After four years of hard work and rigorous study, new graduates of the Pennsylvania College of Optometry can proudly stare at their well-deserved doctor of optometry degree. However, at this particular optometry school, located just outside Philadelphia, new graduates will likely be looking at another document with equal amounts of pride and wonder: a bound portfolio carefully detailing their entire 2,000 to 3,000 patient encounters at PCO.

The goal of having all students experience thousands of patient interactions spread across their four years of study is just one of the many objectives of PCOs major shift in its academic philosophy. During the 1997-1998 academic year, PCO took a look at its curriculum and examined whether its academic caseload and clinical opportunities had kept up with the changes in the profession.

After three years of intensive planningincluding workshops and input from external consultants, numerous faculty committees and working groupsPCO officially launched its new curriculum in the fall of 2001.

Four years ago, Review profiled PCO and the colleges then-new curriculum overhaul, known as Curriculum 2000. Here, we revisit PCO to find out the results of this major academic shift and PCOs continued evolution today.


Seeds of Change

In 2000, PCO took an introspective look at how it was teaching its students and whether this was best preparing graduates to take on entry-level careers as optometrists. The result of this academic analysis was a tremendous change in approach, technology, teaching methodology and clinical experience for students. Plus, the administration had to get the existing faculty on board to support this new direction.

I think one of the many issues we came across is properly integrating all the material and bringing a number of faculty together for a seamless flow of information, says Pierrette Dayhaw-Barker, Ph.D., associate dean of PCOs Foundations of Optometric Medicine Department.

What really sticks out in my mind was the magnitude of the change, says Anthony DiStefano, vice president of Academic Affairs. This was not a small transformation. When we really got into the change, we realized how much of a change was needed and the magnitude of the challenge. Transforming the entire curriculumstructurally, pedagogically and strategicallyinevitably created a monumental effort to transition in the new curriculum, while transitioning out the old.

PCO wasnt the only school that overhauled its curriculum. Most other schools of optometry have undergone similar transformations. Theyve implemented integrated learning courses, stepped up clinical hours, and even given students real-world experience in practice management. (See Integrated in Indiana.)

But, the transition wasnt easy. During the first four years of implementation, we were in effect delivering two significant curricula at the same time, Dr. DiStefano says.

Integrated in Indiana

Last year, incoming first-year students at the Indiana University School of Optometry were the first to experience a major change at this optometry school: a new curriculum.

Like many schools of optometry that are changing their academic and clinical programs to keep pace with the changes in the profession, Indiana University launched its comprehensive new curriculum in the fall of 2006 to ensure its students would be best prepared to succeed as doctors of optometry upon graduation.

Under the new curriculum, the school integrates optics and clinical scenarios through problem-based courses. Students study geometric and visual optics in relation to the eye. They study the whole system, and they learn how all components function together, says Gerald E. Lowther, O.D., M.S., Ph.D., dean of the Indiana University School of Optometry.

Students are introduced to problem-based learning from day one. They get a clinical case, begin researching aspects of the case, and discuss it with their classmates in a group setting. They feel like they are becoming integrated in clinical aspects right away, Dr. Lowther says. This immersion into the clinical aspects of optometry did not happen until the third year under the old curriculum, he says. Courses that were taken before were taken in isolation, he says. Now, basic science material means more to them. It takes on a greater meaning when it pertains to patient care.

On the expanded clinical end, students work on problem-based learning and techniques during their first two years of study. Students work directly in a patient-care setting during the summer between their second and third year.

By year three, they take courses in contact lenses, pediatrics and disease, while they spend two days a week in clinics and primary-care settings.

During year four, they have four 12-week clinical rotations where they work in a variety of settings, including community centers, referral centers, hospitals, prisons, and other sites. Students final two rotations can be anywhere in the country or in the colleges clinic in Mexico.

Another trend Dr. Lowther sees in most optometry schools is an increase in community outreach. This is happening much more frequently than it was 20 years ago. This is very positive not only for students, but for the profession.

Compared to when I went to school, it is like night and day, Dr. Lowther says. Students gain a lot of patient experience. It makes it a lot easier when they go into whatever type of practice they choose.
Before the switch, the curriculum was spread over 35 courses. First-year students took basic didactic courses before taking hands-on lab courses. But, not until their clinical rotations in their fourth year could they really apply this knowledge.

The new curriculum is structured as a series of nine modules that combine theory and clinical studies in a way that sticks for students, Dr. DiStefano says. Now, theory, application and patient care happen simultaneously. While learning facts and theory, students can also try their hands at solving problems in patient care right from the beginning.

PCO hopes the effort translates into better training for students. It helps tie together anatomy, physiology, pharmacology, biochemistry, immunology and sometimes geneticsas opposed to covering the lungs in anatomy while learning about the kidney in pharmacology and the pancreas in biochemistry. It is all tied together, one organ system at a time, says PCO student Stephen Shaw, class of 2009.

The module curriculum has also brought the faculty closer together as well. The modular approach is invigorating the faculty, says Joan Wing, O.D., associate professor and director of Integrated Studies. They form a team.


Problem-Based Learning

Other key elements of the new curriculum include smaller classrooms of eight to nine students and problem-based learning, a method of teaching that is gaining in popularity across many medical disciplines. Where higher education institutions may have used encyclopedic knowledge as their cornerstone of learning, problem-based learning gets the students involved immediately in critical thinking.

For example, instead of listening to a lecture or reading a textbook and then memorizing the information, problem-based learning helps students begin to think on their own, which PCO hopes they will continue to do long after graduation. We wanted students to be proactive in learning, rather than listening to a lecture, says Dr. Dayhaw-Barker. We wanted them to be involved in the learning process.

From day one, PCO students receive a clinical case scenario in these small classroom settings. Students function as a group and use the case setting scenarios as a springboard to research new information, and they have to work together to solve the situation placed before them. National Boards now require more case-based assessments, so this is good training before students have to take their National Boards, Dr. Dayhaw-Barker says.

In a nutshell, problem-based learning allows students to act like a doctor in the clinic, says Mr. Shaw. You can review a chart and request whatever data you would like to help you assess the pseudo-patients condition, he says. You can discuss the scenario with the other students, research information and brainstorm in order to come up with your best diagnosis and treatment plan.

Faculty in the case-based problem-solving classes are there to facilitate, not point out right or wrong answers, which further helps students take ownership of their learning, the faculty believes.

This new focus is having an indirect impact on PCOs admissions. The college is experiencing an increase of students who had problem-based learning courses during their undergraduate studies. Other incoming students who havent yet experienced problem-based learning are in part selecting PCO because they are intrigued with this new teaching methodology, Dr. Dayhaw-Barker says.


More Time in the Clinic

Another cornerstone of PCOs new curriculum is more clinical time for students. Previously, students only had one year of externships. Under the new curriculum, they have one and one-half years, or an entire extra semester of clinical time, added to their college experience. Dr. DiStefano describes this as one of PCOs overarching goals of the change: to give students that much more time to have direct patient encounters.

The extra clinic time was the main reason Mr. Shaw selected PCO. Most students plan to practice as clinical optometrists. What better way to get experience than to actually be out there doing it? he says.

Another major component of the curriculum change is enhanced technology. Each student uses a computer program called Blackboard, which is a distance education delivery system that allows students to record and code different patient encounters, take online classes and access thousands of periodicals.

The open source nature of Blackboard has allowed PCO to develop a revolutionary clinical experience-tracking system that allows the student to record and code different patient encounters, receive assessment on these encounters, and receive a comprehensive portfolio of these encounters at graduation, says Glenn Roedel, M.S., director of Academic Technologies and Learning Resources. This information is not only useful for continued curriculum evaluation, but also for students personal and professional development after graduation.

Logging individual patient encounters helps faculty assess whether students are getting enough experience in specific areas, such as glaucoma. We wanted to develop a way for faculty to know what students wanted and to also be able to respond to students individual needs, says Andrew Buzzelli, O.D., M.S., associate professor and director of Advanced Studies.

Heading Toward the Future

Now, several years into this new curriculum, PCO continues to make changes to even better prepare students to start as entry-level optometrists. The college just added an advanced track in specialty pediatrics as an elective option for students beyond the core entry-level program. This year, students were able to pursue this specialty track, which is similar to a minor in an undergraduate university.

The college plans to add more specialties in the future, including geriatrics, retina and anterior segment disease. Students want to be the best practitioners possible, but they also have special interests, Dr. DiStefano says. These specialties can help students gain significant depth and knowledge in another area.

The college has expanded into other areas of study beyond optometry, including an audiology and a physician assistant program, which launches this fall. During the fall semester, all first-year optometry, audiology and physician assistant program students will take a class together on evidence-based medicine. The faculty believes that taking this course will help all first-year students learn a common language that will guide them as doctors when they become part of an integrated health care system.


The curriculum at PCO continues to progress, as it must in order to keep pace with changes in the profession and to mirror the new competencies that new O.D.s will need following graduation day. Faculty and staff concur that they are constantly adjusting and keeping their ears to the ground to see where the profession is going, and to make sure their students are well prepared for these new competencies.

We all come from different backgrounds, Dr. DiStefano says. Our curriculum innovations are aimed at a long-term transformation on how we approach learning togetherfaculty and students in an interdisciplinary shared learning environment.

Vol. No: 144:11Issue: 11/15/2007