With COVID-19 forcing optometry schools across the nation to close off campuses and cancel in-person labs and non-urgent clinical visits, everyone is learning quickly that necessity really is the mother of invention. Optometric educators have risen to the challenge, with most already comfortable providing their education virtually in a matter of weeks. The latest technology, motivated faculty and eager students have made the transition possible. Here, your colleagues in academia share their stories of adaptation and growth. 

Online Logistics

One of the biggest problems for everyone has been the timeline. COVID-19 came crashing through the door, and decisions to close were made within days. Faculty had to scramble to find new or at least different clinical material that worked with the virtual format, according to Andrew D. Pucker, OD, PhD, an assistant professor at the University of Alabama at Birmingham’s School of Optometry.

Every school has been building its own online curriculum, and many instructors have now switched gears to teach in front of their computer rather than a room full of students.

“Lectures are now given live via Zoom or pre-recorded and posted to Canvas, our established course management system,” says Dr. Pucker. His fourth-year students, for example, have one hour of case review each morning and then a two-hour lecture, both of which come with assessments, homework or both.

Online lectures come with other challenges, according to Chandra Mickles, OD, MSc, an associate professor and director of the Dry Eye Care Center at Nova Southeastern University (NSU) College of Optometry. Not only do professors have to adapt to new technology platforms, but they also have to reformat, upload and administer online testing.

Dr. Pucker leads his class through a case review using the new online video format.
Dr. Pucker leads his class through a case review using the new online video format. ​Click image to enlarge.

“We have to convert all of our exams to online, which is time consuming in itself. We then must format it in a way that will prevent cheating, which adds more time to grading,” she explains. “Live, we can better proctor exams; although there is a program available that uses a webcam for monitoring, it doesn’t compare to live proctoring in which you are able to see many students at once.”

Despite some challenges inherent with real-time online assessments, faculty and students alike have pitched in to help with the transition, ensuring exams run with minimal glitches.

While most in-class material already lends itself to an online format, clinic hours and labs are a different story. Both have required a complete overhaul and plenty of collaboration.

“Clinic sessions have transitioned into interactive case reviews via Zoom,” notes Dr. Pucker. “Some laboratory material is taught virtually while other material is being held for future courses.” Some topics, such as injections, simply can’t be taught online and have been moved to alternative courses, he notes.

Likewise, faculty at Nova are using interactive case reviews and their library of videos to provide clinical and laboratory content. Some are getting particularly creative while working from home, according to Dr. Mickles. “Faculty have been role-playing with family members at home to demonstrate how to perform a particular skill and provide clinical pearls for the students,” she explains.

A Group Effort

Many other resources beyond the colleges themselves are popping up to help students meet their necessary clinical and lab hours. Students at NSU have been using the Student Online Clinical Case Education Program, a collaboration between the American Academy of Optometry, the Associations of Schools and Colleges of Optometry (ASCO) and Johnson & Johnson. The program provides 30-minute live-streaming and recorded experiences, during which primarily Academy Fellows present a clinical case study. Students can ask questions before the session concludes, and the presenter delivers a patient outcome.

The Optometry Education Initiative—provided by the American Academy of CME and the Institute for Continuing Healthcare Education and supported by unrestricted grants from Alcon, Allergan, Novartis and Regeneron—is another good resource, Dr. Mickles says. Students can view a case and listen to opinions on how experts would handle that particular case.

In addition to video case reviews, NSU students are running their own virtual grand rounds and presenting clinical research papers. Faculty are even collaborating with industry to give students unique experiences. Dr. Mickles partnered with Optometric Insights, led by Drs. Dave Kading and Mile Brujic, to allow her students to participate in the virtual iteration of their ocular surface workshop. A 30-minute lecture was followed by presentations from various industry partners involved with dry eye, such as Alcon, Allergan, Johnson & Johnson, Quidel and Novartis, “some of whom demoed their devices,” Dr. Mickles explains. “The students really enjoyed it. I thought it provided good engagement and was an excellent learning experience.”

Industry partners have been offering support throughout this online shift, according to Dr. Mickles. Contact lens manufacturers, for example, are providing numerous Zoom webinars on how to fit their products, particularly the specialty contact lenses.

 “I’ve been pleasantly surprised by everything everyone has been doing,” she says. “I’m very appreciative of all of the support that has been provided by the optometric organizations and industry.” 

A New Way to Participate

Many fear these virtual platforms squelch student participation, but Dr. Pucker feels his students remain fully engaged by asking questions during the live Zoom lectures or by using the chat feature. For some, the anonymity might just give them the confidence they need to come out of their shell a bit.

“One positive thing about this is the students have actually been more engaged, in the sense that they seem more comfortable asking questions during the lecture, especially the quiet students using the chat feature,” Dr. Mickles says. She speculates the social media-savvy students are more comfortable when no one can see them and are thus less hesitant about asking a question. “However, I’ve noticed more questions via email from my students post-lecture, as with large groups, I can’t capture, visually, that they didn't understand a topic and provide immediate adjustment to my teaching style,” she explains.

Nonetheless, you can’t keep track of 100 students in one video session, and she worries some students are slipping through the cracks, still shy when it comes to adding their questions and concerns to the chat function. Small-group video chats might be one solution, as faculty can see each participant on the screen and better gauge their engagement with the subject, she adds.

In Person vs. Online

Drs. Pucker and Mickles agree nothing can compare with in-person training. “You can’t get good at fitting contact lenses or properly diagnose macular edema without actually doing it,” Dr. Mickles notes. “You need the practical experience.”

Added to that, with online classes and case reviews, instructors can’t adjust their teaching style to better engage students who might not be understanding the topic in the same way they would when teaching in-person. “Students don't often verbalize that they don't understand a concept, but this is easily captured by their facial expressions—something you can’t count on with online teaching,” says Dr. Mickles.

Still, Dr. Pucker feels the virtual learning is comparable with the in-person training in many ways. “We have been able to provide meaningful alternative training sessions that I feel are allowing our students to have a meaningful experience,” he says.

“We all know this isn’t ideal, and we have made the best of our current situation to provide students with quality education,” adds Dr. Mickles. 

The Rewards of Hard Work

The sudden need for online learning comes with a few silver linings, one of which may prove beneficial post-pandemic.

“The biggest change that will result from COVID-19 in the optometric curriculum, and health care in general, will be the acceptance of telemedicine,” according to Dr. Pucker.

In addition, faculty will be more comfortable with the various virtual platforms and will be more willing to incorporate them into their lesson plans moving forward, Dr. Mickles adds.

“I do believe students like many aspects of online teaching, such as online assignments and having videos as part of their materials,” she explains. “I think many of us will incorporate more technology into our courses moving forward.”

Dr. Pucker also sees this as an opportunity to make online content that can better train students, leaving clinicians more time for patient care.

Stay Apart, But Come Together

After the pandemic passes, everyone—faculty, staff and students—will never forget the camaraderie it brought with it.

“It has been rewarding to see everyone pull together and make this happen in a way that will allow our fourth-year students to graduate on time,” Dr. Pucker says. “It has also been rewarding to see that we can provide a meaningful, makeshift curriculum online.”

For Dr. Mickles, the sense of community that has grown out of the difficulty is priceless—a community that spans far beyond her own Nova colleagues who themselves have gone above and beyond, she says.

“ASCO has created an open forum where we can share ideas and best practices, and that has been really amazing,” she adds. “It’s allowing us to get to know, virtually, other faculty members across the country whom we may not know because they work in other subspecialty areas.”