Rethinking, reimagining, redoing how optometry learns

Excerpted from the May/June 2021 edition of AOA Focus.

Four decades ago, medical knowledge generally doubled every seven years.

Today?

Try every 73 days.

Like other academics, Roya Attar, O.D., sees firsthand this rapid expansion of medical information as creating a paradox of sorts—knowledge is growing much more exponentially than our ability to assimilate it.

“Medicine and health care altogether are changing at a rapid pace in many aspects, from evidence-based medicine to the delivery of health care,” says Dr. Attar, assistant professor and director of optometric services at the University of Mississippi Medical Center.

“Emerging technologies, such as diagnostic imaging, and treatment modalities, such as genetic testing or pharmacogenetics, are leading us into new frontiers of medicine and health care. Education—whether at a basic, professional or post-graduate level of continuing education—has to keep up with all these changes.”

And change is the constant. Inevitable and necessary, a fundamental shift in the way optometry approaches continuing education (CE) and professional development in the 21st century ensures doctors continue to not only deliver quality, evidence-based patient care but also efficiently operate their practices in a manner that espouses contemporary optometry.

To the latter, Dr. Attar emphasizes that CE goes beyond providing a simple refresher and into the realm of delivering emerging concepts and trends. She emphasizes the adoption of virtual learning platforms that promote greater accessibility, reiterating feedback she received from her lectures during the AOA’s Virtual Learning Livecast in 2020 that the platform increased audience engagement. She points to the emergence of co-lectures with other disciplines, such as endocrinology or rheumatology, in fostering the importance of interdisciplinary care. All the while, she reiterates the importance of multifaceted CE on an ongoing basis to support optometry’s primary eye health care role.

“We know that when doctors work together as part of a patient’s interdisciplinary health care team, it results in a better health outcome for the patient,” Dr. Attar says. And that is the aim.

Better patient care is the end goal of an education initiative nearly four years in the making by the AOA. This re-envisioning of what ongoing, post-graduate optometric education and professional development look like in contemporary practice focuses on delivering the latest education to doctors and staff, when and where they need it to be most effective. That change is happening now.

Value of year-round education

It starts with a change in mindset; namely, realizing the intrinsic value of education alone as opposed to approaching education from the CE-for-licensure standpoint. Ronald L. Benner, O.D., AOA secretary-treasurer and board liaison to the AOA’s Education Center, emphasizes that education is about professional enhancement—the capability to learn about new and current evidence that supports patient care and best practices. So, too, it’s about seeking education that refreshes and expands our foundational knowledge.

“The rate of medical knowledge is now doubling at a much faster rate than ever before and for doctors to keep up with that is tremendous,” Dr. Benner says. “We have to be able to offer professional development courses when and where it is convenient to the doctor, their staff and their practices.”

Toward that end, the AOA’s education initiative is ensuring a year-long curriculum of educational courses that leverage not only traditional, in-person learning settings, such as Optometry’s Meeting^®, but also the evolving and contemporary virtual formats where doctors and staff can still receive their educational hours.

Likewise, the AOA has begun offering association credit for courses provided through these AOA channels. This evolution allows for the AOA to expand education offerings and deliver clinical, business and communication-related topics that advance the practice of contemporary optometry. This new

AOA credit expands the concept of what CE is while still maintaining the high standards for education and delivering innovative and unique content not found elsewhere.

Doctors should know that AOA credit does satisfy most state boards’ CE requirements and is respected by many organizations within the practice of optometry; however, knowing that some states still require specific COPE (Council on Optometric Practitioner Education) credit, the AOA continues to offer these courses for the benefit of members. Dr. Benner stresses that the goal of delivering high-quality and continuous professional development is to give doctors and staff education that not only fulfills clinical education needs but also supports practice efficiencies, such as business or management courses.

“Some people have defined education as needing credit hours for licensure, but we’re really talking about two different things here,” Dr. Benner says. “Education for licensure is sitting through a course for two hours and getting a certificate to prove it—that’s not necessarily professional development. While it can be professionally enhancing, it may not be in the context of a one- or two-hour block that has no follow-up reinforcement. We have taken the position that we want truly professional development that improves patient care and year-round learning.”

George Veliky, O.D., AOA Education Center co-chair, says the speed at which information and knowledge accumulates today makes it nearly impossible to stay fully up to date when relying solely on a single, annual CE event with repeated lectures prepared months in advance. The ongoing COVID-19 public health emergency serves to underscore that point. Perhaps even more markedly, though, the pandemic played the part of accelerator for year-round education.

When COVID-19 restrictions forced the cancellation of traditional, in-person CE events in 2020, doctors of optometry nationwide scrambled to find educational opportunities. The AOA’s pivot from Optometry’s Meeting to the newly launched Virtual Learning Livecast—an online-based event that offered 62 courses and spanned four days with sessions primarily after business hours—and the profession’s positive reception of such an unconventional CE opportunity demonstrated that online education isn’t going away.

“Right now is a prime opportunity to have year-long education and really start to view education as something that isn’t confined to a lecture hall,” Dr. Veliky says. “That’s almost an outdated way of thinking about it since there are so many ways to learn now, and we want to offer those alternate avenues of learning and education to our members beyond simply sitting in a classroom.”

But how does that work? The AOA Education Center envisions a progressive, comprehensive series of courses that can navigate attendees through the fundamentals of a topic to the advanced applications, leveraging each of the AOA’s education platforms in a way that allows doctors and staff to learn at their own pace. In other words, paraoptometric staff education may begin with a fundamental course available on-demand through the AOA’s EyeLearn library. Once completed, that staff may progress to a pair of courses available at the Virtual Learning Livecast and, ultimately, complete the series with a hands-on workshop at Optometry’s Meeting. All the while, that learner earns AOA credit to demonstrate mastery of the subject matter.

Gone are the days of a doctor attending a Thursday lecture at Optometry’s Meeting that leaves them so enthused and excited to implement change, then returning to their office on Monday and thinking, “Okay, where do I start?” Dr. Veliky says. Inevitably, that doctor just waits until next year to sit in that same course to jot down the next take-home point. Dr. Veliky says it’s time to break that monotony.

“If we have an opportunity to have stepwise learning opportunities year-round, we can help people develop the competencies and initiative to help really implement a change that benefits the profession,” he says.

Reimagining: Contemporary education for a contemporary profession

Imagine, for instance, a series of courses on a particular subject, rather than sitting in on a two-hour lecture. Literally, not being confined by conventions and digesting content at your convenience.

In 2021, the AOA Education Center Committee will roll out curricula or programs in five disciplines: diabetes certification, telemedicine, future practice education, financial literacy and vaccines. Courses within the curricula/programs will be offered in various formats year-round, including via webinars, master classes, the Virtual Learning Livecast and EyeLearn Professional Development Hub.

“Continuous, year-round development will offer a greater opportunity for eye care providers to take on the commitment to continue to learn in a world that’s rapidly evolving, as technology gets greater, disease intervention happens earlier and our ability to intervene and treat becomes greater,” Dr. Veliky says.

“That shift will help us become better able to survive and thrive in the ever-evolving health care environment,” he adds. “You can’t simply go to a course once a year and learn and go back and put it into practice. You’ve got to keep learning year-round. You’ve got to.”

Read on to learn more about the new curricula/programs and their rationale.

Diabetes certification: Keeping up with knowledge

With more than 34 million Americans living with diabetes and many millions more prediabetic, doctors of optometry are increasingly the first health care providers to diagnose patients with diabetes.

The AOA’s stellar Evidence-Based Clinical Practice Guideline: Eye Care of the Patient with Diabetes Mellitus, Second Edition, which was released in November 2019, will be a guide for the series of courses on diabetes certification and how to integrate best practices into an optometry practice.

“What we know about diabetes is changing tremendously and the treatment paradigms have shifted tremendously,” Dr. Veliky says. “So, the curricula will be a good opportunity for year-round education and content to be delivered in short doses.

“The curricula will update doctors of optometry about the basics of the disease, the impact of the disease from systemic and ocular standpoints, the treatment modalities, how to work with your endocrinologist, how to talk to patients about better sugar control and the importance of blood pressure and controlling your lipids as well, because diabetes is not just blood sugar,” he says. “It goes hand in hand with hypertension as well as hypercholesterolemia. All three are essential for the best long-term outcome.”

The diabetes curricula is the first to launch and includes courses directed at paraoptometrics and their role in caring for patients with diabetes. Long gone are the days of a single optometrist working by himself or herself in a small office, Dr. Veliky says. The times require a more educated staff.

“I can only see so many patients by myself,” he says. “Paraoptometrics being educated at least to the basics of understanding what’s happening—that’s going to make staff more efficient and the doctor that much more productive.”

Adds Carol Lovell, CPOT, CPOC, Education Center Committee member: “Paraoptometrics are an essential part of the optometric office as we are the first point of contact and the last point of contact with the patient. The courses will allow the optometrist to send their staff for education and know that the paraoptometric will return with the knowledge and confidence to know the specialized testing needed for different medical diagnosis, such as diabetes. The paraoptometric also will know how to communicate to a patient why the testing is important and will know what questions to ask for history taking.”

Financial literacy: Building business acumen

Optometric physicians, Education Center Committee Co-chair Brad Lane, O.D., observes, are taught to assess ocular health and recognize abnormalities, but they seldomly have the knowledge to gauge the well-being of their practices.

“I’ve asked myself several times, ‘Could my practices be diagnosed with bradycardia?’” says Dr. Lane, referring to the condition in which people have slow heart rates. “I think it is important to look at the different stages of our optometric careers and acknowledge the challenges and struggles we face along the way. From the fresh-faced, excited new graduate to the seasoned veteran planning for retirement, we all have questions.

“How do I pay all of these student loans?” he says. “How do I value this practice I would like to purchase? How much is my private practice really worth? Am I really prepared to retire? Or when should I plan to bring on an associate with the expectations of them taking the reins one day? These are questions that can leave us all puzzled and scratching our heads.”

It will benefit doctors to have even a basic understanding of finance and accounting, plus common benchmarking calculations and best practices, to assist them in dealing with stressful financial hardships if or when they arise.

To fill the knowledge gap and be a good steward of his gifts, Dr. Lane earned his master’s in business administration five years ago, but the Education Center Committee wants to provide more accessible education opportunities to doctors. A curriculum focused on financial literacy is being devised.

“Above all, it is important to understand that we have been extremely blessed with the responsibility of caring for others,” says Dr. Lane who practices in West Virginia.

Telemedicine: From policy to practical

Last October, when the AOA Board of Trustees adopted updated and groundbreaking recommendations from its Telehealth Council on its 2017 AOA policy, Jerry Neidigh, O.D., thought hard on how doctors of optometry on the ground could integrate the position statement on telemedicine in optometry into their practices. Dr. Neidigh, who practices in Virginia, is a member of the Telehealth Council.

“When the position paper update was brought to me, I was excited to see the AOA taking the rapid changes in telemedicine and technology to heart,” Dr. Neidigh says. “The AOA’s progressive desire to lead the discussion on telemedicine and on what will continue to become a greater part of our profession and health care was very timely.

“My thought on the position paper was that we needed to not just develop a new position but to take it a step further and educate our members about the AOA’s new position,” he adds. “This includes defining telemedicine and what telemedicine should and shouldn’t be. We all agree that a bona fide doctor-patient relationship is a must and any technology that tries to work around this should not be tolerated. These disruptive technologies put the patient’s health and care at risk.”

Yet, that doesn’t mean telemedicine/telehealth doesn’t have its merits. The telemedicine curricula would: 

• Provide doctors of optometry the tools and education to identify the good and bad of telemedicine/telehealth.
• Prepare doctors of optometry to meet the evolving mindsets and care of patients, changes hastened by the COVID-19 crisis. “This is not to say that a virtual visit can or should replace an in-person visit, but any virtual care must be at least equivalent to an in-person visit,” Dr. Neidigh says.
• Offer practical education on how to integrate telemedicine into practices, including how to start, how to bill for it and how to best utilize their paraoptometric staff in providing it.

“Telemedicine is here to stay, like it or not, and you can choose to watch it from the sidelines, or you can be a part of it, help shape it and provide this service that many of our patients will want,” Dr. Neidigh says. “The more involved we are in these ever-evolving technologies, the better the care we will provide and the safer and healthier our patients will be.”

Vaccination: To vaccinate or a voice for vaccination

Count vaccination as another case of contemporary optometry calling on doctors of optometry to expand their care. And the AOA Education Center Committee fully recognized the opportunity for doctors of optometry as it is planning a program of courses for doctors on vaccination.

“It’s an opportunity we have to show other health care providers what we are capable of,” Dr. Veliky says. “Certainly, in this global pandemic, the ability for us to help out and be vaccinators, or at least be a voice to our patients to be vaccinated, is a necessity.”

Doctors of optometry need to be prepared to administer vaccines if their states allow, or at the very least, talk to patients about getting vaccinated, Dr. Veliky says. He has gone out of his way to talk up the vaccinations with patients who come to his New Jersey practice.

“Being comfortable with that discussion starts with an education about the necessity of vaccines and how they work and the difference between traditional vaccines and mRNA vaccines,” Dr. Veliky says.

“Having the AOA offer education on how vaccines work, their side effects, the adverse effects—these basic educational opportunities—is essential,” he says.

Contemporary practice: advanced procedures

The AOA Education Center Committee is working on a program that would cover such advanced procedures as office-based surgery, local or infiltrative anesthesia, and ophthalmic lasers, along with additional topics selected from the full spectrum of diagnostic testing and therapeutics used in primary eye care. This program will enable doctors, at different points in their practices, to enhance and refine their diagnostic and technical skills. Many of the topics and technical skills doctors of optometry mastered in optometry school—including anatomy, histology and handling small, delicate instruments around the eye under magnification, for example—transfer laterally and seamlessly into the contemporary surgical and laser procedures offered by optometric physicians in many states. The program would dovetail with the AOA’s ongoing advocacy to expand the scope practiced by doctors of optometry in their respective states.

“Ongoing optometric scope expansion is now an inevitability,” says Richard Castillo, O.D., D.O., co-chair of the AOA’s Contemporary Practice Education Task Force. “Outdated practice statutes, which are unable to keep up with the dynamic and constant turnover of the optometric and medical knowledge base are, in many instances, preventing optometric physicians from practicing up to established community standards of care.

“We’re actively planning, gathering resources and establishing opportunities to provide continuous, advanced practice education, including office surgical and laser skill set development to the nation’s optometric physicians,” he adds.

Resources for all the curricula and programs would be available for access by doctors of optometry and others on an ongoing basis through EyeLearn Professional Development Hub.