I, Keith Carlson, MD, co-author of this article, have faced many staffing challenges during my more than 15 years as an ophthalmologist working in private practice. Therefore, when I was approached to fill the Medical Director role at the Ophthalmic Medical Technician (OPMT) Training Program at Alexandria Technical and Community College (ATCC) in April of this year, I did not hesitate to accept. As an anterior segment surgeon, I realize the importance of qualified technicians in gathering surgical measurements for cataract and refractive procedures, as well as post-surgical refractions for eyeglasses. Without these accurate measurements, the high-quality results that we expect for every patient would be negatively impacted.
In recent years, the availability of well-trained technicians has decreased, leaving ophthalmology practices scrambling to find solutions. Some practices have resorted to “making do with less,” others have tried to “up train” current staff members, and still others have utilized standalone online courses. In my experience with each of these, the quality of the result, for the time and effort expended, is lacking. Classically, a hybrid classroom and clinical setting has provided more confident and knowledgeable ophthalmic technicians. Yet, there is a shortage of such training programs in the United States.
The history of the OPMT program
When the last ophthalmic technician training program in Minnesota closed in 2020, the administration in the Health Programs division at ATCC saw an opportunity to be part of the solution. Conversations with local ophthalmologists in both the Twin Cities and rural areas in Minnesota revealed the challenges in both finding and retaining qualified ophthalmic technicians were universal.
The curriculum for our unique program was designed by Aaron V. Shukla, PhD, COMT, Fellow (ATPO, AAOP). Over 20 years, Dr. Shukla has developed and managed two fully accredited ophthalmic programs. In 2000, he was the founding chairman of the Department of Ophthalmic Technologies and the technologist-level (COMT) program at Jones Eye Institute at the University of Arkansas for Medical Sciences in Little Rock, Ark., which is still going strong. From 2006-2019, he was the founding program director of the fully-accredited ophthalmic technician program at St. Catherine University in St. Paul, Minn. Our robust curriculum derives from this and ensures that our students receive a top-tier education, combining online coursework with hands-on clinical experience.
Originally developed to help address the technician shortage locally in Minnesota, it soon became apparent that the staffing shortage is a nation-wide phenomenon. This was the impetus for changing the OPMT program’s delivery mode from an in-person to a hybrid-online model. This change in delivery allows us to reach more students across the nation and makes the program a viable option to the staffing shortage on a national level.
The resultant OPMT program at ATCC is a 60-credit, hybrid-online program. Our courses and skills labs are taught online and our clinical rotations are coordinated so that they are held at convenient locations near the student’s home.
Our faculty is comprised of MDs, COTs and COMTs who bring real-world experience to the online classroom. Our model supports smaller class sizes, which allows for more one-on-one instruction for our students. In four semesters, students of our program obtain an Associate of Applied Science degree and are prepared to enter the workforce as a valuable member of the eye-care team at the intermediate, COT level. Additionally, in March 2023, the International Council of Accreditation (ICA) approved the OPMT program’s letter of intent, allowing our graduates to sit for the IJCAHPO COT exam. The OPMT program at ATCC is actively continuing the process to become fully accredited.
What we have learned about formal technician training programs
The ophthalmic technician community is a passionate group who are eager to share their knowledge. They truly understand the need for and importance of great technical assistance in modern ophthalmology practices. A hybrid-online model, combined with an asynchronous approach to course delivery allows talented ophthalmic professionals the flexibility to teach part-time without disrupting their work schedules or clinic productivity. This also benefits training programs, as instructors keep up to date with evolving clinical practices and advancing technologies that they can incorporate into the curriculum. This ensures graduates have the practical knowledge as well as the skills necessary to add value to the ophthalmology team.
We have also learned that there are organizations dedicated to both the creation and support of formal training programs such as ours. These organizations provide resources for training programs at all levels of IJCAHPO certification. There are three organizations whose resources have helped to strengthen the OPMT program:
- International Council on Accreditation (ICA) has a vast array of resources to assist with the creation of new ophthalmic training programs, which includes curriculum guidance and standards and criteria for program accreditation. Accreditation has many advantages including help in developing self-assessment procedures to identify areas for improvement. It is also a requirement for students to be eligible for IJCAHPO certification upon graduation.
- International Joint Commission of Allied Health Personnel in Ophthalmology (IJCAHPO): Certification should be the end goal of any training program. IJCAHPO has detailed literature on the core content areas included in the certification exams for all three levels of certification, which should be incorporated into a formal training curriculum. The organization also provides many resources for self-study and continuing education opportunities.
- Consortium of Ophthalmic Training Programs (COTP): A membership organization whose mission is to support ophthalmic training programs, COTP resources include insights into the ICA accreditation process, a professional forum for ophthalmic leaders of formal training programs, and access to a mentorship program.
The hybrid nature of a formal training program such as the OPMT program at ATCC with distance learning and local clinical rotation placements is unique and powerful. Personally, I (Keith Carlson, MD), have found that internal training of technicians is time consuming and, in the end, does not provide comprehensive training. Recently, I attended an American Society of Ophthalmic Administrators (ASOA) meeting where the topic of in-house technician training was widely discussed. This discussion revealed that in most instances, the level of training of in-house personnel was limited to the entry level of certification (COA) and technicians trained in-house were less likely to pursue higher levels of certification than graduates of formal training programs. It seems that with the amount of effort expended, a higher level of certification should be expected. The OPMT program, and others like it, can provide graduates with a higher level of skills and practical knowledge, with less effort on the part of the clinic.
We can all be part of the solution
There is a great need in ophthalmology for more qualified technical help. The AAO recently embraced the need for qualified staff by absorbing the Association of Technical Personnel in Ophthalmology (ATPO) into the newly formed American Academy of Ophthalmic Professionals (AAOP). With the aging population, this need will only increase. Given that reality, a hybrid program like the OPMT program can be of great value to busy clinics and their staffing needs. By providing a standardized training model, certified technicians would be able to more easily transition to other subspecialties and advance their careers. Such mobility across the nation would benefit all clinics.
We invite experienced eye techs to participate in our program as a clinical preceptor. An advantage of this is that your clinic will have a pipeline to well-trained technicians and first choice of our graduates.
For all of the training options available, a lack of exposure to the field of ophthalmology remains an obstacle. We can all do our part to tackle this obstacle by promoting awareness of his rewarding career in our clinics and among our family members and friends. Another option is to promote this career path to high school juniors and seniors by talking to students enrolled in allied health programs and by attending high school career fairs. We all need to do our part to attract the next generation of ophthalmic technicians to the field.
Conclusion
The creation of more formal technician training programs is a viable solution to the staffing challenges we face in ophthalmology. There are many resources at our disposal to help us create, improve and maintain quality programs. In addition to more training options, creating awareness for this rewarding career is essential. It is our hope that sharing our experience will open up more opportunities for ophthalmic technician training so that together we can develop the next generation of talented personnel for this rewarding career, and tackle this very real challenge in a meaningful way. OP
