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Staying ahead with trainee supervision requirements.

This article outlines the supervision responsibilities relating to trainee optometrists, dispensing opticians and contact lens opticians.

Optometrists [STANDARDS OF PRACTICE]

Dispensing opticians [STANDARDS OF PRACTICE]

Contact lens opticians [STANDARDS OF PRACTICE]

1 CET POINT

Introduction

The relevant professional bodies currently set the supervisory requirements of work-based placements for pre-registration optometrists, trainee dispensing opticians and trainee contact lens opticians. This information is especially useful for professionals who are considering supervising a trainee or to clarify questions that can arise in practice such as: 'can I supervise more than one trainee?' or 'what does supervision of a trainee really entail?'

The General Optical Council and students

Since September 2005, all optical students, whether in their supervised placement or studying at an optometry institution, have been required by law to register annually with the General Optical Council (GOC). (1) The GOC states that trainee clinical placements must be completed under the supervision of a GOC registered optician with at least two years of post-qualification experience, who has been approved by the GOC and the training provider.

Supervisors and students must maintain their GOC registration for the duration of their placement and renew registration annually. Failure to do so is a breach of the law and could result in the student not being covered by their supervisor's/institution's professional indemnity insurance policy resulting in any work not being accredited towards final qualification.

The new 19 Standards of Practice for Optometrists and Dispensing Opticians came in to effect on 1 April 2016, replacing the previous Code of Conduct for Individual Registrants. (2) At the same time the 18 Standards of Practice for Optical Students were also published. (3) The standards outline the expected behaviour and professional performance for every registrant. Individual registrants are expected to apply their professional judgement when deciding how to comply with these standards. The care, wellbeing and safety of patients must always be their main consideration.

Supervision of GOC registered trainees and unregistered colleagues who undertake delegated functions is covered under Section 9 of the Standards of Practice for Optometrists and Dispensing Opticians. In the Standards of Practice for Optical Students, supervision is covered in Section 8 (see Table 1, page 76). Both the supervisor and the trainee share responsibility for ensuring that supervision does not compromise patient care.

The GOC standards do not provide information on how to supervise, although the Standards for Optical Students highlight that the level of support needed with decision-making will be greater initially. As the level of knowledge and competence increases, the trainee should take more responsibility for these decisions. The level of supervision provided needs to be appropriate to their educational and professional development.

What is appropriate supervision?

McKimm and Halpern expressed the view that supervision implies 'over-seeing'. (4) If we break down the term, 'super' reflects something special or outstanding such as the action of helping support a person's professional learning and development, while 'vision' refers to seeing.

Kilminster et al conducted a review on supervision in clinical practice environments and concluded that: supervision is the provision of guidance and feedback on matters of personal, professional and educational development in the context of a trainee's experience of providing safe and appropriate patient care. (5) Mullin's article on the subject of effective supervision highlighted that supervisors have two key areas of responsibility, which are clinical, and educational: (6)

* Clinical supervision ensures the safety of both trainees and patients while delivering 'on the job' teaching and experience. Supervisors need to personally monitor their trainee's clinical activities, instantly respond to any patient issues or limitations in the trainee's performance and have accountability for the trainee's actions should an allegation of deficient professional performance become apparent

* Educational supervision supports the trainee's development up to the point of qualification. Factors identified as being important are the quality of the supervisor-trainee relationship, establishing mutual respect and professional boundaries, conducting direct observations, providing constructive feedback, careful planning with SMART (specific, measureable, achievable, results orientated, time bound) learning objectives; these need to be agreed by trainee and supervisor as well as provisions for pastoral care through regular appraisals and reviews.

Supervision of trainees, therefore, supports professional development and reinforces learning. It forms part of an effective clinical governance framework by monitoring and improving performance. (4)

Continuous personal supervision outlined by the GOC requires: 'the supervisor to be aware of their trainee's actions, be on the premises in close enough proximity to intervene if required'. The supervisor is, therefore, required to use their professional judgment about how close to the consultation room they need to be in order to provide adequate supervision. This is likely to change as the trainee progresses. (2-3)

Pathways to qualification as an optometrist: supervision criteria

The majority of UK optometry students complete an optometry undergraduate degree, which includes assessment of the Stage 1 GOC competencies. If successful they become eligible to apply for the College of Optometrists' Scheme for Registration; this is a period of supervised pre-registration experience in a clinical environment to gain experience to complete the Stage 2 GOC competencies. Entry onto the GOC Register of Optometrists is dependent upon successful completion of the pre-registration period and passing the Objective Structured Clinical Examination (OSCE).

The GOC also recognises integrated masters level optometry degree programmes, which allow for direct entry onto the Register of Optometrists. This route to qualification incorporates assessments against both the Stage 1 and Stage 2 GOC competencies with the period of supervised practice in an optometry practice/hospital clinic forming part of the curriculum.

Optometrist Scheme for Registration supervision criteria

The GOC empower The College of Optometrists to manage the Scheme for Registration, which marks the transition from student to qualified optometrist. Each trainee is required to complete the three-stage process comprising Stage 1 and 2 work-based assessments and the final stage of OSCEs.

A trainee can have one or multiple supervisors and the arrangements for ensuring that appropriate supervision is in place is the responsibility of the main supervisor. The College of Optometrists' guidance on supervision will now be detailed. (7)

Only supervisor

If the trainee is working in a practice where only one supervisor is present, this supervisor must have been registered with the GOC for a minimum of three continuous years prior to the trainee's start date. The trainee will have all their work supervised by this person unless covered by temporary supervision conditions.

Principal supervisor

Where there are two trainees in the same practice, but only one supervisor who has been GOC registered for a minimum of three continuous years, then a secondary supervisor must be appointed for each trainee. The principle supervisor must take overall responsibility for the trainees and be available to supervise each trainee for half of their working week.

Joint supervisor

If a trainee has more than one supervisor in a single practice, the main supervisor responsibilities can be split equally between them. All supervisors are jointly responsible for the trainee and they should all have been GOC registered for a minimum of three continuous years. If a trainee works between different practices, there must be a supervisor in each practice who has been GOC registered for a minimum of three continuous years.

Second supervisors

Second supervisors, who are not the principle supervisor as outlined above, need to have been GOC registered for a minimum of one year. All supervisors must meet the following terms and conditions:

* Be responsible for the trainee on the days they are supervising with the principle supervisor having overall responsibility for ensuring appropriate training and experience

* Be GOC registered for the minimum specified time

* Be a member or fellow of The College of Optometrists

* Have no complaints declared against them

* Have completed the compulsory supervisor training videos introduced in 2014

* Agree to The College of Optometrists' terms and conditions, supporting the trainee in line with the assessor

* To notify The College of Optometrists if they are no longer able to provide supervision.

Temporary supervision

A trainee can have a temporary supervisor for up to 30 days during the pre-registration year but no more than 20 consecutive days. Providing they do not exceed the stated number of days, the temporary supervisor does not need to be registered with The College of Optometrists. Temporary supervision can be provided by:

* Any GOC registered optometrist/OMP with no minimum GOC registration period required

* Specific supervision for duties within the registrant's area of expertise, for example, a dispensing optician can supervise dispensing duties, a contact lens optician can supervise dispensing and contact lens practice.

If this supervision is required for a longer period, they will need to register with The College of Optometrists and meet the secondary supervisor criteria.

Multiple trainees

A supervisor can have two trainees providing they are at a different stage in their training--for example, one trainee is in Stage 1 of their work based assessments and the other has undertaken their third quarterly work-based assessment. Both trainees must also have access to a consulting room for a minimum of 20 hours per week. The introduction of an additional trainee should not negatively impact upon the training of the first. Alternatively, if they are working in a hospital setting or there are multiple supervisors sharing the supervision, more than one trainee is permissible. Each case is considered at the discretion of the Lead Assessor.

Trainee dispensing optician courses in ophthalmic dispensing

Both Level 5 and 6 qualifications in ophthalmic dispensing require the completion of a pre-qualification period. Trainees working towards an ophthalmic dispensing qualification will receive a practice visit by a practice visitor to approve the suitability of the training placement and supervisor.

For all trainees, entry for the Final Qualifying Examinations is upon completion of a portfolio of work; this includes signed confirmation of 1600 supervised hours in no less than 200 days, all stipulated dispensing tasks and the submission of a minimum of 51 case records.

For trainee dispensing opticians, the GOC definition applies:' (8): the supervisor must be physically present on the premises, contactable, able to intervene and exercise their clinical judgement if required.'

Supervisor criteria

The supervisor must have been GOC registered for a minimum of two consecutive years prior to accepting the responsibility, excluding the student membership period.

Multiple trainees

A supervisor can only have a maximum of two GOC registered trainees at any one time. This includes trainees from any optical discipline--for example, one trainee dispensing optician and one pre-registration optometrist.

Multiple supervisors

Students can register two supervisors--a principal, and a secondary supervisor--but the trainee must spend most time with their principal supervisor. The trainee can complete the placement between a maximum of two practices with a maximum of two supervisors. A registered supervisor may not sign records they did not directly supervise, and only work undertaken in an approved registered practice can be accepted.

Specialist clinic supervisors

Supervision by other appropriate GOC registered specialists is possible, to gain specific clinical experience providing prior approval has been obtained. This can be awarded for up to a three-month fixed period.

Temporary supervision

Currently there is no allowance for temporary supervision by GOC registrants who are not registered supervisors. However, temporary supervision can be arranged with prior approval. ABDO always recommend registering two supervisors to allow for any temporary leave of absence. Any changes to primary and secondary supervisor details should be through contact with ABDO Examinations and Registration Department.

Trainee contact lens opticians

This is usually a part-time role in practice for registered dispensing opticians who are actively studying towards their contact lens qualification, gaining theoretical knowledge and practical skills. To register with ABDO Examination and Registration Department, trainees need to be attending or have completed an approved formal contact lens training course. They need to be supervised in clinics by a GOC registered optometrist or contact lens optician who has a minimum of two years of continuous registration at one main practice. Changes were made to the registration requirements that came into effect from 1 August 2016 which are detailed in the following section.

Practice visit

The student must register their practice and supervisor with ABDO Examinations and Registration as soon as the trainee's personal practical experience with patients begins. Previously this was between six to 12 months prior to the trainee's practical examinations. Submitting these forms to the ABDO Examinations and Registration department is the responsibility of the trainee. The minimum hours required for patient practical experience begins when the supervisor receives confirmation of registration from ABDO. This will trigger a practice visit to ensure that the practice and supervisor meet the requirements for supervision. During this visit, the GOC competency 5.2 will be assessed. This is: "The ability to instruct the patient in contact lens handling, and all aspects of lens wear including care regimes." This competency needs to be passed before the student is eligible to sit the final practical exam.

Principal supervisor

The trainee must have one supervisor who is responsible for all the support and practical experience in one main practice. This must be a registered optometrist, contact lens optician who is on the GOC specialty register or an ophthalmologist and has been qualified a minimum of two years. The ophthalmologist must have specialised in contact lenses for at least two years.

Second supervisor

The trainee can only have one registered supervisor for their practical experience until they have completed at least six months of training and in that period achieved at least 150 hours of supervised practical experience with patients. From this point onwards, a second supervisor can be registered providing they meet the same requirements as the principal supervisor. The trainee can spend up to 33% under the supervision of their secondary supervisor and the principal supervisor has overall responsibility.

Temporary supervision

In the event of temporary absence of the principal supervisor due to ill health or holidays, they are responsible for ensuring that a suitably registered contact lens optician or optometrist provides any emergency supervision for the trainee. ABDO approval is necessary for a period of cover of more than a month.

Multiple trainees

Two trainee contact lens opticians can be aligned to the same supervisor provided each trainee is at a different stage. The first trainee must have completed their required practical experience hours or waiting to reattempt part or all of their ABDO Contact Lens Certificate Examination. Two supervisors would be needed in order to have two trainees in the same practice at the same stage.

Conclusion

Supervision is essential for ensuring trainees develop the ability to understand how to approach clinical situations and make a differential diagnosis. Supervisors also need to take into consideration patient safety, regulatory requirements, best practice approaches and guidance.

The definition of appropriate supervision is consistent across the optical disciplines and in line with GOC regulations. The GOC Standards of Practice outline the supervision conditions and expectations, while leaving it to the discretion and professional judgement of each registrant as to how they make these translate in a clinical environment. Working collaboratively, understanding the rules of supervision, working within your area of expertise, knowing your limitations and seeking additional support when needed are all important to ensure the best patient care is prioritised and delivered.

The GOC require examination and assessment bodies to have systems in place for the approval, listing and reviewing of supervisors as well as the suitability of the practice and the placements. All trainees can be supervised by a variety of optical specialists, within their area of expertise subject to the approval of their organisation

Supervising trainees can be a fun and rewarding experience and not only does it help further future careers, it also allows the supervisor to gain additional skills in teaching, coaching, mentoring and managing performance. Supervision also provides the supervisor with the opportunity to reflect and evaluate on their current views and modes of practice; this can stimulate new perspectives on best practice approaches leading to enhanced patient care.

Exam questions and references

Under the enhanced CET rules of the GOC, MCQs for this exam appear online at www.optometry.co.uk. Please complete online by midnight on 8 April 2017. You will be unable to submit exams after this date. Please note that when taking an exam, the MCQs may require practitioners to apply additional knowledge that has not been covered in the related CET article.

CET points will be uploaded to the GOC within 10 working days. You will then need to log into your CET portfolio by clicking on 'MyGOC' on the GOC website (www.optical.org) to confirm your points.

Visit www.optometry.co.uk, and click on the 'Related CET article' title to view the article and accompanying 'references' in full.

Acknowledgement

The author would like to thank ABDO, The College of Optometrists and Paula Baines for kindly reviewing this article.

Course code: C-54893 Deadline: 8 April 2017

Learning objectives

* Understand responsibilities relating to student supervision (Group 2.9.1)

* Understand responsibilities relating to student supervision (Group 2.9.1)

* Understand responsibilities relating to student supervision (Group 2.9.1)

Neil Retallic MCOptom, FBCLA, FIACLE

* Neil Retallic is a registered optometrist working at the University of Manchester in the post of Optometry Teaching Fellow and Joint Contact Lens Clinic Lead. At Vision Express he is the Learning and Development Manager-Registered Optical. He is the BCLA Education Adviser, a BCLA and IACLE fellow, vice chair of BUCCLE and a visiting lecturer at Aston University. He is a College of Optometrists' council member and examiner, and a committee member for various other organisations across the optical sector.

Caption: Supervising a refraction
Table 1 GOC Standards of Practice ensure that supervision is
undertaken appropriately and complies with the law

Standards for optometrists and       Standards for optical students
dispensing opticians

9.1 Be sufficiently qualified and    8.1 You must only be supervised by
experienced to undertake the         someone who is approved by your
functions you are supervising        employer or training provider

9.2 Only delegate to those who       8.2 Ensure that your supervisor is
have appropriate qualifications,     on the premises, in a position to
knowledge or skills to perform the   oversee the work you undertake and
delegated activity                   is ready to intervene if necessary
                                     in order to protect patients

9.3 Be on the premises, in a         8.3 Your supervisor retains
position to oversee the work         clinical responsibility for the
undertaken and ready to intervene    patient
if necessary in order to protect
patients

9.4 Retain clinical responsibility   8.4 Comply with all legal
for the patient. When delegating,    requirements governing the
you retain responsibility for the    activity
delegated task and for ensuring
that it has been performed to the
appropriate standard

9.5 Take all reasonable steps to
prevent harm to patients arising
from the actions of those being
supervised

9.6 Comply with all legal
requirements governing the
activity

9.7 Ensure that details of those
being supervised or performing
delegated activities are recorded
on the patient record

Table 2 Comparison of the supervision criteria across the optical
disciplines

Supervisor    Trainee DO          Trainee CLO         Pre-registered
                                                      optometrist

Principal     Two years GOC       Two years GOC       Three years GOC
supervisor    registered          registered          registered for
                                                      principal and
                                                      joint supervisors

Multiple      Maximum of two      A secondary         Yes
supervisors   supervisors in      supervisor can be
              two practices       appointed after
                                  the students has
                                  completed six
                                  months and 150
                                  hours of clinical
                                  experience

Additional    Two years GOC       Yes: but only       One year GOC
supervisor    registered          after student has   registered
                                  completed a
                                  minimum of 150
                                  hours and six
                                  months' clinical
                                  experience, two
                                  years GOC
                                  registered

Temporary     This requires       This requires       Yes: up to 30
supervisor    prior approval      prior approval      days, with less
              from ABDO           from ABDO           than 20
                                                      consecutive days
                                                      before need to
                                                      register with The
                                                      College of
                                                      Optometrists

Multiple      Maximum of two      If at different     If at different
trainees      from any optical    stages of           stages of
              discipline          training            training

Specialist    Needs prior         N/A                 Temporary
supervision   approval from                           supervision
              ABDO                                    without need for
                                                      registration

Supervisor    No mandatory        No mandatory        Online supervisor
training      course but          course but          training videos
requirement   information is      information is
              provided as         provided as
              guidance for        guidance for
              supervisors, now    supervisors, now
              available on ABDO   available on ABDO
              College website.    College website
              A CET accredited
              talk if offered
              at training
              institutes by
              ABDO
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Author:Retallic, Neil
Publication:Optometry Today
Date:Mar 1, 2017
Words:3362
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