Impact case study database
Developing New Training to Improve Communication in Optometry
1. Summary of the impact
Improvement of communication skills has traditionally been neglected in optometric training, despite communication being one of the most important aspects of the optometrist–patient relationship. Research at King’s Business School found that changes in the content and structure of communication during optometric consultations have a profound impact on the experience of optometrists and patients. Based on these findings, King’s researchers developed a new ‘Communication Skills’ portfolio for the College of Optometrists (the UK professional body for optometrists), which has been further developed into a credit-bearing training module for its 16,000 members. Since its launch in April 2019, 320 optometrists have enrolled in the module and incorporated the learning into their practice. The success of the new learning material has also influenced university optometry departments to update their modules, further improving the practice of the UK optometry profession.
2. Underpinning research
Good communication helps patients to feel valued, at ease and in control, while poor communication can lead to miscommunication and inaccurate decisions that may adversely impact patients’ health and well-being. Although the importance of communication for good patient care is well known, until recently, communication featured very little in research and teaching in optometry. Previous research on communication between optometrist and patient relied on post-hoc, narrowly prescribed reports generated by standardised patient surveys. In innovative research at King’s Business School, designed in close cooperation with both practicing optometrists and optometrists based in universities, video recordings of optometric consultations were used to examine actual communication and interaction with patients. This was the first such study to use this innovative and sophisticated methodology, significantly advancing data gathering and understanding in the field of communication in a clinical setting.
The research findings demonstrated that small variations in communication with patients can have profound implications for the duration of an eye assessment. For example, at the start of a consultation, patients are often reticent to admit or elaborate on problems with their eyes and vision. This is in part because of the overly blunt and decontextualised nature of the conventional opening question, “do you have any problems with your vision?”. The research suggests patients are reticent because they feel it is the task of the examination to deduce whether any problems exist [1]. This can lead to delays when, later in the examination, specific problems are noticed and require investigation. The research found that patients are far more comfortable being asked about ‘changes’ or ‘concerns’ associated with their vision instead, because these kinds of questions connect more with their own categories of understanding [1,2]. The research concluded that making these adjustments in vocabulary could have a significant impact on the way that businesses operate.
Second, the research demonstrated that, despite increased use of advanced technologies, optometrists still benefit significantly from carefully designed communication practices, which enable them to obtain robust, subjective reports about patients’ ability to see [2,3]. For example, the evidence revealed that when conducting distance and near-distance eye tests (asking patients to read out lines of letters, for example), optometrists are more likely to produce reliable objective measures if they use carefully designed questions and prompts that minimise patient nervousness or anxiety [3,4].
Third, the findings showed that optometrists use communication skills that they have learned in situ rather than through formal training. For example, the professional gestures optometrists use to place lenses in front of patients’ eyes are not a taught practice and yet the research shows that changes in speech and body language can have a significant effect on the outcome of an appointment [4,5].
The findings also emphasised the importance of ascertaining a patient’s orientation to particular communicative practices to avoid potentially grave consequences resulting from communication errors in optometric practice [4,5]. For instance, if a patient describes their visual problems using specific vocabulary, this indicates that the optometrist can employ similar terminology, whereas if the patient reveals that they are attending an eye test for the first time, then this is likely to indicate that references to complex terms need to be accompanied by a clear explanation.
Overall, innovative research from King’s has demonstrated that carefully designed and organised communication between optometrists and their patients is critical to ensure effective consultations. This extends current knowledge by demonstrating the ways in which communication strategies need to be developed and refined to facilitate a more thorough, efficient and pleasant experience for both patient and optometrist.
3. References to the research
The research was subject to strict peer-review processes and was funded by two ESRC grants:
ESRC Grant – Assessing Eye Sight and Ocular Health: The Practical Work of Optometrists (RES-062-23-1391; 2009–2011)
ESRC Knowledge Exchange Grant – The Practical Work of the Optometrist 2: Communication Skills in Optometry. Webb (ES/K005588/1; 2013–2014)
Webb, H., vom Lehn, D., Heath, C., Gibson, W., & Evans, B. (2013). The Problem With ‘Problems’: The Case of Openings in Optometry Consultations. Research on Language & Social Interaction, 46(1), 65–83. DOI: 10.1080/08351813.2012.753724
Gibson, W., Webb, H., & vom Lehn, D. (2012). Ethnomethodological Workplace Studies and Learning in Clinical Practice. In V. Cook, C. Daly, & M. Newman (Eds.), Work-Based Learning in Clinical Settings: Insights from Socio-Cultural Perspectives (pp. 167–187). London: Radcliffe Publishing Ltd.
Vom Lehn, D., Webb, H., Heath, C., & Gibson, W. (2013). Assessing Distance Vision as Interactional Achievement: A Study of Commensuration in Action. Soziale Welt, 64(1–2), 115–136.
Gibson, W., & vom Lehn, D. (2020). Seeing as Accountable Action: The Interactional Accomplishment of Sensorial Work. Current Sociology, 68(1), 77–96. DOI: 10.1177/0011392119857460
Webb, H., Heath, C., vom Lehn, D., & Gibson, W. (2013). Engendering Response: Professional Gesture and the Assessment of Eyesight in Optometry Consultations. Symbolic Interaction, 36(2), 137–158. DOI: 10.1002/symb.55
4. Details of the impact
Despite the importance of communication skills as revealed by King’s research, optometrists traditionally receive limited education and training in communication, whether at university or through programs of Continuing Education and Training (CET). To address this issue, supported by the ESRC and the College of Optometrists, the King’s team worked together with colleagues in optometry based at Anglia Ruskin University and City University to create new training opportunities for optometrists. The innovative training has been delivered through workshops, publications and online modules for professionals, and is now taught in modules in the university setting.
Creating new professional development opportunities for optometrists
King’s researchers closely engaged practitioners throughout the research process in a variety of settings, sharing with them findings and recommendations to improve their optometry practice. For example, the researchers organised a credit-bearing workshop at Optometry Tomorrow 2014, the College of Optometry’s annual conference, AGM and exhibition. In addition, 8 credit-bearing workshops were held at King’s College London and at opticians’ practices in England (each with around 10 participants).
The participants were enthusiastic about the opportunities these workshops offered them, stating that “ I have learnt more about communication this afternoon than I did during my training” and “ We all found your presentation very useful and relevant to real life optometry” [A]. Also, a participant who manages a branch of Boots Opticians said that he and his team “ learned the importance that minute details of communication have for our patients’ experience and satisfaction” [B]. These activities contributed directly to the participants’ professional development, counting as credits for CET. CET is a statutory requirement for all fully qualified optometrists, and is a points-based scheme that practitioners are required to participate in throughout their career to update their skills and knowledge.
The King’s team further enhanced the impact of their research through publication of CET credit-bearing material for the magazines of the Association of Optometrists (the leading representative membership organisation for optometrists in the UK), ‘ Optometry Today’ (circulation of approximately 15,000) and ‘ The Optician’ [C,D,E]. These publications used the research findings to provide optometrists with new guidance for the use and avoidance of certain words, updated question styles and new approaches to improved communication with patients. The Clinical Editor of Optometry Today stated that the articles “ proved highly appealing to our readership. 781 optometrists passed the exams associated with the first article, and 842 optometrists passed the exam related to the second article. I am hoping for more articles by the team in the future” [F].
Developing an online CET credit-bearing course
As a result of the growing profile of the King’s research, the College of Optometrists developed a Communication Skills portfolio. The College of Optometrists saw great value in this portfolio, which was published in 2015 on its website [G], and decided in 2018 to turn it into a credit-bearing CET online course “Eye Examinations: improve your skills” (C-70016). Available to its 16,000 members on the College of Optometrists’ online learning website (DOCET), the online course focuses on communication skills and thus addresses one of the CET Competencies optometrists need to continually maintain.
The course has proven to be very popular, with 320 practicing optometrists enrolled on the course as of 31 December 2020. Of those, 228 successfully completed the course [H]. In their evaluation of the material, optometrists scored the module “ outstanding” [I]. The Director of Research for the College of Optometrists, who oversees this work, stated that: “[t]he learning material co-developed with King’s helps optometrists identify and understand how effective communication can improve the outcomes of a patient/clinician appointment. It assists them in understanding how relatively minor alterations to established habits and patterns of communication within an optometrist appointment can lead to improved experience and better clinical outcomes” [I].
Furthermore, participants in the online module highlighted that the module has helped them to change how they conduct eye exams. For example, one states that based on their learning, they have “ reorganised our furniture in our consultation rooms to ensure we always have eye contact with patients” [B]. Several optometrists say they will revise how they communicate with patients during history-taking and testing, that they will be “ tailoring tests to patients’ needs, rather than [using the] same routine for most” and “ will structure my appointments better to meet the needs of the patient” [J].
Influencing the development of university teaching programmes
King’s research further improved the knowledge and competency of practicing optometrists by influencing the development of university teaching programmes. Building on the success of the College of Optometrists’ course and recognising the enthusiasm of practitioners for the material, universities have used the research findings to enhance the teaching of communication skills in optometry programmes, further contributing to state-of-the-art techniques in conducting eye exams.
For example, the renowned Professor of Optometry, Professor Peter Allen at Anglia University, described the new communication skills portfolio as “ an extraordinary resource”, further stating that: “ Over the past five years, I have used the teaching material in the Optometry programme during the Introduction to Clinical Practice – Clinical Optometry 1 module. We are currently restructuring the course and have decided that interpersonal skills will be an integral part of all five Clinical Optometry modules. Approximately 70 students per year undertake the modules and are examined on the teaching material” [K].
The positive responses from practitioners who have engaged with King’s research through the new teaching material, workshops and publications demonstrate the significant impact the research has had on optometry training and practice. The research provided optometrists with the communication skills needed to conduct effective eye exams, ultimately improving their relationship with patients.
5. Sources to corroborate the impact
Feedback from workshop participants at The Practical Work of the Optometrist 2 , CET activities!, 21 March 2014
Testimonial from: Mehul Patel, Practicing Optometrist at Boots, 30th April 2020
Webb, H., & Allen, P. (2015). Effective Practitioner-Patient Communication in Domiciliary Eye Care Visits. The Optician. (C41655 (O/D)) [14 October]
Webb, H., vom Lehn, D., Evans, B., & Allen, P. (2014). Communication: Part 1 – Soliciting Information From the Patient. Optometry Today, 54, 52–55. (C-35474)
Webb, H., vom Lehn, D., Evans, B., & Allen, P. (2014). Communication: Part 2 – Delivering Findings and Advice to Patients. Optometry Today, 54, 48–51. (C-35804))
Testimonial from: Dr Ian Beasley, Clinical Editor of Optometry Today, 22nd January 2020
College of Optometrists. The practical work of the optometrist 2: communication skills in optometry. [website]
Testimonial from: Brooke Sperry, Research Manager at the College of Optometrists, 3rd February 2021
Testimonial from: Mike Bowen, Director of Research at the College of Optometrists, 15th May 2020
Testimonial from: Barbara Mason, Head of CPD at the College of Optometrists, 5th February 2021
Testimonial from: Professor Peter Allen, Anglia Ruskin University, Cambridge, Assessor and Examiner for the College of Optometrists, 21st January 2020
Additional contextual information
Grant funding
| Grant number | Value of grant |
|---|---|
| ES/K005588/1 | £45,230 |
| RES-062-23-1391 | £285,800 |