Hear from Associate Prof. Peter Hendicott, Immediate Past President of the World Council of Optometry, and Dr. Yazan Gammoh, WCO Education Committee Chairman, on the newly released WCO Competency Framework for Optometry.
PROF. HENDICOTT
Hello, I’m Associate Professor Peter Hendicott, Immediate Past President of the World Council of Optometry, and I’m here today with Dr. Yazan Gammoh, who is Chairman of the WCO Education Committee.
DR. GAMMOH
We’re here today to talk about the newly released WCO Competency Framework for Optometry.
What is the broad purpose of this competency framework?
PROF. HENDICOTT
The framework establishes competencies that are expected as outcomes of tertiary-level optometry education at a minimum level. These competencies align with the long standing WCO definition of optometry, but also, importantly, with other international benchmarks, such as how optometry is described in the WHO’s Eye Care Competency Framework (ECCF). [WCO’s] new framework describes the profession of optometry in terms of what skill set it is able to bring to the international agenda for eye care.
On top of that, the framework will also help countries and educational institutions to develop programs to target specific knowledge and competency gaps, supporting the growth of optometry and its participation in the future health care agenda.
What inspired WCO to revise its competency model?
DR. GAMMOH
Recent vitally important global reports, such as the World Report on Vision and the United Nations General Assembly resolutions, have outlined the challenges facing eye care and the impact of vision impairment on the achievement of the United Nations’ Sustainable Development Goals, especially the inclusion of refractive error correction within the universal health coverage.
Also, as we are aware, the increased uncorrected refractive error and its accompanying potential blinding diseases, for example, diabetic retinopathy, glaucoma, and age related macular degeneration, should call for the need for adequately trained and qualified eye care workers, including optometrists. For that, WCO sought to revise its competency model to better prepare optometrists to meet the eye care needs of the community, now and in the future.
What changes have been made when compared with WCO’s previous model?
PROF. HENDICOTT
The previous [WCO] model people are used to included four progressive levels of competency based on a scope of practice.
So, at a basic level, optical technology services, which is basically refraction only; visual function services, refraction plus some assessment; diagnostic services, where people are looking at the presence of eye disease, etc; and then, for a number of optometrists in different parts of the world, therapeutic services, where optometrists can prescribe medications for a range of eye diseases.
In our past model, people at the second and third level and above were considered optometrists. This document was a very important first step into providing greater harmonization of optometric education. But the tier system, [while] it was a good step, allowed for still a wide variation of education, with some programs struggling to reach an educational level that produced outcomes consistent with WCO’s Concept of Optometry.
So, to support that Concept of Optometry and also to better describe who optometrists are and what they can do, WCO has changed that model into a model that has five competency domains. Each of these lists a range of outcomes expected for graduates to have when they enter the profession of optometry, as well as the competency statements describing what entry-level optometrists should be able to do.
The document also brings together elements of curriculum that are required to support the development of each of these competencies within each domain. So, we’ve tabulated the competencies against the educational curriculum framework that supports their development, and on top of that, we also have a document called the Eye Care Competency Framework (ECCF) from the World Health Organization (WHO), which we’ve mentioned before, and we’ve cross-matched the competencies in our new framework document with those in the ECCF where that’s possible. So, we now have a document that describes the broad skill set of optometrists and which clarifies who they are and what they can do, and that’s important when we look forward to a broader role in health care in the future.
WCO has grouped its competencies into five broad competency domains– can you talk a bit about this choice?
DR. GAMMOH
So, allow me to build on what Peter has just mentioned. Optometry as a profession needs to ensure that graduates entering the optometry profession, through robust and quality education, have the knowledge and skills that underpin the competencies required to equip them for their multiple roles in eye care delivery.
When we were reviewing the models and reviewed the evidence, it has been shown that an optometry curriculum designed to encompass the minimum competencies expected from optometrists to practice as the WCO Concept of Optometry, will allow actually for an increased scope of practice. For that, the WCO, as Peter mentioned earlier, modeled its framework now to have five competency domains designed for a tertiary-level education program, of course with corresponding learning outcomes for entry-level optometry practitioners.
The framework is divided, as I said, into five competency domains. The first one is refractive error and the second one is visual function assessment. Then, we delve into ocular health and ocular diseases. The fourth one is about public health. This was also lacking in the previous WCO model. And last but not least, professional practice, which is actually now considered more and more important.
These competencies, and as Peter has mentioned the WHO Eye Competency Framework, we worked diligently to match them together to allow for an in-depth view of an optometry curriculum.
How does this framework help to advance optometry’s commitment to global eye care?
PROF. HENDICOTT
We’re all well aware from the publication of the World Report on Vision and subsequent document, The Lancet Global Commission on Eye Health, which were produced in the last three or four years, that there’s a range of challenges that are facing eye care in the future.
So as optometrists, we need to be prepared to be able to participate in multiple roles within these health systems, not just in primary care roles, but potentially in secondary care settings, as well as community settings. And we also need to be prepared to work with others in the delivery of care. Future eye care is going to need all practitioners who work in eye care, to work at their maximum scope, using their full range of skills at the highest level. So, the competencies that we put in the framework provide this opportunity for optometry in many countries to argue for a broader role in eye care, as long as practitioners are educated and trained in the right way.
We have the chance to work in a broader scope, different roles in eye care, and potentially in leadership roles in teams of people delivering eye care. It puts optometry in a position where it is able to participate more broadly, but importantly, it also demonstrates to people who are looking at their health system, what skills optometrists have and can bring to better delivery of care.
How do you envision this document being used in optometry education and by government entities?
DR. GAMMOH
So, basically, the framework that has been designed by WCO sets out a minimum level benchmark as to who an optometrist is, in terms of their competency set.
This framework demonstrates a minimum scope of practice, and by clarifying this to the policy makers and legislators, it will enable the profession to be engaged in this discussion around who can really be called an optometrist and of course, their scope of practice. This will help us to build the pathway to legislation to protect the public, which is our main aim. And for educators themselves, they can use this framework to identify competency gaps in their education outcomes. Also, it will allow them to design sort of like a bridging program to grow the skills and competencies of existing optometrists.
What do you view as the most important takeaway from this new framework?
PROF. HENDICOTT
We’ve now got a set of statements that define optometrists in terms of who they are, what they can do and what they can bring to the table in meeting the future demands for eye care. So we set this at a minimum level, recognizing that in some countries, optometric education already provides competencies beyond the ones we’ve outlined in the five domains, most particularly, in the management of ocular disease and treatment of ocular disease with therapeutic drugs, which is not practiced beyond the handful of countries currently in the world.
So as I’ve just said, the document outlines what WCO considers minimum competencies that should be expected as outcomes of optometric education. Importantly, the way these are structured aligns optometry with other current international definitions of optometry, for example, how it’s described in the Eye Care Competency Framework (ECCF) from WHO and also the International Labor Organization.
So, it’s important to clarify to everybody who optometrists are and what they can do, and I think that’s an important step for us as a profession, given the variation in how optometry is labeled in different parts of the world. We’re sort of saying, “No, optometrists are this group of people who have this group of skills and this group of knowledge and can do these things.” That’s important for the development of legislation and important for defining roles and future roles. And on top of that, as Yazan mentioned, whilst we’re talking about entry-level competencies here, WCO recognizes that we also need to further develop our current practitioners and build their skill set and their knowledge set, so they too can make a greater contribution.
So I think the message is: We want to grow as a profession.
The document shows a path for many of us, a way forward in growing the profession and will help us have the profession recognized and have the profession perhaps potentially legislated where it currently isn’t, so that only people who meet the criteria defined in legislation are recognized as optometrists. And that clarifies to the public that practitioners are appropriately educated. So overall, our goal in developing this is to bring the profession forwards and upwards so we can make a greater contribution to the current demands and future demands in eye care.
DR. GAMMOH
We’ve seen lately a trend in countries like the UK, Australia, and many developing countries having a national competency framework. And with the release of the WHO Eye Care Competency Framework (ECCF) and the WCO Competency Framework for Optometry, this will inform educators and policy makers in these countries to envision how optometry is incorporated into their national competency frameworks. So this document is very timely, and as [Peter has] mentioned, it sets minimum competency levels. The WCO is aware that optometry is more advanced in certain countries. This framework will not restrict what is the scope of optometry in these countries, rather help build the optometry curriculum.
As well, we are aware in WCO that, you know, the science is changing, including artificial intelligence. So, we are aware that this document may need to be revised in the near future. However, it’s a bit future-proofed, at least for the time being. But it’s now the time for us to consider this as for what will happen in optometry in the near future and hopefully beyond.
Final thoughts?
PROF. HENICOTT
On behalf of the World Council of Optometry, as the Immediate Past President, I’d like to thank the Education Committee and a significant number of people who volunteered their time and expertise in developing the document.
It’s been a considerable task and gone through many iterations involving lots of people and points of view, but I think with all that, it’s developed a very strong document that will enable the profession to grow, and as Yazan said, not restrict that growth in countries who are at a higher level already. I think we’ve got something we can work forwards with. And to our colleagues, if you do look at the competency framework document and you have any feedback you want to provide to us, we are happy to receive that because through feedback these documents can grow in their strength and their quality.
DR. GAMMOH
May I say something personal? I would like to thank you, Peter, for envisioning this document. Really, you are a visionary leader. We at the WCO Education Committee learned a lot from you. I have to say it, from the bottom of my heart. Also, as you are aware, the WCO website has a Resources page that now is updated to include the WCO Competency Framework for Optometry. So, [it can be viewed] in full on the WCO website.
I would like also to thank all the members of the Education Committee, past and present, who worked diligently to get this into the final shape. Thank you so much.