surviving the pre-reg period · osces –hints and tips question!! competency patching discussion...
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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?
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