A Backward Glance on Optometric Education: Institutional Profile Of

Home , Doctorate, Optometry

Introduction he optometric profession arose from the public’s need for eye care and its unavailability T within the United States in the early 1600s. Optometry schools began as informal proprietary colleges A Backward Glance on and have become formal, structured, accredited four-year programs that offer Optometric Education: a Doctor of Optometry (OD) degree as well as other degrees in physiologi- Institutional Profile of cal optics and vision science. In the past five years, optometric education has Schools and Colleges seen a rise in the number of optometric educational institutions. Also, over the past 50 years, the profession has of Optometry steadily grown and developed from one of refractionists to one of primary care Shilpa J. Register, OD, MS, FAAO healthcare providers for the eye. In light of these trends, reflecting on the past history of the profession, its current status and future will provide an enlight- ening overview of the development of the profession. In this respect, it is important to understand the history of educational institutions to fully understand the history of professions and their relative impact on Abstract society. This information can be used This paper discusses the rich history, current institutional profile and future of as a tool for reflection and guidance for optometry schools and colleges in the United States in relation to core competen- current and future institutions as well as assist students in better understand- cies. The optometric profession arose from the public’s need for eye care and its ing the roots of their profession. Fur- unavailability within the United States in the early 1600s. Optometry schools thermore, the history of optometry can began as informal proprietary colleges and have become formal, structured, ac- help guide our future and bears weight credited four-year programs that offer a Doctor of Optometry (OD) degree as on discussion of important concepts well as other degrees in physiological optics and vision science. such as core competencies. This paper Key Words: History, optometric education, optometric demographics, core will discuss the rich history, current institutional profile and future of optom- competency etry schools and colleges in the United States, and core competency development. Dr. Register is a Clinical Associate Professor at The Ohio State University College of Optometry. History of Schools and She is currently pursuing a PhD in Educational Policy and Leadership in the College of Educa- tion and Human Ecology at The Ohio State University. Dr. Register is active in the American Colleges of Optometry Academy of Optometry, serves as the Association of Schools and Colleges of Optometry representa- In 1620, the first pair of spectacles ar- tive for the Consultation Group on Interprofessional Professionalism, and recently received the Michael G. Harris 2010 AOF Ezell Fellowship. rived in the New World. Over the next 250 years, there was a strong force to hasten optometry’s development from its roots as an optical business into a healthcare profession. Originally, the trade profession of optics was learned through apprenticeship. Charles Pren- tice fought for standards to ensure that the public received the finest optometric service. Then, the profession of practicing refractionists evolved to meet the needs of the public; however, lenses

Optometric Education 76 Volume 36, Number 2 / Winter/Spring 2011 were only available in Europe. In 1833, Concurrently, courses were offered to In 1947, the American Optometric jewelry businessmen began to produce optometrists throughout the country, Foundation (AOF) was created to pro- spectacle frames in Massachusetts. By hence the beginning of optometric ed- mote the growth of optometric science 1852, the demand grew, and approxi- ucation and the profession as we know through support of graduate students mately 15,000 frames were made per it today.4 In 1900, the American Op- in vision science research.4,6 Initially, year. 4 Between 1890 and 1900, many tometric Association (AOA) elected its the AOF was primarily funded from spectacle lenses and optical instruments first president. The AOA aimed to sup- within the profession, but as more pub- were produced in the United States, port optometrists through legislative lic and governmental agencies relied on thereby decreasing our dependence on processes. In 1915, the AOA passed a it for guidance in vision research and Europe. resolution that defined the minimum care, the funding for the AOF expand- 6 In 1907, the first school of optometry, length of optometry courses. This reso- ed to include the public. The AOF has the Needles Institute of Optometry, lution required upgrading the original played an important role in shaping was established in Kansas City, Mo. optometry schools, including the dis- and supporting optometric education qualification of 20 schools.4 through its support of researchers and It eventually relocated to Chicago to 6 merge with the Northern Illinois Col- In 1914, the first public college of op- educators. lege of Optometry.5 In 1905, the Mas- tometry, The Ohio State University, From 1945-1988, eight additional pub- sachusetts School of Optometry was es- was founded. It granted its first degree lic colleges of optometry and one addi- tablished from the reorganization of the in 1915, a Bachelor of Science in Op- tional private school were established.14 Klein School of Optics, which began in tometry.6 From 1894-1932, five addi- This growth in public and private- in 1894 with a mission to instruct opti- tional private schools and colleges of stitutions parallels the immense growth cians on the diagnosis of diseases of the optometry were established.14 In 1927, of undergraduate and graduate institu- fundus using the ophthalmoscope.6,7 Pennsylvania College of Optometry tions across the United States.1,16 The Massachusetts School of Optom- was the first institution to grant a Doc- etry was later renamed as the New Eng- tor of Optometry degree after comple- Current Status of land College of Optometry (NECO) tion of a four-year curriculum.6 In Optometric Education in 1976. All three schools were based 1922, the American Academy of Op- At this time, there are a total of 23 in Boston, although there were several tometry (AAO) was founded with 11 accredited schools and colleges of op- relocations between different build- charter members. Their mission was to tometry. Twenty are members of the ings.8,9 increase the professionalization of op- Association of Schools and Colleges tometry and move away from commer- The Illinois College of Optometry of Optometry (ASCO), and three are cial optometry.15 The AAO conducted (ICO) was formed in 1955 with the affiliate members of ASCO. The 20 post-graduate courses and encouraged merger of the Chicago College of Op- member schools are located within the the formation of local chapters nation- tometry and the Northern Illinois Col- United States and Puerto Rico, and the ally and internationally.6 It also began lege of Optometry, which were found- affiliate members are located in Cana- 4 to hold annual meetings to serve as a ed in 1946 and 1926 respectively. The da and Columbia.17,18 The 20 ASCO forum and meeting place for optom- Northern Illinois College of Optometry member schools within the United etrists where continuing education and had its roots within the Chicago Col- States and Puerto Rico are shown in research is highlighted.6 lege of Ophthalmology and Otology, Table 1 with their founding dates, class established in 1872, where opticians By 1925, a committee of volunteers, size and institutional organization. All were trained by physicians on the use of known as the Council on Optometric 20 of the schools and colleges offer a practical methods using prisms and on Education (COE), was appointed to four-year optometric curriculum grant- detection and correction of optical de- accredit optometric education institu- ing the Doctor of Optometry degree. fects using the ophthalmoscope.10,11,12 tions. The COE became the current Most optometry schools strongly rec- optometric accreditation body known Additionally, the Los Angeles College ommend if not require a bachelor’s as the Accreditation Council on Opto- of Optometry began in 1921 from the degree for applicants.20 New England metric Education (ACOE). Optomet- Ketchum School of Optics that was College of Optometry offers additional ric education began to flourish over the established in 1904 and later became unique degree programs for foreign- next 10 years, reaching a pinnacle when the Southern California College of Op- trained optometrists that encompass an 6,13 OSU offered a PhD degree in physio- tometry (SCCO). All three of these abridged curriculum.26 Other schools logical optics under the direction of Dr. institutions had many changes and offer dual degree programs whereby stu- Glenn A. Fry. From 1935-1955, opto- relocations that mimicked the many dents interested in research and public metric education grew to encompass changes that the optometric profession health can receive an additional Master a formal curriculum, which was a six- underwent. Southern California Col- of Science, Doctorate of Philosophy or year professional course consisting of a lege of Optometry, Illinois College of Master in Public Health degree.20 In the two-year liberal arts program combined Optometry and New England College past 40 years, the number of schools with a four-year specialized professional of Optometry all originated from optics and colleges of optometry has almost education.6 schools at a time when the optometric doubled. Furthermore, there are three profession did not exist. additional institutions, Western Uni-

Optometric Education 77 Volume 36, Number 2 / Winter/Spring 2011 versity of Health Sciences, Midwestern University Arizona College of Optom- Table 1 etry and University of the Incarnate Word, whose optometry programs had Historical Perspective of U.S. Public & Private been granted preliminary approval by Optometry Schools and Colleges 4,6,17,19,20,21,22,23,24,25 the ACOE and were preparing to ad- mit their first incoming classes in Fall 21,24,25 2009. Name of Institution Founding Private/ Number of Year Public Students/ Future of Optometric Yr Education Illinois College of Optometry (ICO) 1872 Private 158

In 1968, Hirsch and Wick predicted New England College of Optometry (NECO) 1894 Private 115 the creation of additional university- affiliated colleges resulting in a total Southern California College of Optometry (SCCO) 1904 Private 98 of 20 university-affiliated schools to completely attain optometry’s profes- Inter American Univ. of Puerto Rico (IAUPR) 1912 Private 50

sional status and fulfill the optometric The Ohio State University (OSU) 1914 Public 64 demand placed by society. They advo- cated the replacement of independent Pennsylvania College of Optometry at Salus 1919 Private 155 schools and colleges with university University (PCO) affiliation to promote professional rec- University of California at Berkeley (UCB) 1923 Public 60 ognition as evidenced by the history of Southern College of Optometry (SCO) 1932 Private 123 dental and pharmacy schools, but recognized the important contributions Pacific Univ. College of Optometry (PUCO) 1945 Private 89 made by the independent schools and colleges of optometry.6 Indiana University (IU) 1951 Public 78

Recently, many healthcare profes- University of Houston (UH) 1952 Public 105 sions recognized by society, including medicine, nursing and pharmacy, have University of Alabama at Birmingham (UAB) 1969 Public 44 retained their professional status in so- State University of New York (SUNY) 1970 Public 72 ciety while offering education through both university-affiliated and indepen- Michigan College of Optometry (MCO-FSU) 1975 Public 36 dent schools and colleges.27,28,29 There- fore, the prediction of all educational University of Missouri - St. Louis (UMSL) 1980 Public 44 institutions being university-affiliated Northeastern State University - Oklahoma College 1988 Public 26 seems to be an unrealistic goal for our of Optometry (NSU-OCO) profession if we are to continue to NOVA Southeastern University (NOVA-SE) 1989 Private 101 serve all members of society. We must remember the importance of all opto- Western University of Health Sciences 2009 Private 70 (WesternU) metric educational institutions as they Midwestern University - Arizona College of 2009 Private 50 serve our profession and continue to Optometry (AZCOPT) contribute to society as stated in the University of the Incarnate Word (UIW) 2009 Private 60 AOA mission.30 Our profession has changed as rapidly as society in general has changed.31 We must remain at the forefront of education by constant evaluation of our academic programs,

curriculum, faculty needs, student ex- 32 pectations and institutional mission, fessions. The futures of optometry Competency in Healthcare vision, goals and objectives. schools and the optometric profession Professions depend on their current actions and The history of optometry schools is objectives to meet the needs of the pub- What is the relationship between the important because it is one of the few lic and the future students. Educational development and continuation of our professional schools that began as pro- institutions need to focus on their profession and optometric education? prietary schools with a commercial unique differences as defined by their Historically, it has been shown that 4,6 focus. Both the change in pedagogy mission and vision to remain viable in optometric education has been at the and change in ethnic demographics the future and must remain cognizant forefront and was instrumental in de- have been slow in optometry, which is of their rich past. veloping our profession. Now, there consistent with other educational pro- are additional stakeholders and facets

Optometric Education 78 Volume 36, Number 2 / Winter/Spring 2011 to optometry. Healthcare professionals are held to a certain standard by the Table 2 public and are expected to be compe- 41 tent and qualified. The public expects Competency Statements from ASCO state boards to ensure competency in their healthcare professionals as well as Knowledge knowledge of basic body systems, processes and causes leading to dysfunction or disease, active involvement in maintenance of mechanisms of action of pharmaceutical agents, structure and processes contributing to refractive competence initiatives.33 Competency error, optics of the eye and ophthalmic lens systems, visual development and visual function, vision therapy and rehabilitation, understanding of psychosocial forces affecting patients, has been defined as the ability to per- practice management strategies and structures, and elements related to clear verbal and written form a job adequately. However, an communication education curriculum should prepare Skills students to not only be competent as cognitive and motor skills necessary to prevent, diagnose, treat and manage clinical conditions within defined, but also to have the pertinent the optometric scope of practice skills and knowledge necessary to rep- Professionalism 34 resent competent professionals. This Personal - including a commitment to life-long learning, incorporation of ethical principles into patient care decisions, problem solving and critical thinking skills, and the recognition of one’s personal skill set represents core competencies limitations in patient care that all healthcare professionals must Professional - including application of professional ethics and standards in the practice of optometry, demonstration of honesty and integrity, respect for patients and commitment to confidentiality, understand before practicing in their understanding potential conflicts of interest in health care, and a commitment to active involvement in profession. organized optometry Empirical Studies The literature contains many articles on the benefits of core competen- However, I argue that competency is conferences and organizations focused cies for various professions as well as much more than knowledge and skills. on education and public health in vi- benefits of competency-based educa- Core competencies should also include sion care that can be used as a resource tion.35,36,37,38,39,40 Most healthcare profes- demonstrable critical thinking skills, to expand core competencies to involve sions have adopted a competency-based communication skills, and the integra- global needs, concerns and expecta- education curriculum through exten- tion and application of knowledge and tions. sive education reform, some of which 34 skills. Psychosocial and interprofes- Reimers claims that schools and col- was introduced by outside sources such sional competencies are usually intro- as the government or the public.36 leges are not preparing their students duced during the last two years of the for global challenges and consequences Competency-based education has the optometric program when students are that include a lack of internationaliza- potential of improving the quality of performing their clinical rotations but tion.39 It is predicted that over the next education and the quality of the stu- should be intertwined throughout the 15 years, there will be major changes dents. Much of the emphasis on edu- entire currriculum. globally as related to politics, environ- cation reform towards a competency- ment and healthcare. Students must based model has been on improving Core Competency have global competency that has been the talents, aptitudes and abilities of the Development defined as the knowledge and skills students, thereby improving their qual- necessary to cross disciplines, compre- ity of life.35 In healthcare professional The development of core optometric hend global events and respond effec- education, the benefits in quality of competencies needs to include needs of tively.39,43 life extend to the patients and towards the public, standards of the profession their quality of care, hence, the heavy and attainable objectives of educational Interprofessionalism has been defined involvement from federal agencies to curriculums. General core competencies as the interaction between practitioners ensure that the public receives valuable, in other healthcare professions such as from different healthcare professions to quality healthcare. medicine have focused on patient care, improve quality of patient care.44 It also medical knowledge, practice-based involves interaction and collaboration Roles of Regulatory learning and experiences, interpersonal between professionals who understand Boards and Professional and communication skills, professional- each other’s disciplines. Interprofes- ism, and systems-based practice, which sional professionalism has been defined Organizations in Policy 42 is a more inclusive definition. as the “consistent demonstration of core Development and Competencies must also address glob- values [and the application of] altru- Implementation al and interprofessional concerns or ism, excellence, caring, ethics, respect, In 2000, a Committee on Attributes needs. There is much disparity in the communication and accountability to from ASCO compiled and developed scope of practice and the definition of achieve optimal health and wellness [in 45 competency statements focused on an optometrist from a global perspec- patient care]”. Interprofessional be- knowledge, skills and professionalism. tive; however, vision care has a dramatic haviors and skills must also be included Table 2 explains each competency cat- effect on individuals and communities in competencies with optometry for the egory. throughout the world. There are global sake of excellent patient care and col-

Optometric Education 79 Volume 36, Number 2 / Winter/Spring 2011 laboration with other healthcare profes- Dr. Aurora Denial; my father, Dr. J.R. 16. Geiger R. The ten generations of sionals. Patel; and my husband, Scott, for vol- American higher education. In: Interprofessional behaviors have been unteering to repeatedly proofread and P.G. Altbach, R.O. Berdhal, P.J. defined as determining the best plan for offer input on this manuscript during Gumport (Eds). American higher patient care, demonstration of cultural preparation. education in the twenty first centu- competence, challenging the status quo References ry. The Johns Hopkins University when patient care is ineffective, involve- Press: Baltimore;1999:38-70. ment in team coordinated patient care, 1. Lucas C. American higher educa- 17. Association of Schools and Colleg- implementation of interprofessional tion: A history. Palgrave Macmilla, es of Optometry. Affiliate Member teaching in chronic illness, and other 2006. 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