Leslie Weingeist France, C.O. [firstname.lastname@example.org]
Most ophthalmologists and clinics now recognize that working with well trained ophthalmic staff improves practice efficiency and patient care and allows the ophthalmologist more time to concentrate efforts where most needed and most appreciated by the patient. The problem is in trying to find well trained personnel. This sometimes lengthy process can be very frustrating and can leave one without experienced help or with having to train staff in clinical examination and testing skills in a piecemeal fashion while simultaneously attending to patient care.
It is time to approach the idea of standardized basic training for ophthalmic assistants in Latin America. The time has come….
Let us agree to set a plan in motion to train ophthalmic personnel with a standardized basic training that can be built upon and modified to meet the needs of individual practices. This whole concept has been a struggle and concern for many of us for too many years.
As a disclaimer, let us quickly acknowledge that there are definitely some very well recognized training programs in Brazil and Chile, to name only two examples at the University level. There are also “in-house training courses” within large clinical practices in a number of countries as well as annual update programs in Mexico, Ecuador and Guatamala to name a few examples. There are, however, too many areas that have no basic or clinical education for those who assist ophthalmologists in their daily practices
Some of the past efforts and hurdles to overcome
On multiple occasions in the past we met with many representatives from Latin American ophthalmology and discussed and argued the “role of the assistant”. We made lists of tasks, lists of skills and lists of “to dos and not to dos”. We discussed what the role of the assistant should be as if it had to be only one idea or as if some “standard” would be foisted upon individual practitioners. That was never the intention then nor is it now.
A few years ago in an effort to address the needs of clinical ophthalmologists we surveyed PAAO member ophthalmologists and personnel already working in some capacity with ophthalmologists to learn what they were doing and what additional skills or knowledge we could teach at the annual or regional meetings.
Small attempts of one and two day courses were offered at Pan American Meetings as well as at national congresses and subspecialty meetings to introduce and highlight ways to work with well trained personnel. Additionally, we organized educational sessions and workshops on topics of relevance to technicians as a means of continuing education.
These efforts were successful, each course was well attended, each served a need, but, each stood alone. What a terrible duplication of effort…. What an enormous expense of time for each organizer, what a small number of people each effort reached and in the end none served the bigger goal of basic education on a wide scale basis.
Developing a new educational model…. the time has come. A pilot program is being developed, one which will offer a basic core curriculum and understanding of clinical topics in ophthalmology with an opportunity to select optional educational modules in special testing techniques and sub-specialty areas of ophthalmology.
The plan is to have all students exposed to the same basic didactic and clinical education. The emphasis will be on clinical applications and basic examination techniques with increasing details as experience and background education is mastered. Clinical exposure to ophthalmic instruments and routine testing techniques will be incorporated into the program. The elective modules will be added as needs arise and technology changes. Examples of elective modules might include community eye health and vision screening, visual field testing, ocular motility, ophthalmic photography, A-scan biometry, OCT testing, and advanced refraction.
Included in the introduction to ophthalmology will be an emphasis on the role, duties and responsibilities of the “ayudante profesional en oftalmologia” [APO]. It goes without saying that the role will be different in each clinical situation and change with increasing clinical expertise. Each student would be asked to sign a Code of Ethics and adhere to a Scope of Practice document insisting that he/she work only with and under the supervision of an ophthalmologist or in an ophthalmic clinical group practice or hospital setting.
We are currently looking at a University recognized program with “satellite” programs and a network of clinical centers throughout Latin America for clinical training.
It cannot be emphasized enough that each ophthalmologist will always be in control of his or her own clinical setting, will know what to expect of the trained personnel and will pick and choose only those tasks/skills which fit their clinic needs. As needs change so too will the educational curricula. Well trained personnel should be expected to be proficient in the designated skills and testing modalities and step into individual practices with very little extra training needed beyond learning the individual ophthalmologists practice style differences and preferences. The program will be sensitive to the needs of individual ophthalmologists and to the specific circumstances in different countries and different communities within a country.
We will be looking for volunteer sites for short clinical rotations and partners for the program. We welcome suggestions and assistance from everyone throughout Latin America…. The time has come…..Ahora es la hora ideal.
Leslie France is a Senior Orthoptist in the Dept of Ophthalmology and Visual Sciences at the University of Wisconsin, Madison, WI USA and a member of the Division of International Ophthalmology
Co-chair of the PAAO Committee on Allied Health
Member of IAPB Vision 2020 Human Resource Working Group
Member AAPOS Committee on International Relations
Past member of the AAO Allied Health Committee
Past commissioner JCAHPO
Past member ORBIS advisory committee
Associate Editor and contributing author to AAO Tecnologia Medica en Oftalmologia Curso Independiente