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A Global Competency-Based Model of Scope of Practice in Optometry. Anthony F. Di Stefano, O.D., M.Ed., M.P.H. Committee. Dr. Norman Wallis, Chair Dr. Robert Chappell Dr. Patricia Kiely Dr. Thomas Lawless Dr. Leon Gross (Consultant) Dr. Anthony Di Stefano (WCO). Introduction. WTO and GATS

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a global competency based model of scope of practice in optometry

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

Anthony F. Di Stefano, O.D., M.Ed., M.P.H.

committee
Committee
  • Dr. Norman Wallis, Chair
  • Dr. Robert Chappell
  • Dr. Patricia Kiely
  • Dr. Thomas Lawless
  • Dr. Leon Gross (Consultant)
  • Dr. Anthony Di Stefano (WCO)
introduction
Introduction
  • WTO and GATS
  • MRAs
  • Optometric initiative
  • ARBO and WCO collaboration
  • WCO and ARBO committee
  • International Advisory Group on Optometric Competencies (IAGOC) (December 2003)
wco concept of optometry statement
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

background prior work
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
ecoo s european diploma structure
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
10 years later
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
categories of service
Categories of Service
  • Optical Technology Services
  • Visual Function Services
  • Ocular Diagnostic Services
  • Ocular Therapeutic Services
optical technology services
Optical Technology Services
  • Management and dispensing of ophthalmic lenses, ophthalmic frames and other ophthalmic devices that correct defects of the visual system
visual function services
Visual Function Services
  • Optical Technology Services

and/plus

  • Investigation, examination, measurement, diagnosis and correction/management of defects of the visual system
ocular diagnostic services
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
ocular therapeutic services
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
competency statements
Competency Statements
  • Work in Australia, Canada, UK, California
  • IAGOC recommended Australian competency statements and system
  • Allocate across 4 stages
optometrists association australia
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
the system
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)
the units
The Units

1 – Professional and clinical responsibilities

  • 2 – Patient history
  • 3 – Patient examination
  • 4 – Diagnosis
  • 5 – Patient management
  • 6 – Recording of clinical data
unit 1 professional and clinical responsibilities
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.
unit 2 patient history
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.
unit 3 patient evaluation
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.
unit 4 diagnosis
Unit 4 – Diagnosis

Elements

  • Interprets and analyses findings to establish a diagnosis or diagnoses.
unit 5 patient management
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.
unit 6 recording of clinical data
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.
allocation to categories
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
the system24
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)
example allocation of system
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.