Life in Australia was turned upside down as we raced to flatten the curve of COVID-19 in March 2020. Universities suspended all face-to-face interactions and UNSW Sydney moved teaching online. Clinical teaching, including optometry, became particularly challenging in this new context, as students in their final year could no longer undertake supervised patient care. This article presents perspectives from both staff and final year students of optometry at UNSW Sydney and their experiences with online teaching.
From the Staff
The week before we closed the doors of the UNSW Optometry Clinic, we held a staff meeting with everyone logged onto computers in different rooms, in order to practice being ‘online people’ rather than working together in person. That’s become a little joke among us: we became ‘online people’.
While others were stockpiling pasta, we were de-identifying patient records in preparation for our online teaching. The timetable was re-organised and students were allocated to virtual clinics, tutorials, and grand rounds.
Simulated patients don’t replace real life, but they have been so beneficial that Suzie will likely need to keep attending virtual clinics for the foreseeable future
As staff we also continued to process our patients’ contact lens orders, post out spectacles, communicate with our patients, and we made the move to become competent telehealth practitioners. Some of us took to leaving our shoes outside at home. Now we can’t believe we ever did wear our shoes into the house.
The use of simulated patients was not new to us. It is a recognised, evidenced-based teaching tool used in medicine, psychology and nursing.1 We had used simulated patients in exam situations and when patients didn’t present to clinic. However, online simulated patients was something new. As we converted bedrooms into virtual clinics, we knew we couldn’t cover all clinical techniques in the online world, but we could concentrate on developing students’ problem-solving and analytical diagnostic skills. Blackboard Collaborate, the UNSW approved student platform for virtual classroom system, allowed us to share files, videos, create polls and facilitate group work to actively engage the students.
We each discovered we had a secret identity: Suzie. At 9am Suzie wanted a bioptic telescope to allow her to drive, at 12pm she had a colour vision assessment for her workplace certification, and at 3pm she brought in her ten-year-old son for myopia control. Yesterday, Suzie brought her grandmother Elizabeth into the clinic for the tenth time. And for the tenth time, Elizabeth very patiently answered in-depth, polite questions about her family history of age-related macular degeneration and her exact dosages of her medication. She also revealed, for the tenth time, purchasing her readers from the dollar store.
The format of our online clinics allowed us to give our students thought-provoking cases at every online experience. We were able to control the diagnoses and present a range of cases that would not be achievable during face-to-face clinics. Our students were able to practice finding their voice: having difficult conversations, giving clear instructions, and speaking appropriately to the patient and situation without jargon. To maintain as much authenticity as possible, all virtual patient experiences were real cases that have come through our clinic doors. The mix of patients was valuable, and reflected real life, where you never know who or what is going to sit in your chair.
Of course, all this would not be achievable without our students, who have shown adaptability and pro-activeness throughout this entire transition. They might be turning up to virtual clinics in their pyjamas, but they have been committed, active learners throughout.
From the Students
They say we should treasure our last years of university, but we didn’t expect 2020 to look so different. When we first heard about COVID-19, we just thought we’d need to wash our hands more and try not to sneeze in public. But then people started fighting over toilet paper, we started wearing masks when we saw our patients, and eventually clinical placements were cancelled. In unprecedented times, we received the announcement that UNSW had made the decision to move all our classes online.
So, rather than in-person clinics, our supervisors ran sessions of ‘virtual patients’ where they played two roles – as themselves and as a patient. The online learning experience brought an array of unanticipated enjoyment while still allowing us to grow in clinical knowledge.
It’s indisputable that the best thing about online classes is being able to show up to class in pyjamas. Even if the upper half of one’s body appeared normal on a webcam, no-one else can discern the comfort of wearing pyjama pants. An honorary mention goes to the blissful sleep-ins and sometimes waking up only five minutes before class began: no more packed buses and two-hour commutes.
In virtual clinics, real cases were used, which challenged our deductive skills to come up with a diagnosis and management plan. We worked as a team with fellow students which meant we could pick each others’ brains to come up with the best answer together. These sessions meant that we could see a variety of cases and become more efficient at clinical decision making, before seeing our real-life patients. This was also an opportunity to get more ‘one-on-one’ time with supervisors and be able to drown them with questions. This is harder in a clinic setting where they are usually juggling several patients and students at the same time.
Online tutorials were quite engaging and the supervisors’ dedication and preparation was evident. For example, a single four hour tutorial with the Centre for Eye Health staff turned into a three day series of tutorials. The UNSW Optometry Clinic staff spontaneously set up a date for a tutorial on amblyopia, which was really helpful. Overall, we learnt more than initially expected given the circumstances. COVID-19 reduced the clinical opportunities we would have experienced, but we used the time as a chance to revise our theoretical knowledge and are even more excited and ready to go now the School of Optometry has reopened.
The pandemic has affected everyone in different ways. The most upsetting effect for some of us was the cancellation of an overseas placement to America. The placement is really competitive, and requires five years of high marks, as well as working weekends to save up to pay for it, while watching your friends in other degrees having an active academic and social life. We are still riding the aftershocks of this earthquake, by trying to get refunds on all our accommodation and flights.
One student recalled an embarrassing moment when asked a question in a red eye tutorial; “After turning on the microphone to reply, the supervisor then said “turn on your video too, I want to see your lovely face”. Unfortunately at this moment, there was unbrushed hair, unruly eyebrows and yes, pyjamas, all revealed on camera. I think it was fair to say this is why I was extremely flustered and answered “it’s Clare” and hastily turned my camera off.”
There have been plenty of moments of fun, too. The online clinic allowed us to not only meet our supervisors but also the pets and pot plants, a scenario that we would unlikely experience during our university degree otherwise.
The software also allowed us to contribute our thoughts on a shared screen. One time during a tea break, we were encouraged to draw a picture. It was not only great to see the creative side of my peers, but our supervisors asked if our art could be screenshotted and distributed: thirty seconds of fame!
Although COVID-19 restrictions have brought the world to a halt, virtual clinics have allowed clinical optometry education to continue at UNSW. Simulated patients don’t replace real life, but they have been so beneficial that Suzie will likely need to keep attending virtual clinics for the foreseeable future. As we write this article, we are excited to be phasing a return to clinic, we are proud of how we have maintained teaching and engagement online. Thanks Suzie, we couldn’t do it without you. We’ll take you out for a coffee when restrictions lift.
Amanda Lea (Staff Optometrist, School of Optometry and Vision Science, UNSW Sydney), Rebecca Dang (Staff Optometrist, School of Optometry and Vision Science, UNSW Sydney),Veronica Giang, Nadine Harithupan, Louise Yau: 2020 final year Master of Clinical Optometry Students, UNSW Sydney, and Dr Sharon Oberstein (Deputy Clinic Director, UNSW Optometry Clinic, UNSW School of Optometry and Vision Science, UNSW Sydney).
- Kenny, Parsons et al. 2007, Cook and Triola 2009, Forsberg, Georg et al. 2011, Elley, Clinick et al. 2012
Cook, D. A. and M. M. Triola (2009). “Virtual patients: a critical literature review and proposed next steps.” Medical Education 43(4): 303-311
Elley, C. R., et al. (2012). “Effectiveness of simulated clinical teaching in general practice: randomised controlled trial.” Journal of primary health care 4(4): 281-287.
Forsberg, E., et al. (2011). “Virtual patients for assessment of clinical reasoning in nursing — A pilot study.” 31(8): 757-762.
Kenny, P., et al. (2007). Virtual patients for clinical therapist skills training. International Workshop on Intelligent Virtual Agents, Springer.