Theme: Skill practice and assessment for AOP trainees
Author: Ramya, Aravind eye Hospital, Chennai
The Aurosiksha offers a uniform platform of skill assessment pertaining to each department under which AOPs are segregated. The assessment is conducted online on a regular basis throughout the initial 2 years of intensive AOP training followed by annual reassessment of each skill throughout the AOPs tenure as an employee at the organization. 28 basic skills Like Hand hygiene, bandage tying and untying, measuring blood pressure etc., 13 advanced skills like preoperative instruction, examination for post-operative complication & postoperative counselling for specialty surgery case. For ward, AOPs are detailed step-wise in modules provided for assessors. The modules help them to mark the asesses in a reproducible and efficient manner. The online assessment is conducted using a tablet device that provides a mobile, easy-to-use, fluid interface through which immediate feedback can be provided to the trainee highlighting the exact problem areas for each AOP.
Author: N. Krishnammal, Aravind Eye Hospital, Tirunelveli
To make Out patient AOP skillful in irrigation of the eye and to help the emergency management of chemical injury patient.
The following ways of teaching skills in irrigation for out patient AOPs are tested.
- Imparting theoretical knowledge in irrigation among sisters through classes.
- Animation video : Providing sisters wih animation or simulation irrigation video to get an idea about the procedure.
- Demo video : Making the sisters aware of the steps of irrigation procedure through pre recorded live videos.
- Role play : Involving sisters in role play which help them learn patient positioning proper syringe handling and anesthetic instillation. We conducted mock- drills to make understanding the steps of the irrigation procedure easy.
- Monitoring by a senior sister : Giving the sisters opportunity to do the irrigation procedure under the guidance of senior sister.
- Evaluation of the skills for irrigation procedure among sisters through a knowledge test.
- Selection of competent skilled AOPs through a Rubric’s Score sheet.
We conclude that by providing proper training in irrigation to out patient AOPs , patient comfort can be increase and patient examination and treatment can be made faster .
Author: Shanmuga Sundari S, Aravind Eye Hospital, Tirunelveli
Vision centres make eye care more accessible to rural people, and can play a role in addressing diseases causing treatable blindness like cataract, refractive errors and diabetic retinopathy. Providing primary eye care through Vision Centres is an effective model for reaching the underserved population. Vision centres manned with well-trained vision technicians are capable of performing refraction and Slit lamp examination. Allied Ophthalmic posted in vision centre should be well trained for refraction ad Slit lamp examination. It is done through following ways.
- Theoretical knowledge about parts of slit lamp and anterior segment evaluation will be taught by ophthalmologist.
- Practical training will be conducted.
- Observation on Slip lamp examination by doctor’s for 15 days.
- Hand on training- AOP’s will be allowed to perform slit lamp examination and the findings will be cross verified by the doctors.
- Skill scoring will be done after training.
- Continuous medical education (CME for Vision centre staff)for keeping them updated on the skill.
- Skill assessment yearly once and performance appraisal will be done.
Author: Dr. Aswin PR, Aravind eye care system
Vision centers were envisaged in the “Vision 2020- the right to sight”. They are manned by Allied Ophthalmic Personnel (AOP) and connected via information technology to the base hospital to provide low-cost primary eye care services to rural communities. The vision center is manned by 2 AOPs, a “Technician” and a “Coordinator”, with well differentiated roles for each.
To evaluate the standard of existing AOP at the vision centers by Objective Structured Clinical Examination (OSCE) and provide targeted training for the staff.
A CME was conducted at Aravind Eye Hospital, Madurai for 66 vision centers across Aravind Eye Care System. Technicians and coordinators were separately evaluated with clinical scenarios, spotters, patient examinations and viva voce on a range of topics as per their role requirement by means of an OSCE with 19 stations and scored out of a total of 150 marks by ophthalmologists.
Technicians had a mean 3.68±3.44 years of experience compared to 4.55±3.51 years among the coordinators. Technicians scored a mean of 108.18±14.42 marks (Range 81-148) while coordinators scored a mean of 122.41±12.19 (Range 100 -140). All candidates scored over 50% while 15.15% of technicians and 56.06% of coordinators scored over 80%. Significant correlation was found between years of experience and marks scored among both technicians (P = 0.0002) and coordinators (P = 0.0125). AOPs who scored less were given targeted training and a reassessment the next day.
Conventional examinations alone may not be sufficient for comprehensive evaluation of AOPs. OSCE provides a good platform for a comprehensive assessment and targeted training. While this requires meticulous planning and team work among the organizers, this model can be useful, improved and duplicated for training and quality assessment of AOPs.
Author: G. Jeyakohila, Aravind eye care system
To compare the computer assisted skill module with the previous manual assessment skills modules for AOP trainee.
We have a total of 20 skill sets assessments in our outpatient department, divided into 2 sets of skills out of which 10 skill sets for 1st year and 10 skill sets for 2nd year AOP trainees
The study explains Stepwise proper assessment of each skill and proper reassessment of a single step which has been missed in the initial assessment. The skill also helps to learn additional knowledge assessment related to that particular skill.
The use of digital assessment will make students and examiner to keep a clear track of skill assessment of each student irrespective of the places/hospitals. The current study shows pre and post assessment of activities and providing knowledge regarding the skills performed. Better skill comes from continuous practice in our daily work, so this digital assessment is been a highly acceptable method for evaluation to improve skills and to compare among the students.
Author: Moniga, Aravind Eye Hospital, Chennai
Patient counselling is a specialized non – clinical activity that involves giving information, explanation, and guidance. Counselling in AECS plays a catalytic role of influencing the people to undergo medical or surgical treatment for their eye problems, thus their service has a direct impact on the quality of eye care service. Effective communication skills of counsellors play a crucial role in increasing awareness in the community, improving quality of eye care service, increasing patient volume, regular follow up and increasing patient satisfaction rate. Communication skills include verbal, non-verbal and written communication. It’s not just what someone says (word choice or the content), but also how it’s said (behavior, tone, eye contact and body language.) In addition to using conventional methods such as presentation on communication skills and a typical class room session, training on communication skills is developed by video recording their practical demo of counselling. The academic senior counsellor facilitates interaction and discussion on each of the videos and gives feedback for improvement. The recording also gives opportunity for the trainee counselor to self-assess their communication skills. This makes trainees understand communication skill in a more practical way. By seeing their own video trainees understand what mistakes (verbal or nonverbal) they do during counseling. After one month video recording is done again followed with discussions on the improvement. This helps counsellors to develop their communication skills and improve on quality of eye care delivery and patient satisfaction.
Author: Kumar Yelagondula, L V Prasad Eye Institute
To report optometry student’s experiences on Objective Structured Clinical Examination (OSCE) using a survey questionnaire.
Optometry internship students appeared for OSCE based exit competency examination after completing their four-weeks of pre-clinical training. A total of 9 OSCE stations were used for the skill based exit examination. Of these, 6 were interactive OSCE stations. Fellow students from other allied ophthalmic training program were used as standardized patients in OSCE interactive stations. The stations represented the optometry comprehensive eye examination techniques. Competency based assessment (CBA) rubrics were used to evaluate the student performance in the OSCE stations. After completing their examination, a validated questionnaire was administered to seek their feedback on OSCE pattern of examination through online survey.
A total of 42 students responded to the online survey (response rate of 87.5%). Eighty-four percentage of the students agreed or strongly agreed that these OSCE stations were well organized. The information provided before the OSCE examination was sufficient and appropriate was reported by 96% of the students. OSCE stations were representative of what I would practice in the clinic was reported by 82%. Seventy six percentage reported that the standardized patients resembled as real cases that they see in optometry practice. Thirty seven percentage reported that the instructions were not clear in the non-interactive OSCE stations.
The pilot study results suggests that OSCE pattern can be used as an exit competency based assessment for optometry students.
Author: Ramalakshmi R M, Aravind eye hospital ,Tirunelveli
To make Out Patient Allied Ophthalmic Personnels skillful in Lacrimal syringing and to help reducing waiting time in the out patient department
To make the AOPs efficient in Syringing procedure which leads to
- Reduce the patient waiting time in OPDs
- Ensures safety for the patient
The following ways of teaching for lacrimal syringing test
- Imparting theoretical knowledge in lacrimal apparatus among sisters through classes.
- Demo video : Making the AOPs learn the steps of procedure through the videos.
- Role play : Involving AOPs in role play which help them learn the procedure step by step.
- Observation with senior AOP : Giving the AOPs opportunity to learn from the senior AOP during the procedure.
- Evaluation of the skills for lacrimal syringing among AOPs through a feedback questionnaire from the mentor of the procedure.
- Selection of competent skilled AOPs through a Rubric’s Score sheet.
Among the proposed methods , showing demo videos and observation with senior sisters during lacrimal syringing are found to be effective in attaining the needed skills in the opd & camp place
We conclude that by providing proper training to the OP AOPs the waiting time of patients drastically reduced. Acquirement of proper skills via the above methods led to better efficiency among sisters and ensured safety for the patients.
Author: Bongajum Abel Keelen, Magrabi ICO Cameroon
Skill Practice and assessment for Allied Ophthalmic Personnel trainees in Magrabi ICO Cameroon Eye Institute (MICEI).
To ensure that our learners are competent in their skills and practice, we proceed as follows:
- Theoretical lectures
- Practicals sessions
Which are divided into several phases;
Theory: Here lectures are dispensed to trainees.
Trainees are evaluated on their understanding of the theoretical concepts of the training
Observation I: Trainees observe the trainer perform on some cases either on a model or volunteers, watch videos, and simulations, they then explain their understanding.
Trial I: Trainees do several cases at the lab under the supervision of the trainer on models, then themselves and later on volunteers.
Practical competences and evaluation
The trainees spend a little time at the clinic to observe while the seniors perform the tasks on some few cases
Trial II: Trainees do trials on patients under the supervision of the seniors and the trainer.
The frequency of exposure to practice will depend on the skill level.
Each trainee keeps a record of the case sheets he/she sees for evaluation.
Trainees gradually perform with little supervision.
Skill Assessment level
Faults are created and trainees are asked to troubleshoot and solve the problems both at the level of the lab and at the clinic as well.
Also cases are seen by the trainer and the trainees are in turn asked to see the same cases to give their impressions for comparison.
Trainees are able to perform the skill with no supervision. Now the trainees are fit and qualified to function out of the set-up or training institution. The final evaluation is done and the trainees are then awarded their certification.
Author: S Alana Teja, Sankar foundation eye hospital
Developing a cadre of AOP poses a particular challenge for ophthalmic personnel competency based assessment are gaining acceptancy as they make students to demonstrate and master over a subject and earn competency without adhering to a rigid course schedule we should ensure that AOP has the potential for assuring Quality and extent of learning Shortening of course duration Revisiting and revising the curriculum of paramedics to align with existing standards 4 identify the core competency of AOP and summarizing those core capabilities that are important across over all success of the hospital Patient care, medical knowledge, professionalism, interpersonal and communication skills, technical and scientific skills, community and health services .
Mapping the area of assessment into the various levels of performance such as Novice – needs assistance to measure visual acuity appropriately and has limited knowledge, Needs assistance in documenting of the findings
BEGINNER – measure visual acuities with Snellen chart ,measure monocular/binocular visual acuity for distance and near, PG vision, pinhole vision and documenting the findings
ADVANCED BEGINNERS Able to perform all the primary visual assessment with all relevant methods and typical cases like nystagmus etc and documenting the findings
COMPETENT-accurate measurement od visual acuities with respect to age with correct usage of appropriate charts, measure monocualr /binocular vision for distance and near, pinhole vision and PG vision
Effective assessment is the driving force behind the conversion of the traditional system of teaching to a competency based education programme to have better results the lessons were altered from lectures to supportive /remedial sessions that reach out to the student. The trainers were selected carefully and were trained to use the outlined competencies the students were counselled for effective role and acquiring knowledge in stipulated time.
Thus a proper planning helps in providing progression of growth and encouraged self -directed remediations …..
Author: Jinat Ferdousi, Deep Eye Care Foundation
As a developing country with a population of 164.7 million, Bangladesh has a large number of visually impaired people around 6 million. With a lot of barriers for getting a proper eye health care service around 1.53% who are aged about 30 years, are blind and 21.6% have low vision. The number of competent eye health care worker is not enough to cover this eye health care need. The aim of this study was to recognize competency of AOP based on skill development and assessment of in a tertiary level hospital in North Bengal.
An observational study for a period of three month was done on 30 AOP trainees. Assessment questions, interviews’, Surveys, and patient satisfaction questionnaire has been prepared to collect information from the study area for building up a strategy for curriculum and service development of the AOP trainees in the hospital.
Out of 30 AOP trainees 33.33% have an excellent academic performance with 90% patient satisfaction rate, which was collected by patient questionnaire. 50% have an average result and 16.67% are still on development stage. Assessment was done by written, Viva and practical examination according to rubric. Scoring system has been done calculating the average of assessments.
Poor: <50%, Satisfactory: 50-59%, Good: 60-79%, Excellent: ≥80%.
Due to continuous monitoring and evaluation of the skill development of AOP trainees by Assessment, An improvement in the academic result, practical skill, hospital service and patient satisfaction is seen improving. This has a positive impact on the eye health care service in the tertiary level hospital where the study was conducted.
Author: Renuga, Aravind Eye Hospital, Chennai
Quality in clinical service delivery plays an integral part in the ultimate goal of eliminating needless blindness. A high volume setting, coupled with a mission to train ophthalmic personnel makes AECS a model training facility to impart high quality and contemporary training skills. In February 2021, iLEARN training hub was established at Aravind Eye Hospital, Chennai in order to standardize and strengthen the training facilities for Mid-level ophthalmic personnel(MLOPs) and optometrists focusing on clinical skills and knowledge.
The iLEARN training hub focusses on creating an environment of learning. In order to enhance knowledge, all clinical and non-clinical departments have training materials including protocols, manuals, videos and posters in the training hub. The posters are made to highlight specific aspects of clinical care delivery, for example how to perform non-contact tonometry. The training hub also provides training for MLOPs in various skills such as vision testing, refraction, visual field testing, keratometry, autorefractometry, tonometry, slit lamp examination, EMR training, recording ECG and steps of CPR on mannequin. Learning these skills before participating in actual patient care will flatten the learning curve and improve quality of care. The teaching and training is done by the respective trainers in each department. The MLOPs are trained to work in the Outpatient department, Operation Theatre, Ward, Counseling, Refraction and in the specialty clinics. The skills are then assessed using on online platform on Aurosiksha.
The training hub provides a platform to learn new skills and refresh their knowledge. It also facilitates better interaction between the MLOP trainees and faculty during and after the training. MLOPs will receive individual attention; thereby learning is more effective .The trainees will have more confidence in examination of patients when they are posted in the respective departments.
Author: Muthusundari K, Aravind Eye Hospital, Tirunelveli
To make optometrist Allied Ophthalmic Personnels (AOP) skillful in practice of retinoscopy.
The following ways of teaching skills in retinoscopy for optometrist AOPs are tested.
- Conveying theoretical knowledge through classes.
- Skill practice on model eyeball and observing red reflex to learn retinoscopy.
- Demonstration video is also useful to teach with and against movement of the red reflex and how to neutralise the reflex and calculate the refractive error.
- Skills of AOPs are evaluated through the Rubrics Score sheet.
- AOPs perform retinoscopy under supervision of one senior AOP.
- A skill knowledge test is conducted among AOPs and accordingly a score is given.
- Viva is conducted on retinoscopy optics & methods.
- Evaluation of the skills for retinoscopy through a feedback questionnaire from senior AOP.
Among the proposed methods, skill practice and retinoscopy evaluation under supervision of senior AOP are found to be effective in attaining the needed skills.
Retinoscopy reduces refraction time and error by quickly determining the appropriate correcting lens, minimising the decisions the patient must make to refine the correction. Retinoscopy proves invaluable when patient cannot cooperate like infants, mentally retarded persons.
Author: Stella Baby A, Aravind Eye Hospital, Tirunelveli
Aim of the study:
Aim of this study is to improve the accuracy of measuring intraocular pressure using I care tonometer
Background of the study:
Clinical practice is an essential part of Allied ophthalmic personal training which links theory with practice particularly in Skill training. This study aimed to improve the accuracy of measuring intraocular pressure with I-care using Traditional Demonstration and Video-assisted training for Allied ophthalmic personal in glaucoma clinic
Skill training was given using following methods.
1. Theoretical knowledge was imparted through classes using power point presentations.
2. Video assisted I care training will be given. Video used for training has the following instruction –Parts of I care, loading i-care tip, Protocol for measuring IOP and cleaning it after use.
3. Allied ophthalmic personal will be then sent for observational posting for 1 week. Traditional demonstration will be done by well-trained senior allied ophthalmic personal for the trainees.
4. AOP will then be asked to measure IOP for 20 patients per day and will be cross verified by the glaucoma specialist the same day for the patients. Deviations in IOP readings will be informed to the trainees.
5. Evaluation will be done at the end of 1 week using Rubrics scoring method
6. After evaluation to improve accuracy if further training is required it will be given.
Combined traditional demonstration and video assisted training is found to be more effective in improving the accuracy of intra ocular pressure measurements using i-care.
Though combined traditional demonstration and video assisted training play a vital role in imparting knowledge to Allied ophthalmic personal, hands on training of skill is required for improving accuracy in IOP measurements using i-care. Also counter verification of the measurement and evaluation should be done to assess the skill level of the trainees.
Author: KK Mariammal, Aravind Eye Hospital, Tirunelveli
To make theatre AOP skillful in assisting the squint surgeries and to help the surgeon reduce the intra – operative time
The following ways of teaching skills in squint for theatre AOPs are tested.
1. Imparting theoretical knowledge in squint among sisters through classes .
2. Animation video : Providing sisters with animation or simulation squint video to get an idea about the surgical procedure.
3. Demo video : Making the sisters aware of the steps of squint surgeries through Pre recorded surgery videos.
4. Role play : Involving sisters in role play which help them learn instrumentation. We conducted mock- drills to make understanding the steps of squint surgery easy.
5 . Assisting a senior sister : Giving the sisters opportunity to learn from the senior staff during squint surgeries and to get them involved in the surgical procedures.
6 . Evaluation of the skills for squint surgeries among sisters through a feedback questionnaire from doctors .
7. Selection of competent skilled AOPs through a Rubric’s Score sheet.
Among the proposed methods , showing demo videos and assisting senior sisters during squint surgeries are found to be effective in attaining the needed skills in theatre AOPs.
We conclude that by providing proper training to the theatre AOPs , better assisting skills can be developed among sisters which help surgeons perform better and reduce the Intra Operative duration and to do skillful surgery
Author: Jasmin modi, Hari Jyot College of Optometry
The prospective study includes a total of 41 students from the third year & internship during September 2020 to June 2021 at rotary eye institute, Navsari. In this study three parameters of PAL measurement were considering -On eye measurement (Vertex distance, Facial wrap, IPD Pantoscopic tilt), Ordering(A size, B size, DBL, Fitting height, effective diameter, Minimum blank size) &Verification(Identification of lens power, find out micro itching, Lens quality, Fitting height & vertex distance). Rubrics show that each parameter contains 5 marks. Total score including (on eye measurement , Ordering , Verification ) is 75. In the Pre-assessment, Students have to take PAL measurements & Rubrics were not disclosed to students. After 1 week of practical session students had to perform PAL measurements in Post assessment. PAL measurement total score was given by the optometrist with the help of rubrics.
Out of 41 students 27 (66%) were female & 14(34%) were male .The mean age was 21 with an age range of 20 to 23 years. In Post assessment mean value of On eye measurement, ordering, verification (18.34 ± 2.36), (25.61 ± 5.21), (12.71 ± 6.64) was significantly improves compares to pre-assessment (7.39 ± 3.64), (21.12 ± 5.18), (2.46 ± 2.36) after practical session. Therefore, the Final score (On eye measurement, Ordering, Verification) also significantly improves between pre (30.34 ± 7.78) post-assessment (58.76± 10.83)
Use of rubrics will make students and examiners perform better & reach competency. The current study shows improvement in PAL measurement Pre and post-assessment due to continuous monitoring of activities and providing knowledge. Skill comes from continuous practice. Nowadays, Rubrics is a highly acceptable method to evaluate skills & to improve them to competency among students. in dispensing optics, skill & accuracy is the only key for dispensing successful PAL wearer
Author: Samir Sutar, C L Gupta Eye Institute
To study the utility of a smartphone-based virtual reality system using anaglyph videos in adults with anisometropic amblyopia.
Patients >/= 18 years of age diagnosed with anisometropic amblyopia, complaint with use of glasses or contact lenses, and with no prior history of amblyopia therapy (patching, penalization, etc.) were included in this non-randomized prospective interventional study. After a comprehensive ocular examination, all the patients were subjected to 4 hours of therapy every day. The therapy was home-based and involved viewing the anaglyph videos in a smartphone (placed within a VR box) through red-blue filters. Visual acuity, stereopsis, contrast sensitivity, and near point of accommodation were recorded at presentation, 3 months, and 6 months after undergoing therapy.
A total of 12 patients were included. The mean age was 20.33 ± 1.96 years (18-23). 8 had hyperopia (mean = +6.12 D ± 1.06, range: +5.00D to + 8.00D). 4 had myopia (mean: -6.62 D ± 2.49, range: -10.00D to -4.5D). The mean BCVA improved from 1.22 LogMAR to 0.9 and 0.8 LogMAR at 3 and 6 months respectively. Stereopsis, contrast sensitivity, near point of accommodation improved from 600 seconds of arc, 0.61 log units, and 20.33 cm to 263.33, 1.12, and 16.33 respectively at 6 months. The changes in all the parameters were statistically significant (P<0.05).
The SPA-VVRT (Smart Phone Anaglyph Video Virtual Reality Therapy) was found to be effective in adults with anisometropic amblyopia and showed significant improvement in visual acuity, stereopsis, contrast sensitivity, and accommodation