The needs and opportunities for post-graduate education and training programmes for the optometry profession in post-apartheid South Africa

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Date
2003
Authors
Kriel, Stefanus Johannes
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University of the Free State
Abstract
English: This research study was undertaken to determine the needs and opportunities for post-graduate education and training programmes in optometry in post-apartheid South Africa. The rationale for this study can be found in the stimuli which contributed to the commencement of the study, namely the Vision 2020 - The Right to Sight Campaign of the World Health Organisation that resulted in the resolution of the World Council of Optometry, entitled the Global Vision Care Campaign. That the abovementioned are fully endorsed by the South African government, is substantiated by policy documents such as the White Paper for the Transformation of the Health System (RSA DoH 1997) and the National Prevention of Blindness Programme (RSA DoH 2000). These aspects resulted in, inter alia, the identification of issues like preventable blindness; the importance of public health; public needs; the lack of human resource development; demographic representation; and the lack of clear clinical competency guidelines. The problem statement pertains to the career ladder for optometry, already accepted in South Africa. It opened the door for magister programmes, allowing practitioners to develop clinical and speciality skills within the scope and parameters set forth and regulated by the Professional Board for Optometry and Dispensing Opticians. Despite this career ladder, there. is a need for a programme aimed at providing education and training to learners in order to become competent to render a professional specialist service in optometry and to contribute to the enhancement of the discipline through research. Such a programme must afford professional optometrists the opportunity to further their education and training in terms of the optometry career ladder, in addition to gaining certain therapeutic privileges and speciality skills. The research took the form of a descriptive and an exploratory survey, comprising a literature review and an empirical investigation. The literature study covered two aspects, namely in the first place factors . influencing the design of optometry education and training programmes. Features like the changing health scene; the history of the development of the optometry profession; the transformation of the health care system in South Africa and the eye care needs of the South African population; as well as the transformation of education and training in South Africa were dealt with. The second aspect covered by the literature review was a selective review of optometry training, which dealt with optometric education and training in South Africa; its history and the current state of affairs; as well as legislation in South Africa. Subsequently optometric training in the rest of Africa and the developed world was discussed in broad terms. The empirical study entailed a questionnaire survey carried out among South African optometry practitioners. A quantitative design was employed, but - because the questionnaire also contained some open-ended questions - the study had a qualitative dimension as well. The overall goal and objectives were to make a contribution to eye care and the prevention of blindness, as well as to make a meaningful contribution to education and training in optometry. The aim was to determine the needs of optometrists with regard to optometric education and training and the opportunities existing in South Africa, measured against the background of the needs of society (from the optometrists' perspective). The objectives were in the first place to enhance competence beyond graduate level, thereby better serving the eye care needs of the population of South Africa in particular and, in an indirect way, of neighbouring countries. In the second place the objective was to make recommendations concerning the delivery of relevant and applicable post-graduate studies at Optometry Schools/Departments. All of these aspects were achieved by conducting the above-mentioned literature study and by using the findings from the questionnaire. The research design consisted of a needs analysis in the form of the questionnaire survey used as the method to determine the needs of optometrists in respect of post-graduate studies, as well as to obtain their views regarding existing opportunities in this regard. The questionnaire consisted of six categories, each containing five different types of items (cf. 5.4.1; Appendix C). Four rounds of questionnaires were sent out over a period of 16 weeks and the response rate was 70.2% (cf. 5.5). After the returned questionnaires had been analysed by the Department of Biostatistics at the University of the Free State, it became possible for the researcher to draw conclusions; discuss the findings; make recommendations; and identify the limitations of the study. Each of the six categories was followed by a summative conclusion as well as by the main findings of the content of that specific category. The main findings as well as those obtained via the literature study, enabled the researcher to make recommendations on post-graduate optometric education in South Africa. Different factors, which are listed under the following headings and subheadings, influenced these recommendations: - Points of departure: These include accessibility; affordability; personal development; professional development; addressing public need; addressing higher education and health policies; addressing research; addressing management skills; and addressing HPCSA Regulations. - Role-players: The role-players include, infer alia, students; providers; the Professional Board; individual optometrists and associations; industry; the public; the State; professional stakeholders; SAQA; and the CHE. - Post-graduate optometric education and training itself was divided into three aspects, namely: -Recommendations concerning the programme. -Recommendations with regard to CPO. -Recommendations on clinical competence based on public needs. The recommendations on clinical competencies were extensively detailed, since they may serve as a basis for the SGB of Optometry and Opticianry. As this study also focused on the public need, the detail in the recommendations regarding competency will help to ensure that the care which the public receive, is optimised. In order not to confuse the professional competencies with the categories of the questionnaire, they were divided into six sections, namely Sections A to F. Each of these sections was divided under the headings "Outcomes"; "Performance criteria"; and "Indicators". Hereafter a framework as a starting point for post-graduate education and training programmes was proposed. In summation, the researcher is of the opinion that the overall goal and objectives of the study were addressed and realised and that meaningful recommendations were made. The latter are in line with legislation and with the policy documents referred to earlier. In addition, recommendations on clinical competencies are in line with international norms. Conclusions are, infer alia, as follows: - Based on current undergraduate programmes, there is a need for a post-graduate programme aimed at providing education and training to learners. - The articulation between the under- and post-graduate programmes will result in an overview of the undergraduate programme. - The role and functions of the Professional Board are pivotal to the success of education at both under-and post-graduate level. - As the current optometry educational model fails to address the immediate public need, this study provides at least some of the guidelines in the design of a new model. - It is clear that CPO (Optometry) is in its infancy in South Africa and its success depends on whether it can influence the delivery of services positively. It is of the utmost importance, however, that - for CPO to be effective - it will need to articulate with formal qualifications. The researcher realises the limitations of the study, namely in the first place that the opinion on the public need was limited, as it was optometrists who were the respondents to this category of the questionnaire. In the second place, literature and statistical sources of the South African situation were limited in that epidemiological data are incomplete and fragmented. In addition, clinical training in optometry had stagnated during the apartheid years. It is recommended that this study be followed by the compilation of a model for post-graduate education and the development of a detailed curriculum plan, as that is essential in order for these recommendations to be successfully implemented. The researcher is of the opinion that the profession as a whole needs a leadership and management model that would ensure cohesion between all the facets of the eye care field. These facets must include, but not be limited to, elements like the providers of education; the quality assurer; professional associations; the State; clinical training networks; service delivery structures; programme development at all levels; as well as CPO articulation with all education and training structures and neighbouring countries. Such a model will provide direction and momentum to education- and needs-driven eye care services in South Africa and will open the way for the profession to develop to its full potential.
Afrikaans: Hierdie navorsingstudie is onderneem om die behoeftes en geleenthede vir nagraadse onderrig- en opleidingsprogramme in optometrie in Suid- Afrika gedurende die periode na apartheid te bepaal. Die grondrede vir hierdie studie is geleë in die aansporing wat bygedra het tot die aanvang van die studie, naamlik die Vision 2020 - The Right to Sight-veldtog van die Wêreldgesondheidsorganisasie, wat die resolusie van die Wêreldraad van Optometrie met die titel die Global Vision Care Campaign tot gevolg gehad het. Dat bogenoemde ten volle deur die Suid-Afrikaanse regering ondersteun word, word bewys deur beleidsdokumente soos die Witskrif vir die Transformasie van die Gesondheidstelsel (RSA DoH 1997) en die Nasionale Voorkoming van Blindheidprogram (RSA DoH 2000). Hierdie aspekte het onder andere die identifikasie van vraagstukke soos voorkombare blindheid; die belangrikheid van openbare gesondheid; openbare behoeftes; die gebrek aan menslike hulpbronontwikkeling; demografiese verteenwoordiging; en die gebrek aan duidelike kliniese vaardigheidsriglyne tot gevolg gehad. Die probleemstelling het betrekking op die loopbaanleer vir optometrie wat alreeds in Suid-Afrika aanvaar is. Dit het die deure geopen vir magisterprogramme en praktisyns die geleentheid gebied om kliniese en spesialisvaardighede te ontwikkel binne die omvang en parameters wat deur die Professionele Raad vir Optometrie en Resepterende Oogkundiges (Professional Board for Optometry and Dispensing Opticians) daargestel en gereguleer word. Ten spyte van hierdie loopbaanleer bestaan daar In behoefte aan In program wat daarop gemik is om onderrig en opleiding aan leerders te voorsien met die oog daarop om In professionele spesialisdiens in optometrie te lewer en tot die verbetering van die dissipline deur middel van navorsing by te dra. So In program moet professionele optometriste die geleentheid bied om hul onderrig en opleiding in terme van die loopbaanleer te bevorder, asook om sekere terapeutiese voorregte en spesialiteitsvaardighede te verkry. Die navorsing het die vorm van In beskrywende en In verkennende ondersoek aangeneem wat uit In literatuuroorsig en In empiriese ondersoek bestaan het. Die literatuuroorsig het twee aspekte gedek, naamlik in die eerste plek faktore wat tot die ontwerp van optometrieonderrig en opleidingsprogramme bydra. Aspekte soos die veranderende gesondheidsomgewing; die geskiedenis van die ontwikkeling van die optometrieprofessie; die transformasie van die gesondheidsorgsisteem in Suid-Afrika en die oogsorgbehoeftes van die Suid-Afrikaanse bevolking; asook die transformasie van onderrig en opleiding in Suid-Afrika is hanteer. Die tweede aspek van die literatuuroorsig was In selektiewe oorsig van optometrie-onderrig, wat optometrie-onderrig en -opleiding in Suid-Afrika hanteer het; die geskiedenis daarvan en die huidige stand van sake; asook wetgewing in Suid-Afrika. Vervolgens is optometrie-onderrig en -opleiding in die res van Afrika en die ontwikkelde wêreld in breë terme bespreek. Die empiriese studie het In vraelys ingesluit wat deur Suid-Afrikaanse optometriepraktisyns ingevul is. In Kwantitatiewe ontwerp is gevolg, maar - omdat die vraelys ook In aantal oop vrae bevat het - het die studie tog ook In kwalitatiewe dimensie gehad. Die oorhoofse doel en oogmerke was om In bydrae tot oogsorg en die voorkoming van blindheid te lewer, asook om In betekenisvolle bydrae tot onderrig en opleiding in optometrie te lewer. Die hoofdoel was om die behoeftes van optometriste met betrekking tot optometrie-onderrig en -opleiding - asook die geleenthede wat in Suid-Afrika bestaan - te bepaal, gemeet teen die agtergrond van die behoeftes van die gemeenskap (vanuit die perspektief van die optometriste). Die onderlinge oogmerke was in die eerste plek om bekwaamheid bo die vlak van graduering te verhoog en om sodoende die oogsorgbehoeftes van die Suid-Afrikaanse bevolking in die besonder en, indirek, ook dié van die aangrensende lande te dien. In die tweede plek was die oogmerk om aanbevelings te maak rakende die onderrig van relevante en toepaslike nagraadse studies in Optometrieskole/-clepartemente. AI hierdie aspekte is bereik deur middel van bogenoemde literatuurstudie en deur die bevindinge van die vraelys te gebruik. Die navorsingsontwerp het bestaan uit 'n behoeftebepaling in die vorm van die vraelysondersoek wat gebruik is as die metode om die behoeftes van die optometriste ten opsigte van nagraadse studies te bepaal, asook om hul standpunte aangaande bestaande geleenthede in hierdie verband te verneem. Die vraelys het uit ses kategorieë bestaan, waarvan elk vyf verskillende soorte items bevat het (vgl. 5.4.1; Aanhangsel C). Vier rondtes vraelyste is oor 'n periode van 16 weke uitgestuur en die responskoers was 70.2% (vgl. 5.5). Nadat die vraelyste wat terug ontvang is deur die Departement van Biostatistiek aan die Universiteit van die Vrystaat ontleed is, het dit vir die navorser moontlik geword om gevolgtrekkings te maak; om die bevindinge te ontleed; om aanbevelings te maak; en om sodoende die beperkinge van die studie te identifiseer. Elk van die ses kategorieë is deur 'n samevattende opsomming gevolg, asook deur die hoofbevindinge van die inhoud van daardie spesifieke kategorie. Die hoofbevindinge, asook daardie wat deur middel van die literatuurstudie bekom is, het die navorser in staat gestelom aanbevelings te maak rakende nagraadse optometrie-onderrig in Suid-Afrika. Verskeie faktore, wat onder die volgende hoofde en subhoofde gelys word, het hierdie aanbevelings beïnvloed: - Vertrekpunte: Hierdie sluit in toeganklikheid; bekostigbaarheid; persoonlike ontwikkeling; die aanspreek van openbare behoeftes; die aanspreek van hoëronderwys- en gesondheidsbeleide; die aanspreek van navorsing; die aanspreek van bestuursvaardighede; en die aanspreek van HPCSA-regulasies. - Rolspelers: Die rolspelers sluit onder andere in studente; voorsieners; die Professionele Raad; individuele optometriste en assosiasies; industrie; die publiek; die Staat; professionele belanghebbendes; die Suid-Afrikaanse Kwalifikasie-owerheid (SAKO) (SAQA); en die Raad op Hoër Onderwys (RHO) (CHE). - Nagraadse onderrig en opleiding is in drie aspekte verdeel, naamlik: -Aanbevelings rakende die program. -Aanbevelings met betrekking tot voortdurende loopbaanontwikkeling. -Aanbevelings rakende kliniese bevoegdheid gebaseer op openbare behoeftes. Die aanbevelings rakende kliniese vaardighede is tot in die fynste besonderhede uiteengesit, aangesien dit as In basis vir die Standaardegenererende Liggaam (SGL) van Optometrie en Optici (Opticianry) mag dien. Aangesien hierdie studie ook op openbare behoeftes gefokus het, .sal die detail in die aanbevelings betreffende bekwaamheid help om te verseker dat die sorg wat die publiek ontvang, verhoog word. Om te verhoed dat die professiOnelevaardighede nie met die kategorieë van die vraelys verwar word nie, is hulle in ses seksies verdeel, naamlik Seksies A tot F. Elk van hierdie seksies is in die afdelings "Uitkomste", "Prestasiekriteria" en "Indikatore/Aanwysers" verdeel. Hierna is In raamwerk as 'n vertrekpunt vir nagraadse onderrig- en opleidingsprogramme voorgestel. Opsommenderwys is die navorser van mening dat die oorhoofse doel en onderlinge oogmerke van die studie aangespreek en verwesenlik is en dat betekenisvolle aanbevelings gemaak is. Laasgenoemde stem ooreen met wetgewing en met die beleidsdokumente waarna vroeër verwys is. Verder stem aanbevelings rakende kliniese bevoegdhede met internasionale norme ooreen. Gevolgtrekkinge sluit onder andere die volgende in: - Gebaseer op huidige voorgraadse programme, bestaan daar 'n behoefte aan nagraadse programme wat gemik is op die voorsiening van opleiding en onderrig aan leerders. - Die artikulasie tussen die voor- en nagraadse programme sal In oorsig van die voorgraadse programme tot gevolg hê. - Die rolle en funksies van die Professionele Raad is deurslaggewend vir die sukses van onderrig beide op voor- en nagraadse vlak. - Aangesien die huidige optometrie-onderrigmodel nie daarin slaag om in die onmiddellike behoeftes van die publiek te voorsien nie, voorsien hierdie studie in ten minste sommige van die riglyne wat nodig is vir die ontwerp van 'n nuwe model. - Dit is duidelik dat VLO (Optometrie) in sy kinderskoene in Suid-Afrika is en die sukses daarvan hang daarvan af of dit die lewering van dienste positief kan beïnvloed. Dit is egter van deurslaggewende belang dat, vir VLO om effektief te wees, dit met formele kwalifikasies sal moet artikuleer. Die navorser besef die beperkinge van die studie, naamlik in die eerste plek dat die opinie van die openbare behoefte beperk was, aangesien dit optometriste was wat die respondente in hierdie kategorie van die vraelys was. In die tweede plek was literatuur en statistiese bronne vir die Suid- Afrikaanse situasie beperk in soverre epidemiologiese gegewens onvolledig en gefragmenteerd was. Verder het kliniese opleiding In optometrie gestagneer gedurende die apartheidsperiode. Dit word aanbeveel dat hierdie studie gevolg word deur en model vir nagraadse studie en die ontwikkeling van engedetailleerde kurrikulumplan, aangesien dit noodsaaklik is met die oog op die suksesvolle implementering van hierdie aanbevelings. Die navorser is van mening dat die professie as geheel enleierskaps- en bestuursmodel benodig wat ensamehang en verband tussen al die fasette van die oogsorgveld sal verseker. Hierdie fasette moet insluit - maar nie beperk wees nie - tot elemente soos die voorsieners van onderrig; die kwaliteitsversekeraar; professionele verenigings; die Staat; kliniese opleidingsnetwerke; en VLO-artikulasie met alle onderrig- en opleidingstrukture, asook met aangrensende lande. So en model sal rigting en momentum aan onderrig- en behoeftegedrewe oogsorgdienste in Suid-Afrika gee en sal die weg baan vir die professie om tot sy volle potensiaal te ontwikkel.
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Dissertation (M.HPE. (Health Professions Education))--University of the Free State, 2003, Post-graduate optometry education and training, National Prevention of Blindness Programme, Vision 2020 - The Right to Sight, White Papers for Education and Training and for Health, Career ladder of the optometrist, Continuing professional development, Professional board, Educational and health care systems, Clinical competencies, College personnel management, Medical personnel -- Training of
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