Ординатура / Офтальмология / Английские материалы / The Professional Qualifying Examination A Survival Guide for Optometrists_Eperjesi, Hodgson, Rundström_2004

46 A GUIDE TO THE PRE-REGISTRATION YEAR

theory-orientated, study as much as possible and ask your supervisor and other qualified optometrists to viva you in a mock examination on a regular basis. It may be better to do less practice work and concentrate fully on the re-takes. It may also be useful to find another practice and another supervisor for this final attempt. If you fail any exams at the third attempt, you will have to wait 18 months before starting the whole cycle and re-take all ten PQEs. However, it is our experience that if you take our advice and prepare well, you are unlikely to end up in that position.

146 USEFUL ADDRESSES

Department of Optometry and Vision Sciences Cardiff University

Redwood Building

King Edward VII Avenue Cathays Park

Cardiff CF10 3NB 029 2087 4852

http://www.cf.ac.uk/optom/

Optometry and Neuroscience UMIST

Sackville Street

Manchester, UK M60 1QD

0161 200 3870 joanne.cohen@umist.ac.uk http://www2.umist.ac.uk/optometry/

School of Biomedical Sciences University of Ulster at Coleraine Cromore Road

Co Londonderry BT52 1SA

08 700 400 700 online@ulster.ac.uk http://www.ulst.ac.uk/

Department of Optometry and Ophthalmic Dispensing School of Applied Sciences

Anglia Polytechnic University East Road

Cambridge CB1 1PT 01223 363271

http://www.apu.ac.uk/appsci/optometry/index.html

Association of Optometrists 61 Southwark Street London SE1 0HL

020 7261 9661 postbox@assoc-optometrists.org http://www.assoc-optometrists.org

http://www.assoc-optometrists.org/student/prereg_learning_scheme.html for a series of typical PQE questions and answers

The College of Optometrists 42 Craven Street

London WC2N 5NG 020 7839 6000

pre_reg@College-optometrists.org

USEFUL ADDRESSES 147

General Optical Council 41 Harley Street London W1N 2DJ

020 7580 3898 goc@optical.org http:/www.optical.org

Institute of Optometry 56–62, Newington Causeway London SE1 6DS

020 7407 4183 admin@ioo.org.uk http://www.ioo.org.uk/

The Orthoptic and Binocular Vision Association 4 Church Street

Tamworth Staffordshire B79 7DE Tel: 01827 61600

(The OBVA organize annual courses for the Binocular Vision PQE that are held in early March at Aston University)

Hirji Associates Consulting in Optometry 7 Milford Road Harborne

Birmingham B17 9RL 0121 682 7041 info@hirji.co.uk http://www.hirji.co.uk/

For information on CHESAS

JCL Consulting

PO Box 336

Beckenham

BR3 4UZ

http://www.jclconsulting.co.uk

50 A GUIDE TO THE PROFESSIONAL QUALIFYING EXAMINATIONS

points that arise. The investigation should demonstrate a logical selection of tests (conducting inappropriate tests will count against you), bearing in mind the history and symptoms, leading to a correct diagnosis and clear recommendations for management. An adequate selection of commonly used equipment will be available. (A sample of the record sheet to be used is on the CD-ROM provided by the CO.)

‘A satisfactory practical must include the assessment of all appropriate aspects of history and symptoms as well as a range of suitable tests to determine the motor and sensory status of the patient.’ Work slowly and methodically through your examination and take care to make accurate observations. You can fail on one mistake. One of us (MH) failed this exam at the first attempt and the examiners’ report simply stated, ‘the candidate diagnosed an exophoria with great panache. Unfortunately the patient had a “tropia”.

‘The oral examination. This will range over the whole syllabus and may include some or all of the topics listed on the reverse of the examination record sheet. ‘You may be asked questions on any area of theory relevant to binocular vision, from visual development and anatomy to clinical techniques and management. There may be some overlap with other PQE topics, for example you may be asked about cycloplegics or about ocular diseases that may result in a binocular vision anomaly.’

7.1.3 Assessment

‘In every case the examiners will look to see that the candidates have:

(i)Completed each procedure of patient examination in a smooth and logical order;

(ii)Demonstrated a command of techniques adequate to produce valid results;

(iii)Demonstrated a clear understanding of the results achieved;

(iv)Not failed to recognize any significant sign or symptom;

(v)Demonstrated in their final determination of each case a logical response to the particular history and symptoms, taking into account the legal and professional responsibilities of a practitioner;

(vi)Readily recognized and differentiated the concomitant and incomitant conditions;

(vii)A sound knowledge of the musculature and innervation of the extraocular muscles;

(viii)Indicated an understanding of the normal and abnormal development of acuity and binocular associations, in so far as these relate to the management of any

anomalies;

(ix)A clear awareness of the criteria for referral.’

ANOMALIES OF BINOCULAR VISION 51

7.2 THE EXAMINATION FORMAT

The examination is split into two halves: a half-hour practical and a half-hour oral. Either can come first. One examiner will be present in each half of the exam and their combined decision will determine your result. It is possible to fail on mistakes made in only one half of the exam!

In the practical part you will be asked to examine one or more patients. Often this means two patients; we have never heard of any trainee being asked to see more than two. It is most likely that you will be asked to assess two patients; one long case and one short case. The long case will be the more involved of the two. You will be given the refractive error (including prism values) and you would be asked to examine the patient. An example of the type of anomaly you might encounter is a decompensated heterophoria or a fully accommodative esotropia. Following the history and symptoms, you should proceed to perform cover tests and an assessment of motility, followed by any other tests that are relevant to the case such as fixation disparity (aligning prism or sphere), determination of the sensory status and grading of the quality of binocularity, using for instance a stereoacuity test. At the end of the examination you will be expected to diagnose and describe the anomaly and state your management.

The short case will probably come second. As time is often running out you may simply be asked to perform one or two tests and comment on your observations. An example of this would be a patient with an extraocular muscle paresis. You may be asked to perform a cover test and assess ocular motility and be expected to observe an underaction, suggest which muscle might be affected and the associated muscle sequelae, and what the diagnosis might be. During the practical, the examiner will watch you closely but probably not interrupt. At the end he or she may ask you a few questions. Do not be afraid to ask the patient any relevant questions, as you would do in practice. If the patient’s condition has previously been assessed they may even tell you what they have! But be careful, as patients are notoriously unreliable. Familiarize yourself with the record sheet used in the BV PQE. The CO will have sent a copy of this to you at the beginning of the pre-registration year.

In the oral part of the PQE a different examiner to the one who examined your practical will assess you. During the 30-minute assessment, questions will range from those requiring one word answers to those that require long explanations, such as explaining your management strategy for a given case. It has been known for candidates to be asked to interpret Hess plots. The same advice applies here as to the rest of the oral PQEs. Think carefully before you answer questions. Try to avoid referring to topics you know little about – some examiners may take your lead and decide to ask you more questions on a topic that you inadvertently mention. Only answer the question asked and do not waffle!

52A GUIDE TO THE PROFESSIONAL QUALIFYING EXAMINATIONS

7.3WHAT DO THE EXAMINERS SAY?

The following are comments provided by two PQE binocular vision examiners.

(a) What advice would you give to a candidate preparing for the exam? A: Gain as much practical experience as possible. Extensive

reading of current textbooks, papers and journals is important.

B: Be prepared to accept that you will probably not know the answer to all the questions asked; the examiner will either re-phrase the question or move onto another topic. In the practical, only do tests that are relevant and provide useful information.

(b)What areas of the subject require:

(i)Sound knowledge?

A: Methods of investigation. Classic anatomy of nerve pathways and muscles.

B: Actions of extraocular muscles and nerve pathways. Landmarks in visual development, e.g. visual acuity, fusion and stereopsis. Criteria for referral. Orthoptic therapy for convergence insufficiency, convergence excess and accommodative insufficiency. Classification of heterophoria and heterotropia. Management of strabismus and being able to differentiate between types that require surgical or conservative treatment or those that need a combination.

(ii)Reasonable knowledge?

A: Recent work and research on aetiology and nervous systems.

B: Syndromes, e.g. Brown’s, Duane’s. Tests for evaluation of BV, e.g. Bagolini lenses, stereopsis, Maddox rod, and Mallett unit.

(iii)Some knowledge?

A: Surgical techniques.

B: Surgical procedures. Examples of systemic and ocular diseases with associated BV problems. The risks associated with leukocoria.

(c)What do you look for in the successful candidate?

A: Attention to detail. Selecting clinically appropriate tests. Ability to recognize significance of findings and patients’ responses.

B: Can the candidate think through the problems at hand and not give textbook statements? Not waffling when they do not know an answer and exposing their lack of knowledge. Having a clear understanding to take concise action in cases when patients need immediate referral.

ANOMALIES OF BINOCULAR VISION 53

(d) What brings marks down?

A: Poor practical technique. Inability to interpret from what has been found in the practical.

B: Candidates unsure of the answers they are giving. Performing tests that are inappropriate – this leads them to run out of time before making a diagnosis. Taking an excessively long time on the cover test and deciding what they want to see rather than what is actually there!

(e) What are the common causes of failure?

A: Inability to recognize deviations and poor knowledge of consequences of binocular problems in infancy.

B: Unable to correctly observe cover test movements. Incorrect diagnosis and treatment plan either in the oral or the practical. Unable to demonstrate clear knowledge of (i) extraocular muscle origins, courses, insertions, innervations, and actions

(ii) landmarks in visual development (iii) orthoptic exercises and their application.

(f) What subject areas do candidates place too little importance upon? A: Anatomy and physiology, and sensory adaptations to

deviations.

B: Anatomy, vision therapy and vision development.

(g) Any other comments?

A: The BV exam is NOT a monster. Most candidates have a very negative attitude to the subject and hence come in with a great amount of anxiety; this leads them to make uncharacteristic mistakes. Thinking of BV like other more ‘enjoyable’ subjects means that half the battle is won. Only answer questions that are asked (both in the practical and oral) and not those you would have like to have been asked.

7.4 HELP AND ADVICE

To follow on from one of examiner A’s last comments, the binocular vision exam is often perceived as something of a monster! It need not be. With good theoretical and practical preparation during the pre-registration year, and some simple revision planning, you should enter the BV PQE with confidence.

In this section we will deal with the practical and oral sections of the BV PQE, then with how to gain experience in binocular vision assessment during the pre-registration year. It would be difficult here to cover in detail any plan of action for the practical. The next section is more of an ideas shower that gives our thoughts on what you might be thinking during the examination. During your revision consider the different types of BV anomaly that you might be faced with, and the best approach for each in terms of investigation and management.