Bridge Between School and Practice
of eyecare practice has grown dramatically in recent decades. For
example, optometry now encompasses diagnostic and therapeutic drugs,
surgical comanagement and much more, yet the length of schooling has
not drastically changed. With all the complex information students
need to absorb in four years or 14 quarters, some of the everyday
aspects of practice such as patient communication and contact lens
fitting can become lower priorities.
realized that it had an opportunity to partner with students and
practitioners to build professional relationships and to foster more
confident and proactive vision care. Helping eyecare professionals
be better contact lens fitters is good for practitioners, good for
their patients and in the long run, good for the industry, says Phil
Keefer, President, The Vision Care Institute. With that idea, The
Vision Care Institute, LLC (TVCI), a Johnson & Johnson Company, was
beginning, our goal at TVCI has been to support academic and
professional achievement, independent of commercial interest.
Although educators use Acuvue lenses in fitting sessions, the
didactic lectures cover a range of options. In this, we modeled TVCI
after another Johnson & Johnson initiative, the Ethicon Endosurgical
Institute, which has been educating doctors on laparoscopic
procedures for more than 20 years.
TVCI boasts a state-of-the-art facility in Jacksonville, Fla., along
with seven sister facilities worldwide. There are about two dozen
faculty members in the United States and many more around the world.
Cumulatively, they've served 10,000 students and professionals since
2004 and, this year alone, another 10,000 eyecare providers will
participate in the program.
program in Jacksonville is open to all fourth-year optometry
students in North America, as well as to opticianry students and
ophthalmology residents. A maximum of 36 students participate in
each session, with about 40 sessions scheduled for 2007. The program
is free, and TVCI also covers travel, lodging and meal expenses for
doesn't seek to replace the education that students receive in their
schools. Rather, its purpose is to set the stage for students to
build on their education, improve their clinical skills and develop
the confidence to bridge that transition from student to practicing
optometry schools have been supportive partners. George Foster, OD,
the Dean of the Northeastern State University-Oklahoma College of
Optometry (NSU-OCO), has attended the program with his students and
views it as an important head start as they prepare to embark on
their own careers.
Dr. Foster's missions is to make sure his students can earn a living
when they graduate. He says TVCI has provided an empowering
experience for his students and that partnering with industry to
help them develop their communication skills and network with
industry leaders has been a great opportunity.
Figure. The Vision Care Institute in Jacksonville, Fla.
The Student Experience
presents an intensive three-day program during which the students
spend almost all of their waking hours together. After an
introductory session, students break out into three smaller groups
that rotate among modules on patient communication, fitting
presbyopes and fitting astigmats.
Doctor-patient communication is a major aspect of modern practice,
yet it's one of the toughest skills to teach. TVCI instructor Kelly
Kerksick, OD, a private practitioner in Columbia, Ill., tries to
stress to students that being a good communicator can make them more
efficient. If young eyecare professionals can learn to make an
assertive professional recommendation, she told a recent class, they
will find that patients have more confidence in them and are more
likely to move forward with the recommended course of action.
start the communications module with a confidential personality
assessment to give them insight into how peers and patients are
likely to perceive them. A didactic session with Dr. Kerksick or
another faculty member is a chance to review basic concepts. From
there, students go right into mock patient encounters in which they
are asked to deliver bad news to a patient or explain presbyopia to
a contact lens wearer who is having trouble reading.
encounters are videotaped so that students can later review their
initial presentation, their coach's recommendations and their
follow-up presentation. Most students show a significant improvement
in their body language, tone and clarity of the information after
their coaching session. Students leave with their video on a DVD
that also contains plenty of constructive feedback.
consistently tell us this communications module is one of the most
memorable aspects of the program. Caleb Schoonover, an NSU-OCO
optometry student and outgoing president of the American Optometric
Student Association, says the experience was intimidating at first
because it pushes students out of their comfort zone. But he says he
learned some valuable lessons about how posture or hand gestures can
affect patients' perceptions. Schoonover says he still catches
himself doing some of the things that he saw himself doing initially
on the DVD, but he's now much more aware of his body language during
Patients Although contact lens education is part of
the curriculum at all optometry schools, actual experience with
fitting more complex cases is often limited. One of our goals at
TVCI is to ensure that new practitioners take with them skills that
will add value to a practice and will help them eventually build
their own patient base.
comfortable fitting specialty lenses is one such skill. In fact,
given the percentage of people who have astigmatism and/or
presbyopia, the day will come when multifocal and toric IOLs aren't
even considered a specialty. But for now, practitioners who know how
to fit these lenses and aren't hesitant to prescribe them are still
in the minority.
astigmatic fitting module, students learn about toric lens design
and fitting principles, learn to identify scribe marks on toric
lenses from a variety of manufacturers and have an opportunity to
fit several patients.
Frank, a fourth-year student at Pennsylvania College of Optometry,
says that the exposure to astigmatic patients was a huge benefit to
her because her contact lens fitting experience in school was
limited. The whole experience was based on providing the best care
for the patient, whether that involved an Acuvue lens or not, she
says, adding that the course really built her confidence in her own
ability to fit these challenging patients.
Patients In the presbyopia module, students have a
didactic lecture on changes in the aging eye and then head into the
exam rooms to fit several presbyopic patients. Afterward, they
receive feedback from faculty, peers and from the patients, then get
a chance to try multifocal lenses themselves.
Figure. TVCI offers experience with the latest
Schoonover says he got some great tips on how to make the transition
through presbyopia easier for patients and how to set patient
University student Tim Birtwhistle says the experience is helpful
for anyone who hopes to have a strong contact lens practice after
graduation. Many people start out with preconceived notions of how
they're going to fit presbyopic patients, but the Institute did a
great job of presenting all the options, from monovision and
modified monovision to multifocal contact lenses, he says.
Birtwhistle left the course with some tools he can use in practice,
such as an algorithm of steps to take in fitting presbyopes that
provides an 80 percent or better success rate.
The Big Picture
We also try to expose students to a broader view of the future of
optometry. Not only will these students be implementing what they
learned in optometry school once they're out in practice, but
they'll also face new challenges such as incorporating higher-order
aberrations into refractive correction and integrating thousands of
digital diagnostic images into patients' medical records.
pulled many of the latest diagnostic devices and other new
technologies together in a lab we call the exam room of the future.
Here, students can get a sneak peak at some of the technologies they
may be using routinely in practice someday.
A Chance to Give Back
proud of the world-class faculty who teach at TVCI while maintaining
busy practices of their own. We ask each of them to serve more as a
coach or mentor to the students who visit TVCI, modeling appropriate
communications and providing feedback.
Kerksick says that teaching at the Institute is one of the most
rewarding things she does. I feel that I've grown tremendously as a
practitioner because the students constantly challenge me to be my
best, she says.
actively seek out faculty members like Dr. Kerksick who have
distinguished themselves in the eyecare professions, are natural
teachers and have a strong interest in mentoring young people. Many
of them field calls or e-mails from former TVCI participants
inquiring about clinical matters, contract negotiations or equipment
purchases. Some have hosted students at their practices or even
hired young optometrists they met through TVCI.
program has evolved, we've sought out younger faculty members that
students can easily relate to, and we've tried to keep our faculty
mix diverse in terms of region, gender, race and practice modality
so that the faculty is representative of the audience we serve.
seems to be a veil of mystery between what students learn in school
and what practitioners know but weren't taught. Our faculty's job is
to pull back that veil for a little while, so that students can
learn from seasoned practitioners who are willing to speak to them
the most exciting new initiatives for the Institute is our
commitment to build satellite TVCI conference rooms at optometry
schools around the country. The conference rooms will mirror those
at the Jacksonville TVCI, with multimedia screens on every wall,
high-speed Internet connections and built-in audio and video
Figure. Dr. Walt West teaches students at TVCI's Sullins
envision that optometry students in California or Michigan or
ophthalmologists in China will be able to watch a patient encounter
in Jacksonville without leaving town. They'll see on the screens in
their conference room exactly what the instructor sees at the slit
lamp in our patient exam room.
Foster, whose school will be receiving one of the first of the new
facilities, agrees that there are many ways the schools can benefit
from these conference centers. He foresees linking up his students
in rural Tahlequah to faculty presenters at other schools or to
professionals around Oklahoma for ongoing communication, education
also be partnering with TVCI to deliver practice management
education to young practitioners in his region, and he says it's a
great opportunity to bring them back to the school for education
that meets their needs. When it comes to the business of running a
practice, Dr. Foster points out that practitioners don't really know
what they don't know until they're actually trying to run a
emphasis for TVCI in the coming years will be developing more
programs for practicing eyecare professionals, including the
university-based seminars and distance learning. As Dr. Foster
notes, once practitioners get beyond their first year or two in
practice, they face a whole new set of hurdles and knowledge
requirements to be effective. We're creating a curriculum now that
will help young practitioners take their practice to the next level.
We also want to reach back in the other direction and offer more
education to younger students to augment what they obtain in school.
to think of TVCI as something unique in our industry. Over the past
three years, we've worked hard to provide insight and inspiration
for students across North America and practitioners worldwide. In
the years to come, we anticipate more opportunities to help eyecare
professionals enhance their patient and professional satisfaction,
productivity and profitability.
TVCI Around the World
the main campus in Jacksonville, Fla., The Vision Care Institute
also has seven international branches:
Additional centers will open soon in Milan, Italy, and in other
major population centers.
the international TVCIs shares the same core mission as the
Institute in the United States, but caters to local needs as
determined by local professionals. TVCI in Prague, for example, has
served participants from 12 European countries in their own
languages. In Japan, most of the participants are fourth-year
ophthalmology residents, who've typically had no education or
training in fitting contact lenses even though they're expected to
do this professionally. In emerging markets like China and India,
contact lens penetration in the marketplace is very low but the
potential for growth is enormous. In these countries, TVCI focuses
on more basic information about the role of eyecare providers and
the importance of routine primary eye care and vision correction.