NCCTO Update and Photos

By Ryan Corte, past AOSA President, OSU

Let's be honest, change isn't easy. With that being said, I hope this article alleviates any anxiety you may have towards the implementation of the NCCTO and provides valuable insight on why you should embrace the change.
I must confess when I first heard the idea behind the NCCTO, like many, I was apprehensive about the situation and had my doubts. However, after being thoroughly educated by the NBEO, I've come to understand and embrace the many benefits the NCCTO brings to optometry. The following are a few of the most common questions I've received in regards to the NCCTO:

"What was wrong with the old format of the Clinical Skills Examination (CSE)?"
Over the past several years, the NBEO has traveled to many of the optometry schools who have previously administered the CSE. They observed, evaluated, and interpreted the way the CSE was being administered at each site and found a couple of key issues:
1) Inter-examiner variability - Each candidate is graded on a specific scoring rubric posted on the NBEO's website [www.optometry.org/cse_evaluation_forms.cfm]. The NBEO found a wide range of variability amongst how candidates were being assessed at each institution (some examiners were strict while others were more forgiving). This was causing a large amount of inconsistency amongst the way each candidate's performance was being assessed.
2) Non-standardized patients - Each institution acquired its own patients to sit for the CSE at their respective locations. Therefore, the NBEO found that many candidates were experiencing variable assessments due to inconsistent patient presentations.
3) Clinic Equipment - The clinical facilities at each institution are designed quite differently and most of the time the examination rooms are arranged for quality patient-care but not necessarily consistent with a clinical skills examination. For example, most clinics have sinks that are mirror-images of the adjoining room so that plumbing can be shared. However, in a testing environment, the rooms must be laid out consistently from room to room. In addition, the ophthalmic equipment often varies from one room to another within a clinic and certainly is highly variable from institution to institution.

"What is the main advantage of the NBEO implementing a one-site location for optometry as a profession?"
As a student, I completely understand the frustration and anxiety that a one site location may cause in regards to exam preparation and travel expenses. After working very closely with the NBEO over the past few years, one of the main things I've learned about their organization is they don't make any decision without doing their research. The individuals on this board spend countless hours weighing out the pros and cons of every decision to ensure the best outcome for our patients and profession. Here are a few of the main advantages of the NCCTO:
1) Standardization and consistency - The NBEO's mission statement is: "To serve the public and the profession of optometry by developing, administering, scoring, and reporting results of valid examinations that assess competence." With a lot of hard work and research on how other professions have standardized their clinical evaluation process, the implementation of the NCCTO will help ensure that all candidates who pass boards are competent to safely practice optometry.
2) Increased leverage for optometric lobbying - If you don't already know, optometry is a legislative profession! Our scope of practice is dictated by the legislatures on the state and federal level. The increased consistency that the NCCTO brings to our profession should strengthen our advocacy in Washington, DC. For example, this year all CSE candidates are required to perform the injections skills examination (ISE). Over time, we will be graduating more and more optometrists who have been fully trained and assess in injections through a standardized process. States that are looking to advance their scope of practice (ie. implement injections) can use this data to help gain support from their legislators. Let's take this one step further. As of right now, two states, Oklahoma and Kentucky, allow optometrists to perform a number of specific laser procedures. This past spring the NBEO established a laser task force with the primary goal of creating a national-level assessment of laser procedure skills. Could the birth of the NCCTO help optometry expand the number of states privileged to perform specific laser procedures? Only time will tell.

"Why not build an east coast and west coast site? Or a more centrally located site?"
1) If the NBEO constructed an east coast and west coast testing center the cost for each candidate to take the exam would jump from $625 (a fee that the NBEO has kept consistent over the past 8-9 years) to AT LEAST $3,333. This calculation does not include the cost of food, travel or lodging expenses. However, even if the NBEO did build a west coast testing center, it still would be in a location that would require travel and lodging expenses for the west coast candidates because it has been a long-held NBEO policy not to locate NBEO facilities in the same city as an optometry school or college.
The NBEO put together the National Center of Clinical Testing in Optometry (NCCTO): An Analysis of Best-Location Issues study that analyzed the top 50 MSAs (Metropolitan Statistical Areas) across the USA and helped determine the best location to put the one site testing center. The data from this study supported their decision that Charlotte, NC was 1 of the top 3 top locations for the NCCTO. The NBEO has provided a copy of this study on their website.
[www.optometry.org/articles/nccto_analysis.pdf]

Closing key points:
1) The NBEO staff informed me that it's not recommended to arrive more than 10-15 minutes earlier than their scheduled examination time. The first 30 minutes of candidates scheduled time at the NCCTO is for them to get checked in. Then the candidate is required to attend a mandatory 45 minute orientation session. Therefore, if a candidate is scheduled to be at the NCCTO at 8am, they won't really be taking the exam until 9:30am. There is ample opportunity to review equipment that is in the orientation room before the orientation actually begins.
2) Remember to bring your white coats.
3) You'll make the examiner's life a lot easier if you perform techniques as they are listed on the grading sheet.
4) Relax! You've been thoroughly trained to perform all the techniques on this clinical skills examination!