Training activity information
Details
Perform and document visual acuity test on patients
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
- What does success look like?
- Identify what is expected of you in relation to performing and documenting visual acuity test on patients. Consider how the learning outcomes apply, including applying psychophysical tests, simulating a prescription, employing effective communication and producing clear, concise and accurate documentation.
- What does successfully performing and documenting a visual acuity test look like, including using different test techniques, understanding the normal range, considering patient communication/ability/vision and effects of refractive error, and potentially paediatric testing?
- Discuss with your training officer to gain clarity on what is expected of you in performing and documenting visual acuity.
- What is your prior experience of this activity?
- Think about what you already know about visual acuity testing procedures, using different charts (e.g., Snellen, LogMAR), and documenting results.
- Consider possible challenges you might face, such as patients with very poor vision, non-English speakers, paediatric patients, or difficulty ensuring accurate results due to patient factors or test technique variations, and think about how you might handle them.
- Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom, regarding adapting techniques for difficult patients or interpreting unusual results.
- Acknowledge how you feel about performing and documenting visual acuity tests on patients
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in executing visual acuity tests accurately across different patient types and circumstances, and effectively documenting the findings – drawing upon previous experiences.
- Identify specific insights you hope to gain regarding the impact of different refractive errors or common pathology on visual acuity, or nuances in communication to optimise patient response.
- What additional considerations do you need to make?
- Consult actions identified following previous experience of visual acuity testing or other psychophysical measurements, if any.
- Identify important information you need to consider before embarking on the activity, such as standard testing distances, proper lighting, when to use pinhole, how to test different age groups, and standard documentation formats.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate while performing and documenting the visual acuity test?
- Are you encountering situations such as:
- The patient exhibiting unexpected cooperation issues (e.g., struggles with the chart, inability to maintain fixation, age-related constraints) that hinder standard testing procedures?
- Unexpected or unusual variations in the visual acuity results (e.g., sudden drop in VA with pinhole, significant discrepancy between eyes) that contradict the patient’s presentation?
- You are struggling to document the result accurately and concisely due to complex measurement parameters or patient constraints?
- How is this experience comparing with previous experiences of similar activities, like performing other psychophysical tests?
- How are you reacting to the unexpected development?
- How is this impacting your actions? Did you adapt or change your test technique in the moment?
- Consider the steps you are taking in the moment, such as:
- Immediately modifying the test technique (e.g., switching to a different chart, adjusting test distance, or using a pinhole) due to patient constraints or unexpected results?
- Are you seeking immediate advice regarding adapting the technique for a difficult patient or interpreting an unusual result?
- Are you quickly re-checking the test setup or communication method to ensure patient understanding and result validity?
- How are you feeling in this moment? Did the unexpected result affect your confidence in the VA measurement? Are you finding it challenging to adapt your application of psychophysical principles?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice when performing the VA test. Did you ensure the patient’s safety and comfort while adapting the technique?
- What are you learning as a result of the unexpected development? For example, are you gaining key learning about effective communication techniques to manage cooperation issues, or insight into how to document ambiguous or complex VA results accurately?
On action
- What happened?
- Begin by summarising the key points of the experience of performing and documenting the visual acuity (VA) test.
- Consider specific events, actions, or interactions that felt important while performing the VA test, such as selecting appropriate charts, managing patient factors (e.g., cooperation), or ensuring clear documentation. How did you feel during this experience about performing and documenting these tests?
- Include any ‘reflect-in-action’ moments, where you had to adapt to the situation as it unfolded while testing visual acuity, for instance, modifying the test technique or charting method due to patient constraints.
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding applying psychophysical tests, specifically visual acuity.
- What strengths did you demonstrate (e.g., effective application of test technique, proficiency in handling patient communication issues, adherence to documentation standards)?
- What skills and/or knowledge gaps were evident (e.g., unfamiliarity with certain VA techniques, gaps in understanding unexpected results, or difficulty applying knowledge of common pathology)?
- Compare this experience against previous engagement with similar activities, like performing other psychophysical tests or VA tests. Were any previously identified actions for development achieved? Has your practice in visual acuity testing improved?
- Identify any challenges you experienced during the VA test (e.g., patient cooperation issues, unexpected results, limitations in documentation) and how you reacted to these. Did this affect your ability to deal with the situation? Were you able to overcome the challenges?
- Identify anything significant about the activity, such as needing to seek advice or clarification regarding the test technique or result, or needing to escalate to ensure you were working within your scope of practice when testing VA.
- Acknowledge any changes in your own feelings now that you are looking back on the experience.
- What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learned, including from any feedback received regarding your ability to perform and document visual acuity tests.
- What will you do differently next time you perform a visual acuity test? Has anything changed in terms of what you would do if you were faced with a similar situation again during VA testing?
- Do you need to practise any aspect of the activity further? E.g., Practising with specific charts, documentation methods, or communication strategies.
Beyond action
- Have you revisited the experiences?
- Have you reviewed your actions from your previous reflections for performing and documenting visual acuity (VA) tests on patients?
- What specific actions did you previously identify you would need to take to improve your practice related to mastering different test techniques, handling patient communication issues, interpreting unexpected results, or improving documentation?
- Have you completed these previously identified actions? If so, how did completing them impact your subsequent performance of this activity? Are you ready to demonstrate this new learning confidently and consistently when performing visual acuity tests?
- How has discussing these experiences with others transformed your view of your performance and documentation of the tests?
- How have these experiences impacted upon current practice?
- Consider how the accumulated learning from performing or reflecting on visual acuity testing will support you in preparing for relevant observed ‘in-person’ assessments for this module, such as the Direct Observation of Practical Skills (DOPS) titled ‘Perform a visual acuity test on a patient’.
- How has your practice related to performing and documenting visual acuity tests developed and evolved over time?
- This includes recognising when something related to visual acuity testing is beyond your scope of practice and when you need to seek advice or help.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Apply psychophysical tests to measure visual function, including visual acuity, contrast sensitivity, visual fields and colour vision. |
| # 4 |
Outcome
Simulate a prescription in a trial frame. |
| # 5 |
Outcome
Employ effective communication with a range of individuals, including the patient and the multidisciplinary team. |
| # 7 |
Outcome
Produce clear, concise and accurate documentation in line with local standards and legislation. |