pre reg visit 1 competencies

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Survival guide to pre-reg stage 1: competency.

Over the first eight or nine months of your supervised pre-registration year, you will aim to gain in confidence dealing with as wide a range of patients as possible (see table 1). Establishing a good rapport with your supervisor, practice staff and stage 1 assessor and ensuring your practical skills meet the requirement for registered optometrists will also be crucial.

In addition trainees must be able to justify clinical actions and patient management – and this will include explaining any refractive correction, treatment or referral activity.

Another requirement is the evidence for your stage 1 assessor to sign you off for all 75 competency elements, and to be able to respond to any requests by the assessor for information to be sent prior to the visit. As part of this, record-keeping must be accurate, legible and meet the GOC standards of practice. It is essential to demonstrate patient consent for use of their records has been agreed.

At least five days of hospital experience must be carried out – sufficient to complete the College hospital log book adequately and also ideally allow evidence for those competencies less likely to be experienced in a high street practice setting (typically the under 2-year-old and anterior chamber cells and flare).

Another requirement is to maintain an up to date knowledge of relevant subjects.

Time to see patients

When you first start to see patients, you may well wonder how it is that the qualified practitioners you observe can complete thorough patient assessments in such an apparently short time while to you, anything less than two hours may seem a rush. As you see more and more patients, you will soon realise your technique becomes more efficient – you are not rushing or cutting corners, but using your time better.

You will begin by sitting in and observing your supervisor (and possibly other optometrists, dispensing opticians and contact lens opticians under direction). Your first patients may well be other staff members and colleagues. As you start to see patients, initially your supervisor should ideally observe you (and continue to do so, albeit less frequently, throughout the year – this is important).

Not only will this help you to adapt your skills where there are any identified concerns well before the assessor watches you, but it is excellent experience getting used to working under observation. I can absolutely confirm that the more you are observed, the less nervous you will be at assessment and usually get better results.

Make sure you start your contact lens work from the start – too many leave this for some weeks and then find it difficult catching up and reaching the required level of experience. Also, as you gain confidence, make sure everyone in the practice knows to get you involved if anyone interesting presents – they might not let you take over but should let you look if there is any rare pathology, challenging case or difficult prescription or dispense.

It is a good idea to have regular post-clinic discussions, not just about your experience, but anyone else’s from which you can learn. These may even be informal social meet-ups after hours if everyone agrees.

Make sure you develop a rota that offers you the right proportion of activities – dispensing, refraction, contact lens work and so on. If another member of staff starts putting you on the shop floor regularly at the expense of your refraction or dispensing, make it known to your supervisor immediately. They should be able to rectify this without you feeling you are causing conflict.

Your supervisor will also be aware of any particular factors that may affect you reaching the right experience at your chosen practice and have a plan ready. For example, I used to supervise at a busy practice in a shopping centre – there were rarely any patients over 70 but there was loads of contact lens work and children. I made sure my pre-reg had one day a week at a nearby smaller practice where everyone seemed to have cataract and macular degeneration.

The College offers guidance as to the patient numbers you might sensibly aim for as you progress and these are summarised in table 2.

Remember – variety and range is as important as numbers.

Survival guide to assessment visits

This visit takes no more than two hours and only addresses 10 competency elements. That said, it is a vital opportunity to establish a good rapport with your assessor and to clarify any points about the subsequent process.

The assessor will need to look at photo identification. They will also ask you to confirm your hospital experience has been arranged – this may not be the case and the assessor will be in a good position to check with the supervisor if there is any problem here, such as change of local hospital policy and so on.

Contact lenses are a core competency

The assessor will go through what is to happen in the coming months (they usually have a PowerPoint on their laptop for this) and make sure you are fully prepared. They will also exchange contact details and book dates in the diary for the remaining visits.

Important points to remember include:

• There are just 10 competency elements covered but this allows you to get the hang of the assessor’s style without too much pressure.
• There will be direct observation of some elements, a requirement for some records and a few elements will require some question and answer sessions – so a good spread of the sorts of things you will have to do lots of later in the year.
• Make sure you know generic names for spectacle and contact lenses – no own-branded names please.
• When assessing the tear film on a patient (usually a consenting staff member), remember that hygiene is essential and you will be watched as you wash your hands and sterilise equipment.
• When you do pupil reflexes, make sure you are not so far way with the light that it can be seen by the patient with both eyes when assessing reflexes and make sure you know what a relative afferent pupillary defect is.
• Make sure you can mark up and focimeter (ideally a manual focimeter) a pair of progressive lenses accurately and know where the tolerances can be referred to in your practice. Ideally you should be able to do this in less than five minutes – focimetry often crops up in the OSCEs and too many trainees each year do not keep up the skill if signed off at this first visit.
• Always focus eyepieces – focimeter, slit-lamp, keratometer.
• Be able to interpret keratometry readings in terms of dioptric power.
• Use this early opportunity to establish your excellent record keeping. For example, you are asked to provide a record of someone with risk factors for a condition. Why not show how this has influenced your actions. For example, if a patient with a glaucomatous relative, make sure you have included a full threshold fields assessment and mention this.

This is likely to take four hours and covers 32 competency elements. This sounds a lot but remember some of your prepared records will cover more than one element – this is a good idea. Your assessor will likewise use some of the direct observations to cover a range of elements – for example the routine assessment will cover many of the communication elements, as well as clinical procedures.

Also, make sure all your prepared records are complete (including any extra documentation and data plots) and have been checked thoroughly in advance. Make sure you have practiced talking about them in advance of the visit and try to predict the sorts of questions you may be asked. Try to make sure they are clearly labelled as to the elements they represent evidence for and, ideally, in an easily accessed container. Avoid spending ages leafing through piles of paper when asked to present evidence for any given element.

• Your log books should be available and show clearly enough detail to reflect the range of refractions and dispenses you have undertaken – not just a list of patient names.
• You will be asked to have a presbyopic patient booked in for assessment 30 minutes into the visit. Remember, using a real patient from the clinic rather than being tempted to use a relative or friend always looks better – and in my view usually leads to better results.
• Make sure you have been observed performing your routine examination several times prior to visit 2.
• Remember the importance of communication – a lot of competency elements cover this so make sure you are polite, introduce yourself, explain things carefully, avoid jargon, and adopt the appropriate level of language for the patient to feel informed and not patronised. Also make sure you spend time summing up your findings and recommendation to the patient – the assessor will remember this so make sure you are polished here.
• You will be well advised to feel comfortable completing a full routine in around 45 minutes by this time – though the session is not timed as strictly as at stage 2 assessments, if you take too long it is viewed as bad practice and you may be asked to repeat at a future visit. If timing is an issue in the early weeks, try to identify with your supervisor where the time is being taken up – often this is easy to identify and remedy by things like practising retinoscopy, or getting better at bracketing comparison tests in subjective.
• Remember your record should accurately reflect what has happened – if you offer advice, record you have done so.
• You will be asked to book in a soft contact lens aftercare appointment – same rules apply regarding communication, but also remember hygiene, hygiene, hygiene (hands every time you are to touch the patient and clean the slit-lamp).
• When checking for staining, a yellow absorption filter makes things a lot easier for you – make sure you have one.
• Remember to evert the lids.
• Prior to visit 2, practice describing field loss and be able to relate it to underlying ocular and pathway structures – there are loads of plots of defects on the internet so practice talking about them.
• Practice answering questions like ‘why did you refer this patient with cataract?’ This may sound obvious but practice out loud your best response.
• Where you have identified a condition and not referred, make sure the management part of your record makes it absolutely clear what you have advised, including the recall if there is no improvement and the exact nature of any drops that may have been given.
• Make sure all referral documentation is legible and dated.
• Make sure you can discuss generic spectacle lens types – and be able to recommend different progressive lens designs (know at least three) for different patient demands if asked.

Another four-hour session with the remaining 33 elements. The session may begin by mopping up points outstanding from visit 2. Some visit 3 competencies are likely to be relevant to your hospital experience so you really should have completed this by now – for example you should have advised about and dispensed a low vision aid by now.

• You will need to book in an RGP aftercare patient – same rules apply as with the previous patients. If you have started your contact lens work right from the start, then the commonly found concerns trying to build up enough RGP experience should not apply to you.
• You will be observed carrying out contact tonometry on a colleague – it will be obvious if you have been doing this regularly from the start of the year (‘sign off’) or if you have just started practising days before the visit (‘we may need to look at that again next visit’). It is usually this patient who you are also asked to fit a soft and an RGP lens to to demonstrate your confidence with the procedure.
• There is a lot of ocular disease covered at visit 3 – make sure you are able to confidently describe the referral process that applies to your practice area – for example, what conditions are fast-tracked, what warrants same day referral and how do you do this, do you refer via the GP for routine conditions or to a triage or outreach unit and so on. This should be well known by now.
• Remember that symptomatic phorias are common – and often managed with advice about vision habits and environment. Too many trainees talk as if this is a rare condition, but these records should be easy to prepare and may be as simple as someone who finds reading in the evenings tiring.
• Make sure you have undertaken plenty of cycloplegic refraction over the year – there should be no resistance in practice to the trainee wanting to do this as long as it is relevant. Avoid showing a record where the technique is only justified by the need to show one to an assessor – be ready to say why you used the drop.

By the end of this visit you should be clear what remains to be done for visit 4 (always aim for this to be your last visit). Remember that stage 2 is next and this will include presenting records of over-arching competencies so do not stop gathering interesting records from which you can select the best for stage 2.

Even if there are some outstanding competencies, the assessor may confirm that they feel you will achieve these at a final fourth visit and you should receive a date for your stage 2 assessment some four to six weeks after completing your requirements.

£ 35.00 £ 25.00

This tutorial consists of an introduction to the pre-reg year along with an interactive journey through the first 12 competencies, including the Opticians act, focimetry, systemic disease and risk factors for common ocular conditions (New content added) Get ahead of others with top tips about how to prepare for assessments and the common errors pre-reg’s make during their first visit and beyond.

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Units of competence for Visit 1: communication, professional conduct, methods of ocular examination, optical appliances, contact lenses, ocular disease and assessment of visual function

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Stage 1 and 2

You should aim to gain in confidence dealing with as wide a range of patients, establishing a good rapport with your supervisor, practice staff and assessor whilst ensuring your practical skills meet the standards set.

You must be able to justify clinical actions and patient management – and this will include explaining any refractive correction, treatment or referral activity.

At least five days of hospital experience should be carried out (although hybrid along with online learning is acceptable) – sufficient to complete the College hospital log book adequately and also ideally allow evidence for those competencies less likely to be experienced in a high street practice setting (typically the under 2-year-old and anterior chamber cells and flare).

The main requirement is the evidence for your stage 1 assessor to sign you off for all competency elements, and to be able to respond to any requests by the assessor for information to be sent prior to the visit. As part of this, record-keeping must be accurate, legible and meet the GOC standards of practice. It is essential to demonstrate patient consent for use of their records has been agreed. You must also maintain up to date knowledge of relevant subjects.

Out of the Box Optics supports you throughout your Stage 1 journey, starting with the complimentary Stage 1 Visit 1 Competency Guide that is available on request by emailing [email protected]

The College of Optometrists has recently changed the format of Stage 2 Assessments. You will already have access to the 108 scenarios, which cover the overarching competencies.

We carefully select FOUR Scenarios per webinar, covering a multitude of competencies. We will systematically deconstruct each of them, in a logical and helpful manner via a Webinar that takes place periodically throughout the year. There are a total of 4 webinars, encasing 16 of the Scenarios.

As and when dates are confirmed, the Webinar(s) will become available to book via this website!

Each and every week, an expert for a specific subject area will explain and demystify clinical skills and competencies, and help set you on a trajectory for success. Each session lasts an hour, and you can sign up to as many as you like.

The Weekly Online Workshops are aimed at Pre-Reg Optometrists at ALL stages of the Scheme for Registration.

Choose and book your workshops below!

Online Workshop: COMMUNICATING WITH KIDS (& their parents!) [Sun 29 Oct] [7pm-8pm]

Pre-Reg Support Workshops

Weekly Online Workshop: Confidence with Cataracts [Sun 26 Nov] [7-8pm]

Weekly Workshop: Optom vs Red Eye 18 Nov]

Weekly Workshop: The Glaucomas Masterclass [Sat 4 Nov] [7.30-8.30pm]

WOW: Confidence with Contact Lenses (Pt 2) [Sun 22 Oct] [7-8pm]

WOW: Systemic Disease & Medication Pt2: Case Scenarios [Sun 12 Nov] [7-8pm]

Want to book your place at the next optoversity challenge, need some assistance.

Online Training for Pre-registration Optometrists & Ophthalmologists

[email protected]

Stages 1 & 2

Stage 1 and Stage 2 can be a daunting prospect as these assessments are unlike the type of assessments you might have experienced at university or undergraduate level. With the help of Optuitions however, we can give you the confidence and ability to better tackle these assessments, and most importantly to develop your understanding for everyday practice too! We offer a variety of online video courses which cover practical as well as theoretical aspects of these assessments. Our videos also include example / mock patient records and key tips to improve your record-keeping skills. Although these videos are primarily focussed on Stage 2 assessments, they are also directly relevant to many Stage 1 competencies too. Prices start from just £10.00 per video (2 day access) OR package deals are also available starting from only £14.00 for 1 week of access ! Details are provided below and here is a short video to give you a flavour:

Please contact us to purchase a course!

PLEASE NOTE THAT FOR STAGE 2 OVERARCHING COMPETENCIES, THE VIDEOS ARE BASED ON THE PATIENT EPISODES AND NOT ON THE ACTUAL CASE SCENARIOS THAT THE COLLEGE ASSESSES YOU ON. WE HAVE CREATED THEORETICAL VIDEOS WITH OUR OWN PATIENT RECORDS.

Direct Observations Packages

• Routine Sight Test – Guided Demonstration and Top Tips & Common Pitfalls only £24.00 for 1 week (2 videos)
• Contact Lens Fitting and Aftercare – Guided Demonstration and Top Tips & Common Pitfalls only £24.00 for 1 week (3 videos)
• BOTH Routine Sight Test AND Contact Lens Fitting and Aftercare  only £39.00 for 1 week (5 videos)

Overarching Competencies Packages

• General Record-Keeping, Top Tips & Common Pitfalls  only £14.00 for 1 week (2 videos)

• Unit 3: Methods of Ocular Examination only £24.00 for 1 week (4 videos)
• Unit 4: Optical Appliances  only £29.00 for 1 week (8 videos)
• Unit 5: Contact Lenses  only £29.00 for 1 week (6 videos)
• Unit 6: Ocular Disease  only £29.00 for 1 week (7 videos)
• Unit 7: Assessment of Visual Function  only £19.00 for 1 week (5 videos)
• Unit 8: Assessment and Management of Binocular Vision  only £29.00 for 1 week (5 videos)
• ALL Overarching competencies packages only £99.00 for 2 weeks (41 videos)

Complete Package

The whole series of 51 videos totalling approx. 26 hours of content will guide you on practical, theoretical and record-keeping concepts, including best practice tips, common pitfalls, and example patient records , to help you better understand all aspects of Stage 2 for only £129.00 for 2 weeks

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• In Person tutoring
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Email: [email protected]

In-person Courses

New Starter

1 day Pre-reg preparation, Logbook and Records Best practice: Prepare yourself before you start at your practice. Get a better understanding of what is expected of you through the year and how to make it as smooth as possible.

Stage 1 Visit 1

1 day Full assessment: Direct observations (practical assessments), discussions of each individual competency and a review of all your own patient records to ensure high quality for when presented to the Assessor.

Stage 1 Visit 2

1 day Practicals: Direct observations only (routine sight test, soft contact lens aftercare and Volk indirect ophthalmoscopy)

1 day Competencies: Scenarios, images and discussions for the theoretical aspects of the competencies in this visit

1 day Record assessment: Review your own patient records and episodes that you are planning on presenting to your Assessor.

2 days Full Visit 2 assessment: Combining direct observations, records assessment and competency evaluation

Stage 1 Visit 3

1 day Practicals: Direct observations only (RGP contact lens aftercare, soft and RGP lens fitting, and Goldmann contact tonometry)

2 days Full Visit 3 assessment: Combining direct observations, records assessment and competency evaluation

1 day Practicals: Direct observation of the routine sight test, soft contact lens fitting and soft contact lens aftercare.

1 day Overarching Competencies: Discussions of the theoretical aspects of the over-arching competencies in this assessment. All competencies will be reviewed although during the assessment your assessor will only pick 8 out of a potential 14.

1 day Record assessment: Review your own patient records and episodes you plan on presenting to your Assessor.

2 days Full Stage 2 assessment: Combining direct observations, records assessment and competency evaluation

10 Stations

15 Stations

C ommercially   aware Optometrist

KPI, Sales motivation, Performance review: Ideally for the qualified optometrist that wishes to get a head start in management training, but suitable for students too

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About optotutor.

Founded in 2019 by Bansi Dhamecha, Optotutor is here to focus on support and guidance for pre-registration student optometrists from before they even start the Scheme for Registration year but we also offer Commercially Aware courses for career progression and instore development.

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Home › Advice & Resources › Optometry › Diary of a Pre-Reg Optometrist – Preparing for my Stage One Visit Two

Diary of a Pre-Reg Optometrist – Preparing for my Stage One Visit Two

March 9, 2023 | Optometry | Pre-reg

Stage One Visit Two -The hardest assessment!

In terms of stage One, visit two is probably the hardest assessment part of Stage One. How I prepared for visit two was by making sure that I had the patient records that I needed.

Utilising your wider team!

The best way about finding the individual patient records that are needed is to let the shopfloor staff know that there is a certain patient encounter that is required and with the help of the optical consultants, they are able to find these patients and book them within your specified clinic,

As a pre-reg its always difficult to be testing and performing shopfloor tasks hence so your optical assistant team are your strongest allies to help you find the patients that you require.

As a pre-reg you want to be testing as many patients as you can and rightly so. This will build your experience of different patients and enable you to learn how to handle the different patients that can walk into practice.

There may be the young straightforward routine patient attending for their two-yearly check-ups to the seasoned 80-year-old patient who may walk in with a condition such as AMD, or maybe a patient with their post cats operative review, you just never know who’ll walk into the door for a sight test on any day!

33 Competencies in the Stage One Visit Two assessment!

There are 33 competencies that are assessed on visit 2 and some are really difficult to achieve. One example would be testing a patient with a colour vision defect. Colour vision defects are rare and it’s not like a patient who has had a colour vision defect will come into practice telling you that they have one! Also this is a complaint that is sometimes overlooked by an optometrist. Colour vision tests are normally performed on the first sight test of a patient, if a defect is picked up then, then a patient would probably know that they have a colour vision deficiency, it’s not like they will tell you on their sight test they have a colour vision deficiency if it’s been longstanding.

Swapping Visit Two competencies with Visit Three

Another great way to achieve and be successful in visit two and achieve competencies is by swapping some competencies of visit 3 and bringing them forward into visit two, there’s no harm in swapping competencies bringing these competencies forward. It maybe easier to find patient records for these competencies,  even if they’re from a different visit.

Looking for a new role after you qualify?

To talk to us about a new role after you qualify as an optometrist visit our  optometry jobs page   to view all our roles or give us a call on   01423 813452  or email us at  [email protected]

If you’re having difficulty in your pre-reg and need some help visit this  AOP page   which gives advice and support for Optical professionals.

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Lead in statement

• A guide to Stage Two
• Direct observation
• Overarching assessment

The overarching assessment is conducted remotely via video call and will last up to two hours. An assessor will use case scenarios, images, field plots and questions to assess your competence in 13 overarching elements of competence.

You and your supervisor will be emailed the outcome of your assessment and will be able to view the results in your My College area within one week of completing both the DO and OA sections of Stage Two.

Preparing for the overarching assessment

You have access to a bank of over 100 case scenarios  for advance preparation. 60 minutes before your scheduled assessment, your assessor will contact you to let you know which eight of these scenarios will be used in your assessment. This matrix illustrates which overarching element of competence is covered by each scenario. You will be assessed in 13 different elements of competence. The elements of competence are the same as at Stage One. We recommend that you familiarise yourself with the format and content of the case scenarios by selecting a range from each unit to revise. Your assessor will introduce each scenario in turn. They will ask you to describe the case and assess your understanding. You may not get through all eight cases in the assessment. Before the assessment starts:

• Find a quiet space to complete the assessment. This can be in your practice or at home.
• Make sure you have access to a computer or tablet with a camera.
• Have a form of photo ID ready to show your assessor.

Your assessor will ask you to confirm that you are alone before the assessment. If appropriate, you can use your camera to show that you are alone. You must keep your camera on at all times. If you deliberately turn off your camera without agreement from your assessor, they have the right to terminate your assessment.

On the day of the overarching assessment 

Your assessor will contact you 60 minutes ahead of the scheduled assessment time with Zoom details and the eight case scenarios you will use. If you have not received your email with the assessment details 50 minutes before your assessment, at [email protected] . Read each of your eight scenarios and highlight the key points. Make yourself aware of what competencies are covered by the record according to the matrix . Consider:  

• What other questions would I ask the patient?
• What other tests would I do to investigate further?
• Are the results what I would expect?
• How would I manage the patient?
• How would I manage the patient if they were older/younger?
• How would I communicate the findings to the patient?
• Is the scenario complete and are all details recorded fully?

When discussing any scenario your assessor can ask questions beyond those competencies listed in the matrix. For example, if a scenario covers 5.1.1 (soft contact lens fit), you could also be asked how you would approach a spectacle dispense for this patient. Competencies will be assessed using at least two forms of evidence. One form will be a case scenario, but field plots, additional images and questions may also be used.

Before the assessment starts

Your assessor will check your ID and ask you to show a sweep of the room to ensure that you are on your own and that you do not have access to a phone or electronic device other than the one you are using for the video call.

If you turn off your screen it is assumed you are cheating and the assessment will stop. Tell your assessor if you need a break – you will need to leave your screen on throughout the break.

This is an open book exam and so you are permitted to access reference material such as notes and reference books.

You must not, however, collude with anyone to complete this assessment or use any other unfair means in an attempt to enhance performance. Any attempt do this will be considered cheating and dealt with as per the  Scheme for Registration Regulations.

Trainee logbook

You must download your logbook to keep track of your patient encounters.

Essential documents

Download important documents for every stage of the Scheme

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How to arrange your supervision or change your practice.

The Scheme for Registration fees.

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Extending or restarting the Scheme, reasonable adjustments, appeals and complaints.

Regulations, policies and reports

Scheme governance documents you should read.

OPTOMETRY REVISION NOTES

This 20 page PDF contains revision notes for visit 2 pre-registration exam, including the evidence type for each competency required.  The framework is based on the new College of Optometrists 2023 Syllabus.

Visit 2 Pre-Reg Revision Notes