Using the world health organisation eye care competency framework to guide curriculum development – a case study

Introduction

In response to the global challenges facing the provision of eye services, the World Health Organisation has developed the Eye Care Competency Framework (ECCF) as a tool for workforce planning and development. This framework provides a framework for performing specific competencies by different cadres of eye health workers across six domains. Singapore National Eye Centre (SNEC) was one of the organisations that offered to adapt and adopt the ECCF as a pilot and provide feedback to WHO regarding its applicability and relevance.^1,2

For this pilot at SNEC, a module from the recently developed Advanced Diploma in Clinical Ophthalmology (for optometrists) was chosen. The Optometry course was chosen for adaptation and alignment with the Eye Care Competency Framework (ECCF) due to its pivotal role in addressing the evolving needs of the eyecare industry at SNEC. Using this module enabled SNEC to understand how the process could be applied more broadly across the range of already developed curricula. It was determined that the ECCF would be aligned to this through a process of discussion and review with a working party comprising clinicians, educators and administrators.

The World Health Organisation (WHO) Eye Care Competency Framework (ECCF) aims to improve the quality of care across all cadres of the eye health workforce. The ECCF establishes a common platform on which the World Health Organisation (WHO) and its partners can launch a regional response to improve eye health services in nations over time. The assignment of explicit competencies to a particular unit or group of eye health personnel is the responsibility of educational institutions and regulatory bodies. The ECCF contains six domains, which are further broken down into clinical and non-clinical competencies. Each competence is then divided into knowledge, skills, attitudes or behaviours. ³

Case report

A modified process adapted from the WHO Rehabilitation Competency Framework was used. ⁴ This method involved locating pertinent information, customising it for the situation, and applying it where it is most appropriate. ⁴ An appropriate program for the pilot was identified, and it was determined that the ECCF would be aligned to this through a process of discussion and review with a working party comprised of clinicians, educators and administrators.

The competencies within the ECCF were compared against the course module content to identify gaps. Once mapped, the ECCF competencies not covered in the ADCO could be incorporated, if relevant, within learning opportunities integrated throughout the programme.

This meant that we would be using a backward design (Figure 1) whereby we had stated the learning outcomes and how students would be assessed, and this now needed to be reviewed for knowledge, skills and behaviours across levels of competence. Essentially, this was a benchmarking process in which we compared and evaluated our curriculum against the ECCF. This allowed our organisation to understand how our current training compared to the standard set by the WHO in the ECCF.OPEN IN VIEWER

Figure 1 illustrates the steps undertaken in the process of aligning the ECCF to the current SNEC Advanced Diploma in Clinical Ophthalmology for Optometrists (ADCO).

The clinical team took on the role of mapping the ECCF to the current module learning outcomes. The process involved working backwards to map the ECCF into the current curriculum document. Existing resources and learning outcomes were aligned to respective behaviours listed in the ECCF’s knowledge, behaviour and skills under the relevant domain.

The following process was followed to map the learning outcomes in the curriculum to the ECCF:

(1.) Align existing resources and learning outcomes to the respective level of Behaviours listed in Competencies/Knowledge & Skills under the relevant Domain;

A draft was collated and disseminated among team members who critiqued it to ensure it aligned with both the curriculum and the ECCF. The clinical team members ensured that the draft document continued to meet the Optometrists and Opticians Board (OOB) requirements. The final draft was agreed on by all members after an active discussion about the flexibility and adaptability of the ECCF.

Discussion

The ECCF provides a general framework for workforce development. For lower-income countries with less developed ophthalmic workforces wanting to improve the quality and relevance of care provided by different cadres of workers, the ECCF could be incorporated into existing frameworks, providing a blueprint for both job roles and scope of practice. For employees, the various levels of proficiency within the ECCF provide a roadmap of standards within a competence. A shortage of human resources for eye health globally has been discussed in the literature for some years, with the recommendation that role optimisation from ophthalmologists may help organisations meet current and future demands. ⁵ As such, the ECCF may assist with workforce planning and development, facilitating building, attracting and retaining a skilled workforce that meets the institution’s and demographics’ demands.

The ECCF may be best suited as a benchmarking tool for countries with well-developed ophthalmic workforces. Benchmarking is most often viewed as a simple comparison exercise rather than a tool for continuous improvement based on active collaboration between organisations that promotes best practice and improves quality of care. Accepting this interpretation of benchmarking and working collaboratively with the WHO, the process may help organisations identify areas for improvement and highlight areas of excellence. Benchmarking will identify gaps between an organisation’s current roles and/or curriculum and the ECCF, enabling the organisation to evaluate and analyse the gap to determine whether changes need to be made.

At the level of evaluation of its application to the ADCO program, it has helped identify what skills and competencies have been covered. The main gaps identified were in the domain of management and leadership which needed to be more explicit in the curriculum. The team felt that this was due to the fact that the students doing the course were registered optometrists currently employed to provide eyecare services, and were not expected to have high level managerial or administrative roles. These managerial or leadership competencies and behaviours specified in the ECCF were outside the objectives of the ADCO. The team opined these gaps were to be addressed at an institutional level, as part of workforce and leadership planning by the Human Resource department, and hence were not true ‘gaps’ in the curriculum.

By mapping out the domains and competencies of each job role and its corresponding education/development plan together with HR, we could identify whether the eye care system had adequately developed relevant professionals of appropriate breadth and depth of expertise to deliver eye care as a system.

Conclusions

The ECCF should be used in conjunction with national legislation governing practice. It should be seen as being flexible and adaptable so that it can be used in diverse contexts. For low-income countries with a poorly resourced and less developed ophthalmic workforce implementing a framework with an evidence base that other countries have adapted might be more efficient than developing new roles and competencies. Achieving a good fit when adapting a framework such as the ECCF in a new context requires careful and systematic planning. Adopting a competency-based framework such as the ECCF will help organisations establish core competencies that will develop practice and provide further learning and development opportunities.

This is a valuable framework for novice program designers to refer to when planning a program. It is beneficial in standardising programs to ensure a minimum standard is met. It may assist education committees within an institution to review and identify gaps across programs (both new and old) developed to see which domains programs may be lacking and improve on them. Furthermore, it is an excellent framework to apply if an institution wants to benchmark against international standards.