The design and implementation of a study to investigate the effectiveness of community vs hospital eye service follow-up for patients with neovascular age-related macular degeneration with quiescent disease.

IntroductionStandard treatment for neovascular age-related macular degeneration (nAMD) is intravitreal injections of anti-VEGF drugs. Following multiple injections, nAMD lesions often become quiescent but there is a high risk of reactivation, and regular review by hospital ophthalmologists is the norm. The present trial examines the feasibility of community optometrists making lesion reactivation decisions.MethodsThe Effectiveness of Community vs Hospital Eye Service (ECHoES) trial is a virtual trial; lesion reactivation decisions were made about vignettes that comprised clinical data, colour fundus photographs, and optical coherence tomograms displayed on a web-based platform. Participants were either hospital ophthalmologists or community optometrists. All participants were provided with webinar training on the disease, its management, and assessment of the retinal imaging outputs. In a balanced design, 96 participants each assessed 42 vignettes; a total of 288 vignettes were assessed seven times by each professional group.The primary outcome is a participant's judgement of lesion reactivation compared with a reference standard. Secondary outcomes are the frequency of sight threatening errors; judgements about specific lesion components; participant-rated confidence in their decisions about the primary outcome; cost effectiveness of follow-up by optometrists rather than ophthalmologists.DiscussionThis trial addresses an important question for the NHS, namely whether, with appropriate training, community optometrists can make retreatment decisions for patients with nAMD to the same standard as hospital ophthalmologists. The trial employed a novel approach as participation was entirely through a web-based application; the trial required very few resources compared with those that would have been needed for a conventional randomised controlled clinical trial.

Veterinary school admission interviews, part 1: literature overview.

An analysis of the admission interview used by schools in four health professions (veterinary medicine, allopathic medicine, optometry, and dentistry) portrays a largely similar approach to selection interviews: INTERVIEW USE: At least 80% of schools interview applicants. For schools that offer interviews, at least 40% of candidates are interviewed (a strong academic profile is the number one determinant of receiving an interview offer). The interview is one of the three most important selection tools used by schools. Less than 26% of schools fix the interview's weight in the selection process (fixed weights range from 31% to 35%). INTERVIEW PURPOSE AND CONTENT: The most common purposes of the interview are to (1) gather information, (2) make decisions, (3) verify information provided in other parts of the application, (4) recruit candidates, and/or (5) promote public relations. The most common characteristics and skills interviewers are interested in assessing are motivation for the profession, interpersonal skills, and communication skills. The desire to assess cognitive ability with the interview (>25% of schools) is surprising in view of the use of other selection tools (e.g., GPA). INTERVIEW FORMAT: Medical schools are more likely to offer two interviews per candidate, while optometry schools are more likely to offer one interview per candidate. Individual interviews (one interviewer, one candidate) are the predominant format among medical schools, while panel interviews (more than one interviewer, one candidate) are the most common format among optometry schools. The duration of the interview is 30 to 45 minutes. Interview questions most often address facts and knowledge, hypothetical situations, and the ability to meet program requirements. Most interviews do not meet the criteria for a structured interview, which has demonstrated greater validity and reliability than semi-structured or unstructured interviews. INTERVIEWERS: Interviewers are most likely to be health care faculty members (e.g., veterinarians at a veterinary school). Interviewers receive limited training. RECOMMENDATIONS FOR INCREASING INTERVIEW RELIABILITY AND VALIDITY: The purpose(s) of the interview must be clearly articulated so that the interview and interviewer training can be designed to achieve that purpose. Interview structure should be increased by developing a "job analysis" set of questions that is posed to all candidates and scored using behavioral anchors. Interviewers should receive more training in rater bias, listening skills, and interview structure. Panel interviews should be used to increase reliability. Interviewers should not have access to the candidate's application unless the interview is used to verify information. To increase the utility of the interview in the selection process, the weight of the interview in relation to other selection components should be determined.

Comparison of entrance requirements for health care professions.

OBJECTIVE: To compare U.S. chiropractic college admissions requirements with those of allopathy, osteopathy, optometry, podiatry and dentistry. DESIGN: Survey. PARTICIPANTS: The schools that participated in the comparison were selected based on their geographic location within the United States. The number of schools selected were 16 chiropractic college, 17 allopathic colleges, 16 osteopathic colleges, 16 optometric colleges, 7 podiatric colleges and 15 dental colleges. MAIN OUTCOME MEASURES: Information collected from the individual schools included: (a) minimum number of undergraduate semester hours (toward a bachelor's degree) that are required on entrance; (b) actual percentage of applicants with a 4-yr bachelor's degree on entrance; (c) minimum GPA required on entrance and (d) actual average GPA of applicants on entrance. RESULTS: Averages were computed for each outcome. Overall, allopathic averages were highest and chiropractic averages were lowest for each of the four outcome measures, with the other programs scoring at varying points in between. CONCLUSION: Successful completion of preprofessional requirements may be an indicator for success within a rigorous professional curriculum. These data reflect overall differences between health-care professions on a very few entrance criteria. Further investigation is needed to understand the long-term impact of these differences as well as the possible economic or political factors that may be influencing these results.

Improving student understanding and management of patients through role-playing and video taping.

A teaching program that uses video tape and simulated patients assists the student in developing skills necessary for good professional relationships with patients and augments the student's ability in patient inverviewing and effective interview behavior. Role-playing by selected drama students and community theatre actors involves common problems encountered in the optometrist's office and management of problem patients (angry, aggressive, shy, withdrawn, talkative, flirt, hypocondriac, etc.).