Hindsight: Journal of Optometry History, Volume 48, Number 2 | Page 56Goss: Optometric Education A Note on Some Aspects of Optometric Education in the 1980s and 1990s David A. Goss, O.D., Ph.D. School of Optometry, Indiana University, Bloomington, IN 47405 dgoss@indiana.edu SUMMIT ON OPTOMETRIC EDUCATION In 1992, Richard L. Hopping observed that: “At no previous time in the history of the optometric profession has there been a greater need for the full cooperation of the entire profession in order to move the educational establishment and thus the profession forward to an even higher level.”1 In 1992 through 1994 a series of eight conferences was held to evaluate the status of optometric education and to study what should be done to prepare for the future. Over 200 participants represented the American Academy of Optometry, American Foundation for Vision Awareness, American Optometric Association, American Optometric Foundation, American Optometric Student Association, Association of Schools and Colleges of Optometry, College of Optometrists in Vision Development, International Association of Boards of Examiners in Optometry, National Board of Examiners in Optometry, National Optometric Association, Optometric Extension Program, and faculties of each of the optometry schools. Representatives of the corporate sponsors, Alcon, Allergan, CIBA, and Vistakon, also attended. The eight conferences were: (1) Georgetown Conference, examining a broad range of topics, March 19-22, 1992; (2) Scope of Optometric Practice Conference, July 9-12, 1992; (3) Curriculum Conference, July 30-August 1, 1992; (4) Conference on Optometric Students, January 10-12, 1993; (5) Conference on Optometric Research, April 1-4, 1993; (6) Conference on Graduate Education, Residencies, and Fellowships, August 26-29, 1993; (7) Conference on Financing Optometric Education, November 18-21, 1993; and (8) Action Plan Conference, October 8-11, 1994. Richard L. Hopping served as Chairman of the Summit on Optometric Education Conferences. Hopping, L. Edward Elliot, president of the American Optometric Association in 1991-92, and Larry DeCook, president of the AOA in 1994-95, were the only persons to attend all eight conferences.2 Among the concepts discussed at the conference on scope of practice were what constitutes entry level competence and the need for optometry to practice primary, secondary, and tertiary levels of care. Factors identified as affecting scope of practice included matters such as public welfare, professional judgment, education, training, and new technologies. The 1978 Association of Schools and Colleges of Optometry Curriculum had significant impact in the 1980s, but by the 1990s its limitations were beginning to be recognized. Its emphasis on knowledge limited its ability to keep up with expansion of scope of practice. Developing an understanding of concepts, learning problem solving Hindsight: Journal of Optometry History, Volume 48, Number 2 | Page 57Goss: Optometric Education skills, and gaining an appreciation for lifelong learning came to be considered more important than knowledge of facts. The expansion of learning in the biological sciences also required additional facilities and equipment. It was agreed that research was essential for the future survival and growth of optometry. To make efficient use of resources, the importance of collaboration between optometric institutions and with other professions studying vision was emphasized. The idea of a training program for optometric clinician-scientists was also discussed. It was observed that graduate programs and residencies could serve as a vehicle for expansion of scope of optometric scope of practice and for certification in optometric subspecialties. The need for recruitment of graduate students, for the informing of graduate students concerning uniquely optometric areas of study, for a strategic plan for residencies, and for the development of fellowships in optometry were among areas identified as requiring attention. In reading through the monograph summarizing the conferences, perhaps the greatest sense of urgency could be felt in the section on the conference on financing optometric education.2 At one place, it was stated that the resource gap was “really big, not just big.” (p. 123) Identified areas of need included meeting increased operating costs, resources needed for expansion of scope, maintenance and expansion of faculty and infrastructure, expansion of research, replacement of reduced government scholarship funding, provision of adequate student loans and financial aid, and resources for new technology. DISCUSSION ON NUMBER OF OPTOMETRY SCHOOLS One matter discussed at the Summit on Optometric Education that has had a great deal of attention in the following years was whether additional optometry schools should be started. At that time, there were 16 optometry schools in the United States. Hopping1 pointed out the great increase in optometry graduates in the eight years following the end of World War II due to the very large classes admitted at some schools. He stated that: “Had the profession not graduated the number of optometrists that it did at that time… we would not be the major provider in the eye/vision care field today and we would not have captured our distribution system and the primary care position that the profession enjoys today.”1 Hopping noted that there were many factors affecting manpower needs in the health professions and that longitudinal manpower studies should be conducted on a regular basis. He also suggested that appropriate ratios of faculty, space, library volumes, and patient encounters per student should be evaluated. Jack Bennett3 pointed out that in 1976 the American Optometric Association recommended a total of 22 schools, but in 1984 changed the recommendation to four new schools for a total of 19. Bennett listed the reasons in favor of additional schools as: (1) There is a need for additional optometrists, particularly in light of expanding scope of care, aging of the population, and unmet needs in areas such as low vision and rehabilitation. (2) An optometry school is a political resource for legislative and regulatory matters. (3) Schools are resources for needed research. (4) Schools have a positive impact on the professional image perceived by the public, funding agencies, governmental entities, and other professions. (5) Schools have an important role in continuing education. Bennett Hindsight: Journal of Optometry History, Volume 48, Number 2 | Page 58Goss: Optometric Education gave as a significant argument against the addition of new schools that it would dilute financial, applicant pool, and faculty resources. Bennett concluded that additional schools were warranted but only under appropriate conditions in areas of need. Earle Hunter4 was of the opinion that additional schools were not needed because existing schools could increase or decrease the number of students admitted to adjust to perceived changes in manpower needs. Lorraine Voorhees5 observed that schools can improve the professional image of optometry by being a center for research and specialty patient care, but she felt that overall there are more arguments for not having more schools. Her reasons for that conclusion were: (1) Manpower projections do not suggest a need for additional graduates. (2) The applicant pool is not large enough to ensure high academic standards for all admitted students. (3) Financial support is a limiting factor. (4) There may not be adequate financial aid for students. (5) There may not be enough qualified individuals for additional faculty positions. INCREASING CURRICULAR EMPHASIS ON OCULAR DISEASE AND PHARMACOLOGY The expansion of curricular elements devoted to disease and pharmacology continued through the closing decades of the twentieth century. For example, comparing the 1979-80 and 1999-2001 Bulletins for the Indiana University School of Optometry, there was an increase of three semester credit hours in courses on general and ocular pathology and ocular disease. Looking at the 1981-82 and 2000-2002 Bulletins for the Northeastern State University College of Optometry in Oklahoma, the increase was seven semester credit hours. Over those time spans, there was a decrease of one credit hour in courses on geometrical and physical optics at both schools. A 1983 comparison of lecture hours on pharmacology given to medical students and to optometry students at Indiana University in Bloomington indicated that the total number of hours was the same, but there was more emphasis on ocular pharmacology in the optometry curriculum and more breadth of coverage in the medical school curriculum.6 Similar results were found in a 1985 study comparing 41 optometry, medical, and dental schools in 14 states.7 The vast majority of respondents to a survey of optometrists graduating from Indiana University School of Optometry before 1995 supported the trend of increasing curricular emphasis on ocular disease, but they also strongly felt that optometrists should continue to be very good at all aspects of eye and vision care, including refraction, basic binocular vision problems, and contact lenses, as well as ocular disease.8 Such a response was undoubtedly due in part to the fact that an average of 93% of the respondents’ income was derived from traditional optometric services compared to an average of 7% from treatment of ocular diseases. INCREASING NUMBER OF OPTOMETRIC RESIDENCY PROGRAMS The number of accredited optometry residency programs increased in the 1980s and 1990s, going over 20 programs in 1983, over 40 programs in 1986, and over 60 in 1995. In 1996, that jumped up to 82 accredited residency programs.9 The 139 residency Hindsight: Journal of Optometry History, Volume 48, Number 2 | Page 59Goss: Optometric Education positions in accredited and accreditation candidate programs in 1996 made it possible for about 10% of optometry school graduates to pursue residency education. THE NEW ENGLAND COLLEGE OF OPTOMETRY ACCELERATED O.D. PROGRAM In 1983, Pease reported on ten years of experience with the accelerated O.D. program at the New England College of Optometry (NEWENCO) for persons holding a Ph.D. degree in the sciences. The program was started in 1972, one year after a similar accelerated program for the M.D. degree at the University of Miami School of Medicine. The initial planners for the accelerated O.D. program at NEWENCO were William R. Baldwin and John H. Carter, and its first director was Norman E. Wallis. From 1972 to 1981, 85 students were enrolled in the program and 74 (69 men and 5 women) had graduated. The most common original fields of the students were physics, psychology, biochemistry, and biology. Their mean age was 37 years, with a range of 27 to 54 years. Curricular content was “essentially the same” as in the four year curriculum, and the number of clock hours in clinical rotations was the same.10 The primary areas of employment of the 66 graduates in the first eight years of the program were optometry practice (37) and teaching/research (20), with 18 of the latter having full-time positions at optometry schools.10 This program has been very successful in providing faculty to optometry schools. Three of my colleagues at Northeastern State University (NSU) in Oklahoma hired in the early 1980s were graduates of the NEWENCO program and had long careers as outstanding instructors at NSU (Lynn Cyert, George Fulk, and Roger West). By 1994, the entrance requirement of a Ph.D. in science had been modified to a doctorate level degree in medicine or science.11 Through 1995, there were 140 graduates of the NEWENCO accelerated O.D. program.12 Out of 101 of them who responded to a survey, 37% were self-employed and 35% were employed in education and/or research. Among the respondents were faculty members at twelve optometry schools and two medical schools. Two-thirds were members of the American Optometric Association and one-third were members of the American Academy of Optometry. Their performance on basic science and clinical science sections of the National Board Examination in Optometry far exceeded national averages. References 1. Hopping RL. What should be the proper size and number of optometric schools? J Am Optom Assoc 1992;63:808-811. 2. Gregg JR, ed. The Georgetown Summit: A Critical Assessment of Optometric Education. St. Louis: American Optometric Association, 1995. 3. Bennett JW. The pros and cons of developing additional schools and colleges of optometry. Typescript of paper presented at the Summit on Optometric Education, 1993. 4. Hunter EL. The pros and cons of developing additional schools and colleges of optometry. J Am Optom Assoc 1992;63:865-866. 5. Voorhees LI. Topic: discuss the pros and cons of developing additional schools and colleges of optometry. Typescript of paper presented at the Summit on Optometric Education, 1993. Hindsight: Journal of Optometry History, Volume 48, Number 2 | Page 60Goss: Optometric Education 6. Hegeman S. Comparison of pharmacology courses for optometry and medical students, Indiana University, Bloomington. J Optom Ed 1983;9:22-23. 7. Waigandt M, Waigandt A. An analysis of pharmacology training in schools of optometry, medicine and dentistry. J Optom Ed 1985;10:20-25. 8. Grosvenor T, Goss DA. A survey of Indiana University School of Optometry alumni. Optom Ed 1998;23:114-120. 9. Haffner AN. Optometric residency education: past, present, and future. Optom Ed 1997;22:82-86. 10. Pease PL. The accelerated O.D. program: the two-year program after ten years. J Optom Ed 1983;8:15-19. 11. Heath DA, Caruso J, Chauncey DM. Developing innovative programs for unique student populations. J Am Optom Assoc 1994;65:865-871. 12. Chauncey DM. The accelerated doctor of optometry program: outcomes assessment. Optom Ed 1998;23:108-113.