Independent Prescribing

One down…

There is A LOT to learn… masses…heaps…mountains. It’s all so interesting too. I just wish I had 12 months rather than four! And it’s not even four months (as advertised). We only have until 17th Jan to get all the assignments in. Aston really have to work on their communication skills!

But…I have my first case record! She phoned the practice today. She’s a referral I made in early March 19. Suspected new and active Ocular Mucous Membrane Pemphigoid, the first I’d seen in my entire career. I’d referred her through the secure Ophthalmologist email service, so I’d taken dozens of photographs. After intial treatment locally she’d eventually been referred to a larger centre for a biopsy and was ringing to confirm her diagnosis with us. I rather hope I sounded empathetic and not super excited as I pumped her for every last detail of her drug regime and casually asked if she’d mind if I wrote up her record (anonymously of course) for an examination I was taking. She was more than happy to be of help and told me to phone her if I needed more information, which was very kind. The best thing about this case record for me was that one of the differential diagnoses of the rare OcMMP is the more common pseudopemphigoid. This is almost solely caused by a reaction to topical medication, most commonly glaucoma medication. As the module is heavily weighted towards to glaucoma and the associated medications this is a useful feature of the disease.

Round 2 (Ding Ding)

I started Module 2 today: OP4OPT2 Prescribing for Disorders of the Eye. This builds on the last module and will take me into the details, ethics, and practical aspects of prescribing. We’re hitting the ground running with ‘Evidence Based Practice’. There are twelve sections for Module:

Evidence Based Practice
Professional Aspects of Precribing
Infection Control
Ophthalmic Dermatology
Red Eye – Optometric Management
Cataract Co-management
Refractive Surgery Co-management
Glaucoma Co-management
AMD – Updates and Co-management
Diabetic Retinopathy – Updates and Co-management
Systemic Disorders With Impact on Ocular Prescribing
Management of Patients with Additional Needs

Having scanned quickly through all the sections this seems even more intense than the last module. The volume of lectures, links, and additional resources to wade through is vast. There is no essay included in the assignments this time but there are three case records and VIMOC examination. They are looking for more in depth analysis of the case records this time…more awareness of how I would manage patients if I had an IP qualification. A heavy emphasis on glaucoma is stressed.

I’ve already decided what I need to look for in my case records: I need one glaucoma patient, one patient whose management would definitely have have been changed by my having an IP qualification, and one which probably wouldn’t…because knowing the limits of my professional skills, both experientially and legally is very important…and if one of these could be a contact lens patient it would be great. I’m now on an impatient patient hunt.


Update. First module passed with a satisfyingly high score. The feedback for the case records was thorough and useful. The essay was well received but the person marking it pointed out that while they enjoyed the essay, and it was well-written and concisely argued they would like to have seen a lot more discussion opened up at the end. So it was too short not too long! After all that editing and stressing. I could kick myself, but as all I had to do was pass and I did that just fine, I’m over it. Large glass of wine here I come.

No Fanfare!

I have a completed essay. I’ve run it by two IP-qualified friends who both said very nice things about it. It’s 4.5 sides of A4, plus references so I’m 30% over the 3 sides of A4 suggested but I have been as economical as I can while still answering the question. I’m actually quietly proud of my efforts. We’ll now see whether that pride is misplaced. Back in a sec…

OK…I hit the submission button for all four of the final assigments for this module. I feel this deserved little fanfare, some digital fireworks and a ‘CONGRATULATIONS, YOU HAVE SUBMITTED YOUR ASSIGNMENTS SUCCESSFULLY, ON TIME, NOW GO AND HAVE A LARGE GIN AND TONIC AND A NICE BATH’ notification. I expected a ‘PING – your assigmment has been successfully uploaded‘ notification at the very least, but as seems to be the case with all Aston communications the reality was ambiguous! The fact there wasn’t an error message is the best that can be said for the system, so keep your fingers crossed for me.

Essay, Essay, Essay

Essay, essay, essay! What’s black and white and red all over? 

My Merlot-spattered second draft!

Rubbish joke…bit like this essay.

Writing is going slowly, and involved much moaning and quite a lot of merlot consumption, but it’s gradually coming together. I’ve just surfaced for air and more wine. The course spiel says approximately 3 sides of A4, but I’m sure mine will be a lot longer. Is that bad? Am I waffling? I’ve pared everything down to the bare essentials but I still have so much to say. I’ve always been really good at sticking to word counts. I like boundaries because it lets me know how much detail is required, but 3 sides of A4? Is that .9 font? .12? Double spaced? Give me a word count!!! I asked by email but received no reply. I asked again but the reply email was basically ‘3 sides of A4 as per the instructions.’ I have to say that communication does not seem to be Aston University’s strong suit. I’m investing a considerable amount of money in this and the tutor interaction (and the quality some of the MCQ assessments) seem very slapdash and shoddy.

“Mini essay (typically ~3 A4 sides, not including references) on the misuse of medications reflecting how practitioners and patients may misuse ocular medications and how to minimise the likelihood of this happening. Please see the “Essay Marking Scheme” for a detailed description.”

Cracking the Case(s)

The two case records were reasonably straightforward to write up. I keep detailed records anyway, with lots of images, so that part was fine. The tricky part was the evaluation reflecting on my role, the actions I took, the procedures I carried out and how my role might have been different if I’d had an IP qualification. All the steps and procedures which seemed perfectly reasonable at the time of the examination suddenly have me doubting myself under the scrutiny of detailed analysis. Thankfully mostly I feel happy and confident with my actions, though I’ve highlighted a couple of gaps and areas I might have handled things differently in the light of all my recent studies. At least it proves I was paying attention to the course material right?

Critiquing their case record is easy…and hard. It’s so easy to pick holes in someone else’s case record, but then I find I have to reread my own case records to check I haven’t missed something vital or dropped a clanger! Now I have to tackle that essay…head down…see you on the other side.

The Other 90%

All my coursework is finally complete. 10% of the course has taken about 70% of the time! I’m freaking out over this slightly, but hoping my obsessively detailed notes will help fuel my essay and case records.

The good news is that I have a really interesting second case record. I’ve given a lot of thought to these case records. I decided to go with one case that could be and was managed successfully in practice without the IP qualification (Blepharitis), and discuss how as an IP I might have been able to more for that patient if the condition had not improved or if it had flared again. The second case I decided, should be one I could not have managed in practice, even with an IP qualification, to demonstrate that although my knowledge would have informed my handling of the case I also knew where the boundaries of my role in its management lay. This second case is a paediatric flare-up of pre-existing and previously dormant toxoplasmosis, which although unfortunate for the child was a bit of a gift to someone looking for exactly the right presentation, with plenty of photos and hospital follow-up letters. (Child is fully recovered now by the way). So I’d better press on.

A Bit of a Moan

It’s been a bit of a mixed bag lecture wise. Some are clear, enaging and interesting and some sound as though they’ve been recorded by someone wearing a pillowcase over their head,  or under water. One was so monotone I nearly fell asleep several times and had to keep rewinding to listen. To be fair I seem to remember my undergraduate lecturers being similarly variable in quality.

In at least two of the exams the answers to one or more of the MCQ questions (on which you receive immediate feedback, were wrong…as in the wrong answer was given the ‘correct’ mark and my correct answer was marked wrong!). The first time I spotted this I dropped an email to the tutor and the mark was reinstated (I know…it’s one mark and only one mark from part of the course worth 10% of the total, but I worked hard for that mark dammit!). The second time the tutor agreed the answer to the question was wrong but didn’t reinstate the mark. When I queried it she told me that my concerns would be taken on board when the course was presented in its new iteration! I was a bit miffed about that. If the answer to the question was wrong…that means I dropped a mark while someone else who maybe answered incorrectly got a mark. I sound so petty don’t I? Maybe I am…but I WANT MY MARK BACK!

Also, while I’m having a moan, most of the MCQs are designed to test our knowledge of the subject we just studied quite fairly, but the Medicine and the Law questions were APPALLING! Truly awful. They contained so many double and triple negatives that they seemed solely designed to catch us out on the use of the English language. Now a cynic might say I’m only annoyed because although I passed these two exams it was by a slim margin (whereas I’ve rocked all the others). Maybe they’re right… onwards and upwards we go.

Don’t Panic!

I have been hammering the coursework! It’s neverending. I’m panicking that I won’t get through it all in time to write an intelligent essay. I’m also stressing about the case histories. I know they don’t want weird and wonderful; they want normal cases we’d see in practice. I had a great one…a perfect case study which I’d managed successfully in practice. It was a recurrent erosion, but when I checked the ‘sample case record’ given as an example of the sort of thing expected it was also a recurrent erosion. So now I feel I have to find a different case to work up. Back to the drawing board.

Diving In

I began to wade through the course material today. I took the time to look at every subject section in OPT1.

Anatomy and Physiology
Immunology and Microbiology
Ocular Pathology
History taking
Public Health Issues Relevant to Optometrists
Principles of Pharmacology
Ocular Pharmacy and Therapeutics
Medicines and the Law Pt 1
Medicines and the Law Pt 2
Medical Errors and Pharmaco-vigilance
Influences on Prescribing Practice
Medicine Taking Behaviours
Effective Prescribing
Medical and Optometry Ethics

The blurb says each section features a ‘lecture’ but in practice for each section there may be multiple lectures, multiple papers to read and digest, and many links to follow to other videos or resources. There is a LOT of material to get through. When you get through each little section of the module there is a short (1 hour) MCQ exam which has to be passed. There are 14 ‘little’ sections and together they total just 10% of the course marks.

At this point I was hyperventilating until I realised that while the exams were presumably to confirm you’d studied the section, the real point of all the study was to be able to produce the case studies, critiques and essays, which between them account for the other 90% of the marks. So, I made up my mind not to skimp on the study to get to the big marks more quickly. In we go. Wish me luck.