Canadian Examiners in Optometry Examinateurs Canadiens en Optométrie Guide to the Canadian Assessment of Competence in Optometry Version 1.06.2011
Page 1 The purpose of this Guide is to summarize and explain the content and structure of the CACO, and to illustrate the relationship between the CACO and the daily practice activities required of Canadian Optometrists when providing safe and effective optometric care. THE DEVELOPMENT OF THE CACO Canadian Examiners in Optometry (CEO) assesses the competence of optometrists seeking authorization to practice in Canada using the Canadian Assessment of Competence in Optometry (CACO). Understanding that practice competencies are different than academic achievements, CEO designs the CACO to test the activities required for safe and effective optometric practice in Canada. Optometrists from across Canada contribute to the articulation of the essential activities and tasks that comprise competence. This description of competence has been titled Competence-Based Performance Standards (CBPS) and can be found on the CEO website under Research & Publications. The CACO relies heavily on these competence standards for its design and content. CEO intends to evolve the CACO in relation to the competencies set out in the CBPS. COMPETENCIES REQUIRED OF OPTOMETRISTS PRACTISING IN CANADA CEO identified four professional roles * fulfilled by optometrists in Canada. These are to: Provide Comprehensive Eye and Vision Care Optometrists meet patients eye and vision care-related needs with the objectives of achieving appropriate outcomes and maintaining or improving patients quality of life. Collaborate Optometrists support an integrated health care system by collaborating with other health care professionals and service providers to facilitate the management of the overall health needs, and to encourage the well-being, of patients. Manage Optometrists apply management skills to optimize the care of patients and make efficient use of health resources. Educate Optometrists provide education with the goal of encouraging appropriate, effective and comprehensive eye and vision care. ATTRIBUTES UNDERLYING OPTOMETRIC COMPETENCIES Knowledge, Reasoning and Skills Optometrists have knowledge and comprehension of the core information associated with their profession. They make evidence-based decisions during daily practice and apply their knowledge to appropriately perform required professional skills. Planning and Implementation Optometrists have effective planning and implementation abilities including time management, resource management, delegation skills and organizational skills. Optometrists have the necessary skills to plan and implement change, to understand and consider the human reaction to change, and to recognize when change is required for fulfillment of professional and societal responsibilities. * Updated 2008. These general attributes have been adapted, with permission, from those developed by the Association of Faculties of Pharmacy of Canada. In turn, the AFPC incorporated work by the American Association of Colleges of Pharmacy and the University of Toronto Faculty of Pharmacy when developing their general attributes.
Page 2 Communication Abilities Optometrists have effective communication skills, including the ability to effectively use and respond to written, verbal and non-verbal communications. Values and Ethical Principles Optometrists apply ethical principles in professional and social contexts. They have developed behaviours that both recognize and respect cultural and personal variability in values, communication and life styles. Optometrists apply ethical principles when decision-making and take responsibility for outcomes associated with their decisions. Self-directed Learning Abilities Optometrists have self-directed learning capabilities in order to maintain and advance their practice and professional role in society. They effectively self assess and use feedback from others to identify their learning needs and to satisfy these needs on an ongoing basis. PROFESSIONAL ROLES The daily practice activities of optometrists are different than those of other health care professionals. To more easily understand these activities, CEO grouped them into four professional roles, which are: providing eye and vision care, collaborating with and referring to other health care providers, managing practice, and educating within their profession. Definitions of each of these professional roles can be found in the section of this Guide entitled Competencies Required of Optometrists Practising in Canada. ATTRIBUTES Optometrists need to possess a number of attributes to enable them to fulfill their professional roles. These attributes underlie professional, thoughtful, and ethical performance of their roles and are consistent with the public's expectations for quality health care. These attributes are described in this Guide under Attributes Underlying Optometric Competencies. COMPETENCE-BASED PERFORMANCE STANDARDS Performance standards describe the minimum level of performance expected of competent optometrists in specific situations in practice. Competence Based Performance Standards (CBPS) provide precise guidance about the nature of patients and problems that may be encountered in taking the CACO. BLUEPRINT OF THE CACO The blueprint of the CACO links the competencies required of Canadian Optometrists to the questions contained with the CACO. The use of the blueprint ensures that frequently performed and critical competencies are assessed and allow candidates to see the relative emphasis of each of these competencies within the CACO. PROFESSIONAL COMPETENCY AND ELEMENT CEO is working towards integrating new assessment methods into the CACO to allow assessment of the complete range of competencies required of Optometrists. At present, the focus remains on those competencies determined to be the most important to the provision of safe and effective optometric care.
Page 3 R OLES & TASKS Role 1. Provide comprehensive eye and vision care Optometrists meet patients eye and vision care-related needs with the objectives of achieving appropriate outcomes and maintaining or improving patients quality of life. 1.1 develop and maintain professional relationships with the patient 1.2 establish the reasons for the patient's visit 1.3 obtain the patient's health history 1.4 examine the patient 1.5 facilitate complete management of the patient s eye and vision care needs 1.6 diagnose eye and vision care conditions 1.7 develop, recommend and implement patient management plans 1.8 provide follow-up care 1.9 facilitate continuity of care Role 2. Collaborate Optometrists support an integrated health care system by collaborating with other health care professionals and service providers to facilitate the management of the overall health needs, and to encourage the well-being, of patients. 2.1 identify the significance of non-ocular conditions 2.2 facilitate management of the patient s non-ocular health problems 2.3 manage medical emergencies 2.4 facilitate management of the patient s overall health needs 2.5 support other health care professionals Role 3: Manage Optometrists apply management skills to optimise the care of their patients and make efficient use of health resources. 3.1 manage their professional practice environment 3.2 support the financial sustainability of their practice 3.3 see patients in a timely manner 3.4 manage staff Role 4: Educate Optometrists provide education with the goal of encouraging appropriate, effective, comprehensive eye and vision care. 4.1 promote understanding of optometry within the health care community 4.2 participate in the education of optometry students
Page 4 STRUCTURE OF THE CACO The CACO is comprised of six components, each of which represents an essential collection of competencies and attributes required of an optometrist. The successful completion of all six components of competence by an individual is necessary for the profession of optometry in Canada to recognize that individual as a competent optometrist. Each component is administered using either written examinations or performance examinations. The Table of Specifications on the subsequent page(s) will provide you with additional information on the subject matter of the Component and the distribution of questions within the subject matter. EACH OF THE FOLLOWING SIX COMPONENTS OF THE CACO MUST BE INDIVIDUALLY PASSED IN ORDER TO SUCCESSFULLY COMPLETE THE CACO Ocular Therapeutics Synthesis The Ocular Therapeutics component consists of 120 multiple choice questions relating to the use of therapeutic pharmaceutical agents and is administered in one 3 hour session. Questions focus on: General Microbiology General Immunology General Pharmacology Ocular Pharmacology Ocular Disease/Trauma: Treatment, Management & Prognosis The Synthesis component consists of 248 multiple choice questions relating to 62 different case scenarios and is administered in two sessions of 3.5 and 4 hours. Cases focus on: Refractive conditions of the eye and their management Accommodative conditions of the eye and vision system and their treatment and management Oculomotor conditions of the eye and vision system and their treatment and management Sensory-integrative conditions of the eye and vision system and their treatment and management Ocular disease and trauma and its treatment and management Systemic disease and its treatment and management Clinical Skills Components The four skills components consist of the accurate performance of common clinical techniques performed associated with four different clinical scenarios. These four components are administered in one 4 hour session as follows: Clinical Skills Component 1: Interviewing and assessing refractive and accommodative conditions Patient Interview Visual Acuity Interpupillary Distance and Static Subjective Refraction Retinoscopy Nearpoint Addition Interpersonal & Communication Skills Clinical Skills Component 2: Assessing Oculomotor and Sensory-Integrative functions Cover Tests at Distance Cover Tests at Near Maddox Rod Test Amplitude of Accommodation Extraocular Muscle Functions Nearpoint of Convergence Fusional Vergence Ranges Stereoacuity Pupillary Testing Interpersonal & Communication Skills Clinical Skills Component 3: Assessing Ocular and System Disease Confrontation Visual Fields Applanation Tonometry Biomicroscopy Direct Ophthalmoscopy Fundus Lens with Biomicroscopy Gonioscopy Binocular Indirect Ophthalmoscopy Interpersonal & Communication Skills Clinical Skills Component 4: Assessing Ophthalmic Appliances Keratometry Preparation/placement of rigid gas permeable lens Preparation/Placement of Soft Contact Lensometry & Verification of Spectacles Lens Adjustment of Spectacles/Frames Diagnostic RGP Contact Lens & Removal Diagnostic Soft Contact Lens & Removal Interpersonal & Communication Skills
Page 5 CACO TABLE OF SPECIFICATIONS The table of specifications provides candidates with finely detailed content areas assessed within each of the six components of the CACO along with the approximate number of questions for each of these areas. This information is provided primarily to assure candidates that the CACO focuses on subject matter that is relevant to daily practice as defined by the professional competencies. 1. SYNTHESIS COMPONENT 62 cases and 248 questions with weighting set by the profession Component Weighting 1.1. Refractive Error and its treatment & management: 12 cases 1.1.1. Optics of the eye 1.1.2. Myopia 1.1.3. Hyperopia 1.1.4. Astigmatism 1.1.5. Refractive Surgery/Orthokeratology 1.1.6. Keratoconus 1.1.7. Low Vision 1.2. Accommodative Conditions of the Eye and Vision System and their treatment & management: 3 cases 1.2.1. Presbyopia 1.2.2. Insufficiency in youth 1.2.3. Infacility 1.2.4. Spasm 1.3. Oculomotor Conditions of the Eye and Vision System and their treatment and management: 7 cases 1.3.1. Ocular Motility 1.3.2. Strabismus 1.3.3. Convergence Excess/Insufficiency 1.3.4. Divergence Excess/Insufficiency 1.3.5. Hyperphoria/A & V Patterns 1.3.6. Extra-Ocular Muscle Palsy 1.3.7. Nystagmus 1.4. Sensory Integrative Conditions of the Eye and Vision System and their treatment & management: 8 cases 1.4.1. Light Sensation & Entoptic Phenomena 1.4.2. Visual Perception 1.4.3. Amblyopia 1.4.4. Spectacle Adaption & Aniseikonia 1.4.5. Sensory Neurovisual Pathway, Cerebrovascular Accidents, Visual Fields 1.4.6. Headaches 1.4.7. Colour Vision 1.4.8. Supression/Eccentric Fixation/ARC 1.5. Ocular Conditions, involving: 21 cases 1.5.1. Optic Nerve 1.5.2. Posterior Pole, excluding the optic nerve 1.5.3. Conjunctiva 1.5.4. Cornea 1.5.5. Anterior Chamber, Angle Structures, Abnormal IOP 1.5.6. Lens, cataract, Aphakia, Pseudophakia 1.5.7. Pupils 1.5.8. Lacrimal System 1.5.9. Anterior Uvea 1.5.10. Peripheral Fundus and the Vitreous 1.5.11. Sclera/Episclera 1.5.12. Adnexae, Orbit, Extraocular Musculature
Page 6 1.6. Systemic Disease and its Treatment and Management: 11 cases 1.6.1. Blood, Heart & Circulation 1.6.2. Bones, Joints & Muscles 1.6.3. Brain and Nerves 1.6.4. Digestive System 1.6.5. Ear, Nose and Throat 1.6.6. Metabolism and the Endocrine System 1.6.7. Immune System 1.6.8. Kidneys and Urinary System 1.6.9. Lungs and Respiration 1.6.10. Mouth and Teeth 1.6.11. Skin, Hair and Nails 1.6.12. Reproductive System 1.6.13. Psychosocial Disease 1.6.14. Infectious Disease 1.6.15. Congenital and Hereditary Conditions 1.6.16. Oncology 3 5 3 5 Component Weighting 2.1. General Microbiology 2 5 2.2. General Immunology 4 7 2.3. General Pharmacology 18 2.4. Ocular Pharmacology 28 2.5. Ocular Disease/Trauma, including treatment, management and prognosis of: 2.5.1. Ocular Adnexa 3 7 2.5.2. Lacrimal System 3 5 2.5.3. Conjunctiva 6 10 2.5.4. Cornea 8 12 2.5.5. Sclera/Episclera 2.5.6. Anterior Uvea (including iris and ciliary body) 5 9 2.5.7. Pupillary, Accommodative and Refractive Pathology 2.5.8. Orbit 2.5.9. Anterior Chamber, Angle Structure and Abnormal IOP 5 7 2.5.10. Lens, Aphakia and Pseudophakia 2.5.11. Posterior Pole 3 6 2.5.12. Peripheral Fundus and Vitreous 3 5 2.5.13. Optic Nerve 3 7 2.5.14. Sensory Neurovisual Pathway 2 5 2.5.15. Oculomotor System 2 5 2. OCULAR THERAPEUTICS COMPONENT - 120 Questions
Page 7 CLINICAL SKILLS COMPONENT: SESSION 1 Skills & Techniques in Interviewing & Assessing Refractive Accommodative Conditions Number of Items A. Patient Interview 8 B. Measurement of Visual Acuity 6 C. Measurement of Interpupillary Distance and Static Retinoscopy 12 D. Subjective Refraction 12 E. Nearpoint Addition 8 F. Interpersonal and Communication Skills 6 Total Clinical Skills Session One Items 52 Items CLINICAL SKILLS COMPONENT: SESSION 2 Skills & Techniques in Assessing Oculomotor and Sensory-Integrative Functions Number of Items A. Cover Tests at Distance 10 B. Cover Tests at Near 10 C. Maddox Rod (subjective angle testing) 9 D. Amplitude of Accommodation 3 E. Extraocular Muscle Functions (quantitative & qualitative) 5 F. Nearpoint of Convergence 2 G. Fusional Vergence Ranges 6 H. Pupillary Testing 13 I. Stereoacuity 3 J. Interpersonal and Communication Skills 6 Total Clinical Skills Session Two Items 67 Items CLINICAL SKILLS COMPONENT: SESSION 3 Skills & Techniques in Assessing Ocular and Systemic Disease Number of Items A. Confrontation Visual Fields 5 B. Applanation Tonometry (Goldmann or Perkins instrument as available) 5 C. Biomicroscopy on Non-dilated Eye 13 D. Direct Ophthalmoscopy 7 E. Fundus Lens with Biomicroscopy 7 F. Gonioscopy on Non-dilated Eye 8 G. Binocular Indirect Ophthalmoscopy on Dilated Eye 12 H. Interpersonal and Communication Skills 6 Total Clinical Skills Session Three Items 63 Items CLINICAL SKILLS COMPONENT: SESSION 4 Skills & Techniques in Assessing Ophthalmic Appliances Number of Items A. Keratometry 7 B. Application of a Diagnostic Rigid Gas Permeable (RGP) Contact Lens on the Eye 4 C. Application of a Diagnostic Soft Toric Contact Lens on the Eye 3 D. Lensometry and Verification of Spectacles 18 E. Adjustment of Spectacles 6 F. Evaluation and Removal of Diagnostic Rigid Gas Permeable (RGP) Lens 6 G. Evaluation and Removal of Diagnostic Soft Toric Contact Lens 7 H. Interpersonal and Communication Skills, Overall Impression 6 Total Clinical Skills Session Four Items 57 Items
Page 8 REFERENCES: 1. Association of Faculties of Pharmacy of Canada (1997). Outcomes for a Baccalaureate in Pharmacy Graduate in Canada 2. Chalmers, R.K., Grotpeter, J.J., Hollenbeck, R.G., Nickman, N.A., Wincor, M.Z., Loacker, G., Meyer, S.M. (1992). Ability-based outcome goals for the professional curriculum: a report of the Focus Group on Liberalization of the Professional Curriculum. American Journal of Pharmaceutical Education, 56, 304-9. 3. Gonczi A, Hager P, Oliver L (1990). Establishing Competency based Standards in the Professions. National Office of Overseas Skills Recognition. Research Paper No. 1. Australian Government Publishing Service, Canberra. Version 2009.1 CANADIAN ASSESSMENT OF COMPETENCE IN OPTOMETRY L'ÉVALUATION CANADIENNE STANDARDISÉE EN OPTOMÉTRIE