are assessed. ODx The nature of the disease state is determined. OTx The structure and health of the ocular adnexae and their ability to function are assessed. OTx The structure and health of the anterior segment and its ability to function are assessed. OTx The structure and health of the ocular media and their ability to function are assessed. OTx The structure and health of the posterior segment and its ability to function are assessed. OTx The nature of the disease state is determined. OTx Microbiological tests are selected and ordered. 38

25 Element 3.4: Assesses central and peripheral sensory visual function and the integrity of the visual pathways. VF Vision and visual acuity are measured. VF Visual fields are measured. Element 3.5: Assesses refractive status. VF Colour vision is assessed. ODxS Pupil function is assessed. VF The spherical, astigmatic and presbyopic corrections are measured. 37

26 Element 3.6: Assesses oculomotor and binocular function. VF Eye alignment and the state of fixation are assessed. VF The quality and range of the patient's eye movements are determined. VF The status of sensory fusion is determined. VF The adaptability of the vergence system is determined. VF Placement and adaptability of accommodation are assessed. ODx Eye alignment and the state of fixation are assessed. ODx The quality and range of the patient's eye movements are determined. ODx The status of sensory fusion is determined. ODx The adaptability of the vergence system is determined. ODx Placement and adaptability of accommodation are assessed. 38

27 Element 3.7: Assesses visual information processing VF Visual perceptual abilities are assessed. VF Visual-motor integration is assessed. ODx Visual perceptual abilities are assessed. ODx Visual-motor integration is assessed. Element 3.8: Assesses the significance of signs and symptoms found incidental to the ocular examination in relation to the patient's eye and/or general health. ODx Pertinent non-ocular signs and symptoms found incidentally during the ocular examination are identified and considered. OTx Pertinent non-ocular signs and symptoms found incidentally during the ocular examination are identified and considered. ODx Ensures that significant non-ocular signs and symptoms are investigated. OTx Ensures that significant non-ocular signs and symptoms are investigated. 37

28 UNIT 4: DIAGNOSIS Element 4.1: Interprets and analyses findings to establish a diagnosis or diagnoses. VF Accuracy and validity of test results and information from the case history and other sources are critically appraised. VF Test results and other information are analysed, interpreted and integrated to establish the diagnosis or diagnoses. ODx Accuracy and validity of test results and information from the case history and other sources are critically appraised. ODx Test results and other information are analysed, interpreted and integrated to establish the diagnosis or diagnoses. OTx Accuracy and validity of test results and information from the case history and other sources are critically appraised. OTx Test results and other information are analysed, interpreted and integrated to establish the diagnosis or diagnoses. 38

29 UNIT 5: PATIENT MANAGEMENT Element 5.1: Designs a management plan for each patient and implements the plan agreed to with the patient. VF The diagnosis is presented and explained to the patient. VF Consideration is given to the relative importance or urgency of the presenting problems and examination findings. VF Management options to address the patient s needs are explained. VF A course of management is chosen with the patient, following counselling and explanation of the likely course of the condition, case management and prognosis. ODx The diagnosis is presented and explained to the patient. ODx Consideration is given to the relative importance or urgency of the presenting problems and examination findings. ODx Management options to address the patient s needs are explained. ODx A course of management is chosen with the patient, following counselling and explanation of the likely course of the condition, case management and prognosis. OTx The diagnosis is presented and explained to the patient. OTx Consideration is given to the relative importance or urgency of the presenting problems and examination findings. OTx Management options to address the patient s needs are explained. OTx A course of management is chosen with the patient, following counselling and explanation of the likely course of the condition, case management and prognosis. 37

30 Element 5.1: Designs a management plan for each patient and implements the plan agreed to with the patient (continued). ODx The informed consent of the patient is obtained for the initiation and continuation of treatment. ODx Patients requiring ongoing care and review are recalled as their clinical condition indicates, and management is modified as indicated. OTx The informed consent of the patient is obtained for the initiation and continuation of treatment. OTx Patients requiring ongoing care and review are recalled as their clinical condition indicates, and management is modified as indicated. Element 5.2: Prescribes spectacles VF The suitability of spectacles as a form of correction for the patient is assessed. VF The patient's refraction, visual requirements and other findings are applied to determine the spectacle prescription. ODx The patient's refraction, visual requirements and other findings are applied to determine the spectacle prescription. 38

31 Element 5.3: Prescribes contact lenses VF The suitability of contact lenses as a form of correction for the patient is assessed. ODx The suitability of contact lenses as a form of correction for the patient is assessed. VF The patient's refraction, visual requirements and other findings are applied to determine the contact lens prescription. VF Therapeutic and cosmetic contact lenses are recommended and prescribed. OTx Therapeutic and cosmetic contact lenses are recommended and prescribed. OT Contact lenses are correctly ordered and on receipt, parameters are verified before the lenses are supplied to the patient. VF Contact lenses are checked on the eye for physical fitting and visual performance. 37