The quality of optometry clinical placements in Australia – alongside opportunities to perform simulation-based learning and equipping students for the future of remote optometry consultations – is in the spotlight as part of an Ahpra review.
A special committee is seeking industry feedback on its draft guidance on embedding good practice in clinical placements, simulation-based learning and virtual care in “initial student health practitioner education” across various health professions, including optometry.
“These activities enable students to develop the capabilities they need for contemporary practice, and to safely and competently deliver patient-centred care,” committee chair Professor Andrew Wilson said.
Students studying optometry have various clinical placement opportunities, depending on the university they are studying at, which intensify in duration and patient involvement as they near final-year graduation. The review’s focus on virtual care exposure comes at a vital juncture, as optometry networks begin rolling out remote optometry services to regional patients with limited access to primary eyecare. OPSM and Specsavers are among those piloting this model, supported by high tech equipment.
According to Ahpra’s Accreditation Committee, evidence on the value of clinical placements for student learning is mixed, with a lack of studies reporting objective, quantifiable learning outcomes. However, studies have found students can develop their clinical as well as non-clinical skills on placements. The data also demonstrates several factors influence student learning outcomes from placements, including learning activities that prepare students for practise in the real-world and experiences requiring students to actively participate. Placements in diverse settings, adopting a model that suits the work context, and longer, more continuous placements may also enhance the learning experience.
Universities contacted by Insight revealed an appetite for virtual care experiences and even virtual reality simulation to build confidence. They also highlighted some issues with the current framework, including out-of-pocket expense of attending placements.
As part of its 3.5-year optometry course, Deakin University, based in Victoria, runs mock telehealth consults for history taking, examination and planning/management discussions in practical classes with actor patients.
“These run across second- and third-year classes throughout each year, starting with history taking in year two and building up to the actor patient classes in year three,” Deakin’s head of optometric clinical placements Associate Professor Heather Connor said.
Held over 10 consecutive trimesters, Deakin’s optometry program is described as Australia’s only accelerated Bachelor of Vision Science/Master of Optometry course. Placements vary from half a day or full day for optometry and ophthalmology, to four days a week in practice during the clinical residential placement. Students also attend the Australian College of Optometry for one week twice a trimester.
“There is definitely a place for virtual simulation in training optometry students as it offers us ways to prepare our students to make the most of the clinical placements.”
Simulation-based learning is also incorporated into the program. A/Prof Connor said these were held in the pre-clinical phase and allowed students to learn in a low stakes environment without inconveniencing real patients.
These simulations include working with 3D printed models, augmented reality applications, structured communication and clinical reasoning tasks, and virtual international grand rounds with optometry students from India and Malawi, and with UK and Swedish students soon.
“Each course in Australia runs their own placements with individual frameworks. At Deakin, we have a structured progression to placement, starting with observations and gradually scaffolding increasing amounts of clinical work until students begin their final residential placement which is modelled on the longitudinal integrated clerkships that many successful medical programs employ,” she said.
“There are pros and cons of all models, but research we have undertaken supports the longer-term placement structure as it allows students to really integrate into the practice and to work collaboratively with the optometrists and other practice staff.”
A/Prof Connor added: “There is definitely a place for virtual simulation in training optometry students as it offers us ways to prepare our students to make the most of the clinical placements which are so vital for their development as optometry professionals. We review this process continually and are always looking for feedback and ways to improve the experience for students and clinical partners.”
Addressing ‘placement poverty’
Professor Lisa Keay, head of the UNSW School of Optometry and Vision Science, said clinical placements were designed to reflect the full range of modes of practice, so could include remote optometry consultations in future.
Currently, UNSW graduates spend the equivalent of one year in face-to-face clinical training by the end of their Masters in Clinical Optometry, in a range of practice settings and locations. This includes its internal UNSW Optometry Clinic providing more than 5000 student-led consultations annually, alongside experiences at the Centre for Eye Health, Australian College of Optometry, Guide Dogs Low Vision Clinic, rural and metropolitan optometry practices, and opportunities for international placement and working in Aboriginal and Torres Strait Islander communities. Students also observe ophthalmologists across multiple placement settings, and the university supports students to experience hospital optometry placements at Prince of Wales and Royal Hobart Hospitals.
When considering the clinical placement framework in optometry, Prof Keay said one challenge is balancing the best placement opportunities against out-of-pocket costs to students. She said the recent Universities Accord highlighted some students have significant financial hardship while meeting requirements for work-integrated learning using the phrase “placement poverty”.
“The government has not yet responded to the many recommendations from the Accord, including recommendation of financial support for placements,” she said.
“We are working with our student cohort to understand financial hardship and respond with a range of supportive measures including a small number of grants for equipment purchase and placement bursaries. We acknowledge the generous annual donation from Young Optometrists since 2022 to support equipment purchase for students in need. We also see tremendous goodwill from our placement hosts and industry partners who enable and support clinical training for our students.”
She said placements provided critical skills in developing work-ready graduates from improving clinical skills, understanding organisational/work requirements and dealing with communication, as well as understanding the social context surrounding healthcare practice.
“Our training enables development of competencies from pre-clinical laboratories, simulated learning before independent practice in a supportive environment,” she said.
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