Decentralised clinical training in optometry: a developmental strategy for eye health in KwaZulu Natal?

Scope of optometry practice in Trinidad and Tobago: A cross-sectional study

Background and Aim

To report the scope of optometry practice in Trinidad and Tobago to identify areas that need improvement.

Methods

A cross-sectional study of optometrists in Trinidad and Tobago was conducted using a validated self-structured questionnaire. Data obtained was exported to the Statistical Package for Social Sciences. Descriptive analysis and Pearson χ 2 were used to summarize the demographic data and determine associations, respectively.

Result

A total of 63 optometrists participated in the study. Majority of them were females (69.8%, n = 44), Christians (65.1%), East Indians (47.6%), and 30 years and below (66.7%). Most (87%) of them utilized routine optometric equipment in their clinical practice including autorefractors, retinoscopes, direct ophthalmoscopes, lensometers, phoropters, slit lamp biomicroscopes, trial lens boxes, and visual acuity chart projectors. A few of them have noncontact tonometer (4.8%), Volk lenses (1.6%), and perform color vision tests (1.6%). Fewer (12.7%, n = 8) practitioners provided low-vision services. The use of pharmaceutical agents was prevalent among the participants (55.6%). Additionally, the provision of contact lenses was the most frequently practiced service among the participants (85.7%, n = 54). A significant association was observed between the provision of low-vision services and sex (p = 0.03).

Conclusion

The scope of optometry practice in Trinidad and Tobago is in accordance with the basic guidelines set out by the World Council of Optometry but there is need to get more involved in the provision of low vision and other specialty services.

Supervisor experiences of extended clinical placements in optometry: a mixed methods study

BACKGROUND

In Australia, optometry students have traditionally undertaken their clinical training in short-block rotations at University-led teaching clinics in metropolitan locations. Demand for clinical placements is growing as the number of optometry students steadily increases. As such, universities and clinical education providers must look for more diverse methods of student placement. Extended clinical placements in community-based settings are one alternative: a model similar to the longitudinal clerkships in medicine. This study aimed to explore the experience of extended clinical placements from the perspective of the optometrists who supervised students. It also sought to determine whether there were differences in views between metropolitan and rural practitioners.

METHODS

This mixed methods study included a survey and interviews with optometrists who had previously supervised Deakin University optometry students on an extended 26-week (2 x 13-weeks) clinical placement. Lines of enquiry focused on; the benefits and challenges associated with extended placements; areas for improvement; duration of the placement; and willingness to supervise further students. Interviews were transcribed verbatim and analysed using Braun and Clarke's 6 step method of thematic analysis with a qualitative descriptive approach.

RESULTS

Supervisors felt that hosting a student prompted greater reflective practice and critical appraisal of clinical decisions. The extended nature of the placement was thought to foster greater immersion in the clinical setting and community for the students and establish a stronger relationship between supervisor and student. Supervisors recognised the importance of role-modelling and mentoring the next generation of optometrists however noted that taking on a student was a sizeable commitment. Willingness to host a student was not dependent on the supervisor's location (rural vs metropolitan) p = 0.57. However, interviews uncovered motivations that were unique to supervisors residing in rural locations, such as succession planning.

CONCLUSION

Overall, supervisors were positive about the value of student extended clinical placement in optometry and felt that it was a fulfilling and professionally beneficial experience. Lack of time and financial remuneration were the key downsides highlighted. Schools of optometry might carefully consider engaging in discussion about the duration of such placements, but 26 weeks was considered appropriate by supervisors.

A road less travelled: Undergraduate midwifery students' experiences of a decentralised clinical training platform

Background

In South Africa, the critical skill base shortage of healthcare workers, the underperforming global health indicators and the planned roll out of the National Health Insurance have burdened South African higher education authorities to rapidly expand nursing student enrolments. The expansion in student numbers has placed increased demands on overstretched educational institutions, and students are confronted with challenges of congestion in classrooms and clinical facilities, while lecturers encounter difficulties in the process of clinical allocation. A solution is to utilise decentralised clinical training platforms (DCTPs) and allocate students in rural hospitals.

Aim

To explore and describe undergraduate midwifery students' reflections of their DCTP experiences, in order to inform future practice of decentralisation in student training.

Setting

The study was conducted in the nursing discipline of an urban-based university in KwaZulu-Natal, South Africa, involving undergraduate midwifery students. The university had commenced a programme of allocating students to decentralised clinical sites.

Method

Elo and Kyngäs' content analysis was used to analyse the experiences of DCTP by undergraduate midwifery students (n = 14) as expressed in a focus group (n = 11) and three individual interviews (n = 3).

Results

The following four categories emerged: Recognition as a team member, engaging support, win-win platform and juxtaposed challenges.

Conclusion

In the presence of support and teamwork, rural settings can develop undergraduate student midwives, not only in the areas of midwifery competency but also in their personal capacity, and strengthen the responsiveness, preparedness and relevance of midwifery graduates.