Department of Optometry and Visual Science

Training in Therapeutics: A Guide for Optometrists

Module 1: Principles of Therapeutics

Module 2: Principles of Prescribing

Module 3: Independent Prescribing

February 2012

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This guide is designed for registered optometrists taking the Principles of
Therapeutics (POT) and/or Principles of Prescribing (POP) modules at City
University who wish to qualify as 1) an Additional Supply (AS) optometrist or
2) continue training to qualify as an Independent Prescriber.

Successful attainment of AS status requires a structured study plan leading to

successful completion of (1) the City University POT and POP examinations
and (2) a five day clinical placement and (3) the College of Optometrists’
Therapeutics Common Final Assessment (TCFA) in AS.

Successful attainment of Independent Prescribing (IP) status requires a

structured study plan leading to successful completion of (1) the City
University POT and POP examinations, (2) the City University IP examination
(following proof of appropriate therapeutic experience), (3) a seven day (if
already completed AS clinical placement) or a twelve day clinical placement
and (4) the College of Optometrists’ Therapeutics Common Final Assessment
(TCFA) in IP.

This guide has been divided into the following sections:

 Structure of the training programme
 What is the City University POT/POP module examination?
 How to study for the examination
 Analysing questions and sample questions
 Clinical placements
 What is the College of Optometrists’ Therapeutics Common Final
Assessment (TCFA) examination?
 Reading lists and useful websites

Structure of the programme

The overall structure of City University’s modular programme leading to
specialist registration in AS/IP is shown below:

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In order to qualify for a place on module 3: IP, you must complete the
assessment relating to POT and POP. In addition, students applying for the
IP module (Module 3) must satisfy the GOC therapeutic experience
requirements in the IP optometrists’ intended area of practice (see IP Training
Handbook):
http://www.optical.org/goc/filemanager/root/site_assets/education_handbooks/
ip_handbook_july_08.pdf)

What is the City University POT module examination?

The first opportunity to sit the examination will be on 21st March/30th May
2012. The second opportunity will be 24th October 2012. The examination
ensures that the necessary learning outcomes from the module have been
attained (learning outcomes comply with the requirements laid down in the
‘Handbook for Optometry Specialist Registration in Therapeutic Prescribing’,
July 2008 (see Appendix 1A).

The duration of the examination is two hours and consists of (1) a one hour
paper consisting of multiple choice questions (MCQs), and (2) a one
hour ‘patient management case scenarios’ (PMCS) examination.

What is the City University POP examination?

The first opportunity to sit the examination will be following the November
2012 course. The examination ensures that the necessary learning outcomes
from the module have been attained (learning outcomes comply with the

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requirements laid down in the ‘Handbook for Optometry Specialist
Registration in Therapeutic Prescribing, July 2008 (see Appendix 1A).

The duration of the examination is two hours and consists of (1) a one hour
short answer question (SAQ) paper, and (2) a one hour ‘objective
structured clinical examination’ (OSCE).

Once both parts of the City AS theory examination have been successfully
completed, you may proceed to the five-day clinical placement which is part of
the AS training programme. Alternatively, you may wish to continue your
training and apply for the IP module (showing evidence of therapeutic
experience) and complete your twelve day clinical placement once the IP City
exam has been passed (see Appendix 1B).

If you should fail either or both assessments at the first attempt, you are
entitled to a second sitting. Should you fail the examination at the second
sitting, you are required to repeat the module/s.

How to study for the POT and/or POP examination

The POT assessment will test foundation knowledge in anatomy,
immunology, microbiology and pharmacology and reflects the basic principles
underpinning the AS/IP prescribing pathway. The main focus of the POT
assessment is:
 anatomy and physiology of the eye and orbit
 clinical ocular immunology, microbiology and pharmacology
 diagnosis and management of common anterior segment eye
conditions

The POP examination is designed to test your ability to successfully diagnose

and manage ocular disease in relation to AS.
The main focus of the POP assessment is:
 management of specific ocular conditions i.e. dry eye, lid margin
disease, management of infective and allergic conjunctivitis,
management of superficial injury.
 evidence based practice and clinical governance in relation to
prescribing
 prescribing safely and professionally

Analysing questions and sample questions

Principles of Therapeutics: MCQs
One common method of approaching the MCQs is described below:
Read and analyse the question. Look at answer (a). If your analysis is that (a)
is wrong, mark (a) with a line through it. Then repeat for (b), (c) and (d). It’s
easier to mark out the wrong ones first – if left with more than one correct

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answer, try to mark the incorrect one. When an answer appears to be correct,
put a dot next to it. Again, analyse all possible answers once more.

Some MCQs consist of a stem which contains the question part of the item
and four/five responses. You may also be required to fill in the ‘missing
words’ (see example). The exam does not employ questions with answers
such as:
‘b and c above’
‘all but b and c above’
‘all of the above’
‘none of the above’

MCQs are designed to text knowledge: there is no desire to trick candidates.

However, in order to test detailed knowledge, the difference between a right
and a wrong answer may not be immediately apparent.

Sample MCQs
These questions illustrate the format of the questions in the City theory paper
(not necessarily the content).

Excretion of a drug is most often accomplished by which one of the following

organs?
a. Liver
b. Kidney
c. Brain
d. Salivary gland

Systemic tetracyclines are generally avoided in treatment of chlamydial

infections in children and pregnant women because of:
a. Allergic conjunctivitis
b. Nausea and vertigo
c. Bone growth depression and tooth discolouration
d. Ineffectiveness against chlamydial infections

Fleischer’s ring is a deposition of ……………in the cornea and is associated

with ……………
a. Iron, keratoglobus
b. Iron, keratoconus
c. Copper, keratoconus
d. Calcium, keratoglobus
e. Pigment, keratoconus

Principles of Therapeutics: PMCS

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PMCSs usually show an image. The signs and symptoms are often provided
and questions focus on diagnosis and management of the disease.

Sample PMCS

This 24 year-old male was referred by his family doctor because of this
ocular appearance. It was initially diagnosed as a subconjunctival
haemorrhage but failed to resolve over the past four weeks.

a. What does the image show?

There are dark reddish lesions found mainly on the inferior bulbar and
palpebral conjunctiva. The lesions resemble subconjunctival haemorrhage (2).

In a patient at risk for AIDS, a "non-resolving subconjunctival haemorrhage"

should raise the possibility of Kaposi's sarcoma (1)

b. Who is the most likely type of patient at risk of this condition?

Patients with HIV (1)

c. How would you manage this patient?

Refer to an ophthalmologist (1)

Principles of Prescribing: SAQs

SAQs are usually one sentence questions. The answer usually covers at
least 2 or 3 points in a sentence, or even bullet point form.

Sample SAQ
What is a retrovirus? Illustrate your answer with an example of a
retrovirus.
A retrovirus is a virus with an RNA genome that replicates by using a viral
enzyme to transcribe its RNA into DNA in the host cell (2)
Retroviruses are enveloped viruses that belong to the viral family
Retroviridae. (1)

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Example: Human immunodeficiency virus (HIV) (1)

Principles of Prescribing: OSCEs

This examination constitutes six stations. For three stations you will be
expected to take a history from a patient with a particular ophthalmic
presentation. You will be expected to differentially diagnose the condition on
history alone and suggest an appropriate management plan. All of this will be
relayed to the patient rather than the examiner. The patient will not actually
have the condition; rather they will be ‘expert’ patients who have been
appropriately trained to respond to your questions. You should treat the
OSCE as a real consultation and relate to the patient as you would in practice.

Two of the OSCEs will be patient examination stations where a history will be
provided and you will be asked to examine the anterior eye and adnexa as
appropriate. You should ensure patient safety and comfort and adopt
appropriate hygiene procedures. You should explain to the examiner and the
patient what you are doing. However, you will not take any further history from
the patient. These stations are simply assessing your clinical skills.

The final OSCE is a medicines information station. You will be provided with a
paper copy of the BNF and computer access the online version. Using either
resource you will be asked to look up specific information about selected
drugs.

Clinical Placement
If you have no previous level of training you are required to complete a five
day clinical placement to qualify as an AS optometrist and a twelve day
clinical placement if you wish to qualify as an Independent Prescriber.

A guide is included to help inform you and your mentor of the requirements of
the clinical placement (Appendix 2). The Handbook provided by the GOC
should also be followed.

What is the College of Optometrists’ Therapeutics Common Final

Assessment?
The TCFA in AS consists of a 30 minute oral examination based on the
submission of a portfolio of practice evidence. The portfolio should include
four extended case reports and submission is required at least seven weeks
prior to the assessment deadline. The portfolio template can be found at:
http://www.college-
optometrists.org/index.aspx/pcms/site.education.ex.cfa_2.cfa_home2/

The TCFA in IP consists of (i) a Logbook and (ii) a Key Features assessment.
During the clinical placement, a Logbook of practice evidence must be
maintained in order to verify that learning outcomes have been achieved
(Appendix 2). The Logbook template is available from http://www.college-
optometrists.org/index.aspx/pcms/site.education.ex.cfa_2.cfa_home2/

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The Logbook must be completed and submitted along with the TCFA in AS/IP
examination application form.

The Logbook will be used to ensure that you have covered a wide enough
range of conditions in your clinical placement and that the logbook has been
completed correctly. Following successful completion, candidates can then
proceed to complete the TCFA assessment in IP which is a computer-based
key features scenario examination (MCQs based on clinical scenarios).
Further information is available on the College of Optometrists’ website.

Reading lists and useful websites

It is important to take time to study learning about diseases of the anterior
segment. Several books will help you in addition to the lecture notes that you
receive. Those with an * are important reference books.

Anatomy and Physiology

Kaufman, P. and Albert, A. (2002) Adler’s Physiology of the Eye. 10th ed. London: Elsevier.
Oyster, W.C. (1999) The Human Eye, Structure and Function. MA: Sinauer Associates.
Standring, S. (ed) (2008) Grays Anatomy - The anatomical basis of clinical practice. 40th ed.
London: Elsevier.

Microbiology/Immunology
Actor, J. (2006) Integrated Immunology and Microbiology. London: Elsevier.
Helbert, M. (2006) Flesh and bones of Immunology. London: Elsevier.
Male, D., Brostoff, J., Roth, D and Riott, I. (2006) Immunology. 7th ed. London: Elsevier.

Pharmacology
Bartlett, J. and Jaanus, S. (2008) Clinical Ocular Pharmacology. 5th ed. New York: Elsevier.*
Neal, M. (2005) Medical Pharmacology at a Glance. 5th ed. London: Blackwell.
Rang, H., Dale, M., Ritter, J. and Flower, R. (2007) Rang & Dale's Pharmacology. Edinburgh:
Churchhill Livingstone.

Ocular Disease
Bruce, A. and Loughman, M. (2002) Anterior Eye Disease and Therapeutics A-Z. 1st ed.
Oxford: Butterworth Heinemann.*
Bruce, A., O'Day, J., McKay, D. and Swann, P. (2008) Posterior Eye Disease and Glaucoma
A-Z. 1st ed. London: Elsevier.
Denniston, A. and Murray, P. (2006) Oxford Handbook of Ophthalmology. 1st ed. Oxford:
Oxford University Press.
Fraser, S., Riaz, A. and Kon, C. (2001) Eye Know How. London: BMJ Books.
http://emedicine.medscape.com/ophthalmology.
Jackson, T. L. (2007) Moorfields Manual of Ophthalmology. London: Mosby.*
Kanski, J. (2006) Clinical Ophthalmology, A systematic approach. 5th ed. Oxford: Butterworth
Heinemann.*

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Kanski, J. (2008) Clinical diagnosis in Opthalmology. London: Mosby*
Stapleton, F. (ed) (2003) Anterior Eye and Therapeutics: Diagnosis and Management. 1st ed.
Sydney: Butterworth Heinemann.
The Wills’ Eye Insitutute (2008) The Wills Eye Manual: Office and Emergency Room
Diagnosis and Treatment of Eye Disease. 5th ed. New York: Lippincott Williams and Wilkins.*

Prescribing
Beauchamp, T.L. and Childress, J.F. (2001) Principles of biomedical ethics. 5th ed. Oxford:
Oxford University Press.
Brazier M (1992) Medicine, patients and the law. London: Penguin.
British National Formulary (2010) Number 59.
British Medical Association & the Royal Pharmaceutical Society of Great Britain. London.
Code of Ethics for Pharmacists and Pharmacy Technicians. (2008) RPSGB. London.
Galbraith, A., Bullock, S., Manias, E., Hunt, B. and Richards, A. (1999) Fundamentals of
pharmacology: A text for nurses and health professionals. Harlow: Addison Wesley
Longman.
Herfindal, E.T. and Gourley, D.R. (1996) Textbook of therapeutics: drug and disease
management. 6th ed. Baltimore: Williams & Wilkins.
http://www.mhra.gov.uk/Howweregulate/Medicines/Availabilityprescribingsellingandsupplying
ofmedicines/ExemptionsfromMedicinesActrestrictions/Nurseandpharmacistindependentprescr
ibing/index.htm.
http://www.dh.gov.uk/en/Healthcare/Medicinespharmacyandindustry/Prescriptions/TheNon-
MedicalPrescribingProgramme/Independentpharmacistprescribing/index.htm.
http://www.bma.org.uk/ap.nsf/Content/InfoOnPrescrib0904~Supp&IndepPres.
http://www.npc.co.uk/MeReC_Extra/2007/no23_2006.htm.
http://www.pharmj.com/mep/index.html.
http://www.rpsgb.org.uk/pdfs/controlofentrybrief.pdf.
Lancaster, T., Straus, S. and Straus, S.S. (1999) Practising evidence-based primary care.
London: BMJ Publishing Group.
Luker, K.A. and Wolfson, D.J. (1999) Medicines management for clinical nurses. London:
Blackwell Science.
Medicines Ethics and Practice Pharmaceutical Press (2008); Rev Ed edition.
Merry, A. and McCall-Smith, A. (2001) Errors, Medicine and the Law, Cambridge: Cambridge
University Press.
Reid, J.L., Rubin, P.C. and Whiting, B. (2001) Lecture notes on clinical pharmacology 6th ed.
Oxford: Blackwell Science.
Spalton, D.J., Hitchings, R.A. and Hunter, P. (2004) Atlas of Ophthalmology. St Louis: Mosby.
United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) (2008)
Standards for medicines management.
UKCC (2008) Standards of proficiency for nurse and midwife prescribers: Protecting the
public through professional standards.

N.B. Notes relating to each lecture are provided in a module folder for all
students. Individual lecture notes also specify recommended further reading
(including journal articles and research reports)

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If you have any further queries please contact Dr Michelle L Hennelly at
M.Hennelly@city.ac.uk.

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 Appendix 1

A) Outline curriculum for a training programme to prepare optometrists

to sell, supply or write written (signed) orders for drugs at Additional
Supply (Exemption Level 2) Level.

1. Aim
To prepare optometrists to sell, supply or write written orders for drugs at
Additional Supply (Exemption Level 2) Level and to meet the standards set by
the General Optical Council for entry to specialist registers.

2. Learning outcomes
Following completion of the appropriate training optometrists should be able
to demonstrate:
[a] an ability to take a comprehensive medical history and examine the eye
using appropriate instrumentation and clinical techniques
[b] knowledge of the pathophysiology, clinical features and natural course of
the conditions being treated
[c] an ability to identify the nature and severity of the presenting condition and
generate an appropriate management plan
[d] an ability to monitor the response to treatment and modify the
management plan or refer if necessary
[e] an ability to critically apply knowledge of pharmacology to prescribing
practice
[f] an ability to critically evaluate sources of information, advice and decision
support in prescribing practice, taking into account current evidence based
practice
[g] knowledge of the indications, cautions, interactions and contraindications
of ophthalmic medicines
[h] an awareness of own limitations and an ability to practise within a
framework of professional accountability and responsibility
[i] an understanding of the legal basis of the use and supply of Additional
Supply (Exemptions Level 2) medicines
[j] a reflective approach in the review and development of prescribing practice

3. Indicative content
[a] Clinical and pharmaceutical knowledge
Anatomy and physiology of the eye and adnexae
General and ocular immunology
General and ocular microbiology
Principles of pharmacology
- Pharmacokinetics and pharmacodynamics
- Drug design, formulation and delivery
- Physiological/pathological alterations in drug response e.g. age,
ethnicity, pregnancy, co-morbidity
Disorders of the anterior eye
- Pathogenesis, clinical features, management
Ocular pharmacology and therapeutics
- Indications, dose, precautions, contraindications, interactions
[b] History taking, examination techniques and methods of monitoring

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 History taking
- Presenting symptoms
- Medical and medication history
Methods of ocular examination
- Equipment and techniques
Development of a clinical management plan
Monitoring compliance and response to treatment
Knowledge of natural history and clinical profile of conditions being treated
Identifying and reporting adverse drug reactions
Knowledge of own limitations and criteria for referral
[c] Evidence based practice and clinical governance in relation to
prescribing
Principles of evidence based practice and critical appraisal skills
Auditing, monitoring and evaluating prescribing practice
Clinical governance
Risk assessment and risk management
[d] Legal basis of prescribing
Drug legislation
Drug licensing
Exemptions to the Medicines Act
Prescription writing
[e] Prescribing safely and professionally
Sources of drug information
Record keeping
Medication errors
Influences on prescribing practice
Patient confidentiality and data protection
Professional codes of practice
Public health policy e.g. antimicrobial use and resistance
Inappropriate prescribing and misuse of medicines
Reflective practice

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B) Outline curriculum for a training programme to prepare optometrists
to practise as Independent/Supplementary Prescribers.

1. Aim
To prepare optometrists to practise as independent/supplementary
prescribers and to meet the standards set by the General Optical Council for
entry on to the appropriate specialist therapeutic prescribing register.

2. Learning outcomes
Following completion of the appropriate training programme, an optometrist
should be able to demonstrate:
[a] an understanding of his or her role as an independent prescriber, an
awareness of the limitations of his or her experience and an ability to work
within the limits of his or her professional competence
[b] an ability to take a comprehensive medical history and examine the eye
and adnexa using appropriate instrumentation and clinical techniques
[c] knowledge of the pathophysiology, clinical features and natural course of
the conditions being treated
[d] an ability to identify the nature and severity of the presenting condition and
to generate an appropriate patient-specific clinical management plan
[e] an ability to monitor the response to treatment, to review both the working
and the differential diagnosis, and to modify treatment or refer / consult / seek
guidance as appropriate
[f] an ability to prescribe, safely, appropriately and cost effectively
[g] an ability to take a shared approach to decision making by assessing
patients’
needs for medicines, taking account of their preferences and values and
those of their carers when making prescribing decisions
[h] an ability, when working as a supplementary prescriber, to work within a
prescribing partnership and to accept the scope and limitations of a patient
specific clinical management plan
[i] an ability to critically evaluate sources of information, advice and decision
support in prescribing practice, taking into account current evidence based
practice
[j] an understanding of the public health issues related to medicines use
[k] an understanding of the legal, ethical and professional framework for
accountability and responsibility in relation to prescribing
[l] an ability to work within clinical governance frameworks that include audit of
prescribing practice and personal development

3. Indicative content
[a] Clinical and pharmaceutical knowledge
Principles of pharmacology
- Pharmacokinetics & pharmacodynamics of topical ophthalmic &
systemically administered medicines
- Drug design, formulation and delivery
- Physiological/pathological alterations in drug response e.g. age,
ethnicity, pregnant or breastfeeding women, co-morbidity
- Potential for unwanted effects e.g. allergy, adverse drug reactions,
interactions

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Pathogenesis, clinical features natural history and management of the
conditions for which the optometrist intends to prescribe
Action, indications, cautions, contraindications and side effects of drugs used
in the treatment of disorders of the eye and adnexa
[b] History taking, examination techniques, decision making and review
- History taking
- Presenting symptoms
- Medical and medication history
Methods of ocular assessment
- Equipment and techniques
- Diagnostic tests
Concept of a working diagnosis
Development of a treatment plan including selection and optimisation of a
drug regimen
Patient-specific clinical management plans in the context of a supplementary
prescribing partnership
Principles of concordance
Assessment of responses to treatment against the objectives of the treatment
plan/clinical management plan
Identifying and reporting adverse drug reactions
[c] Prescribing in an individual and team context
Autonomous working and clinical decision making within professional
expertise and competence – knowing when and how to refer / consult / seek
guidance from another member of the healthcare team
Effective communication and team working with other professionals
The responsibility of an independent prescriber in the development, delivery
and review of a patient-specific clinical management plan
The responsibility of a supplementary prescriber in collaborating with an
independent prescriber in the the delivery and review of a patient-specific
clinical management plan
Negotiating support/training for prescribing role
Development and maintenance of professional knowledge and competence in
relation to the condition(s) which the optometrist intends to manage (with or
without the prescription of drugs)
[d] Evidence based practice and clinical governance in relation to
prescribing
Principles of evidence based practice and critical appraisal skills
Information systems / decision making support tools
Auditing, monitoring and evaluating prescribing practice
Local and professional clinical governance policies and procedure
Risk assessment and risk management
Reflective practice, continuing professional development and support
networks
[e] Legal basis of prescribing
Drug legislation
Drug licensing
Legislation affecting prescribing practice
Prescription writing/ prescription pads
[f] Prescribing safely and professionally
Sources of drug information

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Record keeping
Medication errors
Influences on prescribing practice
Patient confidentiality and data protection
Professional codes of practice
Inappropriate prescribing and misuse of medicines
Local and national policies impacting on prescribing practice
Local and national frameworks for medicines use
Antimicrobial use and resistance
Budgetary constraints at local and national level
Safe Disposal of Medicines

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 Appendix 2

LEARNING IN PRACTICE

MENTOR PACK

A guide to help ophthalmologists to prepare for and carry out the role of
designated mentor to optometrists undertaking training for specialist
registration in therapeutic prescribing

February 2012

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Introduction

In order to qualify for specialist registration in therapeutic prescribing,

optometrists must undergo a GOC accredited training programme consisting
of a University-based taught component covering the diagnosis and
management of ocular disease, and the principles of prescribing. This is
followed by a period of practice-based learning that is designed to further
develop competency in the assessment and management of ocular disease
and to integrate prescribing theory and practice. The practice component of
the programme must take place in an appropriate UK ophthalmic care setting
under the supervision of a designated ophthalmologist mentor.

The purpose of this guide is to:

 Provide background on specialist therapeutic prescribing by
optometrists
 Describe the City University training model for optometrist prescribers
 Outline the role and responsibilities of the designated ophthalmologist
mentor
 Present an overview of some of the theory underpinning teaching and
learning

Background

The Review of Prescribing, Supply and Adminstration of Medicines led by Dr

June Crown and published in 1999 recommended that the legal authority to
prescribe should be extended to certain non-medical groups. In July 2000 the
NHS plan endorsed the Review’s recommendations. The key principles of the
extension of prescribing responsibilities are:
 Patient safety is paramount
 Patients should benefit from faster access to care, including the
medicines they need
 Making better use of the skills of a range of healthcare professionals

There are now several legal mechanisms by which an optometrist can

prescribe, supply or administer medicines to patients:
 Independent prescribing (IP)
 Supplementary prescribing (SP)
 Medicines Act Exemptions (entry level and additional supply (AS))

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Independent prescribing
Independent prescribers take responsibility for the clinical assessment of the
patient, establishing a diagnosis and determining the clinical management
required (including prescribing where necessary). Legislation to allow
optometrists to train as independent prescribers came in to force in June
2008.

Supplementary prescribing
Supplementary prescribing is defined as ‘a voluntary partnership between an
independent prescriber and a supplementary prescriber to implement an
agreed patient-specific clinical management plan with the patient’s
agreement’. The plan sets out how much responsibility should be delegated
and refers to a named patient and to their specific condition. Legislation to
allow optometrists to train as supplementary prescribers came in to force in
June 2005. As from January 2010, supplementary prescribing is now part of
IP.

Medicines Act Exemptions

There are exemptions granted to certain groups of health professionals from
the restrictions imposed by the Medicines Act on the sale and supply of
particular Prescription only medicines (POMs), Pharmacy (P) medicines and
General sales list (GSL) medicines.

Entry Level
Exemptions from the general rules laid down in the Medicines Act are
permitted for all registered optometrists. These allow optometrists to use
various diagnostic drugs (including mydriatics, cycloplegics and local
anaesthetics) and to use and supply specific therapeutic POMs, such as
chloramphenicol and fusidic acid. Furthermore, legislation that came in to
force in April 2005 also allows optometrists to sell GSL or P medicines. A
recent survey of the scope of optometrist’s therapeutic practice commissioned
by the College of Optometrists (Needle et al, 2008) indicated that significant
numbers of practitioners were regularly managing common non sight-
threatening conditions using this exemption route.

Additional Supply
Since June 2005, appropriately qualified optometrists have been able to
access a further list of POM exemptions, termed ‘additional supply’. The
rationale behind ‘Additional Supply’ Exemptions is to provide optometrists with
access to medicines to allow them to manage a range of common non-sight
threatening disorders including:
 infective conjunctivitis
 allergic conjunctivitis
 blepharitis
 dry eye
 superficial injury
These medicines can be sold or supplied by the optometrist directly to the
patient in an emergency, or routinely obtained by the patient from the
pharmacist, against a written order signed by the optometrist.

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Learning in Practice
Trainees must undertake a clinical practice placement within the hospital eye
service (or specialist general practice) under the supervision of a designated
ophthalmologist. It is the responsibility of the trainee to inform the College of
Optometrists of the details of the placement.

The period of practice-based learning should ensure that the trainee:

 Is competent in the assessment, diagnosis and management of the
ophthalmic conditions for which the optometrist intends to prescribe
 Is able to recognise sight-threatening conditions that should be referred
 Is able to consult effectively with patients
 Is able to monitor the response to treatment, to review both the working
diagnosis and to modify treatment or refer/ consult/ seek guidance as
appropriate
 Makes clinical decisions based on and with reference to the needs of
the patient
 Is aware of their own limitations and makes clinical decisions based on
the needs of the patient
 Critically analyses and evaluates his or her ongoing performance in
relation to prescribing practice

Clinical training should be structured to ensure that each trainee is exposed to

sufficient numbers of patients presenting with the conditions that her or she
will manage therapeutically. In addition, the trainee should be exposed to a
range of ophthalmic conditions so as to develop differential diagnostic skills.

Each trainee should maintain a Portfolio (or in the case of IP, a Logbook) of
Practice Evidence to verify that learning outcomes have been achieved.
Full details of the Portfolio/Logbook and the TCFA in AS/IP is available on the
College of Optometrists’ website:
http://www.college-
optometrists.org/index.aspx/pcms/site.education.ex.cfa_2.cfa_home2/

On successful completion of the requisite period of clinical practice

optometrists may apply to sit the Common Final Assessment in Specialist
Qualifications.

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The role and responsibilities of the designated mentor

What is a mentor expected to do?

The mentor will provide supervision, support and arrange appropriate clinical
experience so that the trainee can develop links between the theory and
practice of prescribing. Furthermore the mentor will facilitate in the
achievement of the learning outcomes specified by the General Optical
Council (GOC). It is not the mentor’s responsibility to formally assess the
learning outcomes since these will be assessed by the University and the
College of Optometrists.

During an initial meeting with the trainee the mentor can plan a training
programme based on the optometrist’s learning needs. During the placement
the mentor should:
 Facilitate learning by encouraging critical thinking and reflection
 Provide dedicated time and opportunities for the trainee to observe
how the mentor conducts a consultation with patients and the
development of a management plan
 Allow opportunities for the trainee to carry out consultations and
suggest management and prescribing options, which are then
discussed with the mentor
 Provide opportunities for case-based discussions to consolidate the
learning experience

Will this impact on the clinical time?

As the approach to teaching and learning is developed on an individual basis,
it is difficult to predict how much time this will involve. However, given that all
trainees are experienced optometrists, it is hoped that this will not be too
onerous. The trainee will not need to spend the entire placement with the
mentor, as other clinicians may be better placed to provide some of the
learning opportunities. However, the mentor maintains overall responsibility
for the trainee and will validate their clinical experience. The Royal College of
Ophthalmologists has issued advice to ophthalmologists regarding clinical
placements:

http://www.rcophth.ac.uk/standards/supplementary-prescribing.

Teaching and learning

How do adults learn?

The mechanisms of adult learning are complex and relatively unknown,
although it is generally acknowledged that adults learn in a different way to
children and adolescents. Adult learners display the following characteristics:
 They are not beginners, but are in a continuing process of growth
 They bring a unique package of experiences and values with them
 They come to education with intentions
 They bring expectations about the learning process
 They have competing interests: including the realities of their lives

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  They already have their own set patterns of learning

So, adults learn best when:

 They are engaged in planning their learning programme
 They are encouraged to be self-directed
 Their past experiences are taken into account and used within the
learning process
 They can recognise how the learning can be applied in a practical way
 Their individual learning needs and learning styles are taken into
account
 The trainer / educator takes a facilitative approach to teaching, rather
than a didactic one
 The climate / environment is conducive to learning

There is a school of thought that adults learn best from self-directed learning.
Teaching of adults should be aimed at guiding the trainees learning rather
than direct instruction. In reality, effective teaching and learning often requires
a blend of both approaches, based on what is being taught.

Once you agree in principle to being a Mentor, a City University

representative will be available to answer any queries regarding the clinical
placement. If appropriate, payment per trainee can be locally negotiated. It
may be possible to bring together a small group of optometrists from the same
geographical location that can be mentored collectively by the same
ophthalmologist.

You are encouraged to work closely with the University to ensure that the
trainees learning needs are met. If you require any further information, please
do not hesitate to contact me email: J.G.Lawrenson@city.ac.uk or tel: 0207
040 4310.

Professor John Lawrenson

Director of the City University Prescribing Training Programme

References

Adult Learning. GP training website

http://www.gp-
training.net/training/educational_theory/adult_learning/index.htm

Department of Health. Review of prescribing, supply and administration of

medicines. March 1999

Department of Health. The NHS Plan: a plan investment, a plan for reform.
July 2000

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Needle, J., Petchey, R., Lawrenson J.G. (2008) A survey of the scope of
therapeutic practice by UK optometrists and attitudes to an extended
prescribing role. Ophthalmic & Physiological Optics, 28, 193-203

Titcomb, LC & Lawrenson, J.G. (2006) Recent changes in medicines

legislation that affect optometrists. Optometry in Practice, 7, 23-34

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