Number of patient encounters by mid-level eye care providers and their proficiency in refraction

The Pacific Eye Institute (PEI) is a regional training centre for eye care personnel. PEI trains nurses and technicians in a variety of competencies including refraction. In 2009, 8 nurses and 1 refractionist completed a refraction module. The aim of this study was to examine students' exposure to different types of refractive error patients and consider its influence on student performance. The 2359 patient records from 2009 were divided by student examiner, and frequencies of patient encounters were calculated. The student nurses saw on average 163 patients (maximum 193, minimum 141). The student refractionist saw 371 patients. Hyperopia, presbyopia, hyperopia with presbyopia, emmetropia and ocular disease constituted greater than 75% of patient encounters for all but one student. The median number of astigmatic patients seen by the student nurses was 21, with 6 of 8 students seeing less than 25 astigmatic patients in the year. The student refractionist saw 54 astigmatic patients. All students, by the end of the year, were proficient in hyperopic, myopic and presbyopic spherical refraction. The majority of students were not proficient in sphero-cylindrical refraction. Less than 25 astigmatic patient encounters, therefore, seems insufficient to produce mid-level eye care providers with sufficient skill in sphero-cylindrical refraction. The two students who excelled at sphero-cylindrical refraction saw over 50 astigmatic patients and the least proficient saw only 18. Patient encounters should be tracked throughout the students' education to ensure appropriate exposure to all patient types especially astigmats.