Surprised

So this will be a meandering post. It will consist of a few stories, seemingly unrelated, but with skill and daring I will bring them all together in a climactic paragraph (or 10) that will shed light on this momentous, yet disappointing tale.

It all started on Sunday - our first day of school this week. I had a group of third year students walk into our office and announce that they were to do a school vision screening later that day.

If you will recall optometry in most parts of the world (I think everywhere but the US and Canada) is an undergraduate degree. Some countries offer a masters degree above the Bachelor but for the most part it is a B.Sc. This is the case here in Palestine. Our students go through a four year program. First year is mostly basic sciences and then optometry curriculum is added in a little bit at a time. So these third years are a little over a year away from graduating with a degree in optometry. After they graduate they are required to pass a licensing exam and then they can go out into the world and Optometrize to their hearts content.

We have a couple of girls who are called "Teaching Assistants". They were trained in Jordan (in what we think is a four year program but may have been a two year program). We were never really told what their roles in the school are. It appears to me that they fill the very necessary role of keeping chairs firmly planted to the ground. They do a good job of it. I have yet to see a chair float to the ceiling with them around. They do a good job of sitting in them. We have tried to make use of them. Asking them to come to our lectures and labs - to help - but also to hear the way we do things so if students have questions they can answer them from our perspective. They have come to a few lectures and labs but generally leave after a few minutes. I've heard through the grapevine that they disagree with how we are teaching things.

If you go on the An-Najah website you will see that this optometry program is designed to bring "advanced optometry" to the region. I'm not sure what "advanced optometry" is but I take it to read that the school hopes to introduce professionals who are trained to do more than simply refract (find eyeglass/contact lens prescriptions). In the literature on the schools website it specifically states that what is holding this development back is a lack of trained educators - i.e. those optometrist trained in Jordan are not qualified to teach the type of optometry that is being introduced to Palestine.

Last Wednesday in my Environmental Optometry class (basically a class about the visual system in work/school/recreation and how optometrists should be involved in ocular protection from work/sport injuries, electromagnetic radiation. Also includes driving/flying vision and vision screenings) I was talking about what a screening entails. We listed tests and talked about whether or not they were necessary for screenings. We talked about why to do screenings and where to do screenings. It was a good class but we didn't finish. We were too finish this Wednesday.

Throughout this semester I've come to the slow, yet startling realization, that I overestimated what my students know. I just learned that a series of tests I assumed (yes, I know assumed) they were taught were actually never taught and simply didn't have a place in the curriculum (not because they weren't important but due to oversight). These tests are known as Entrance Skills. (Visual Acuity - you know 20/20 stuff. Cover Test - to see if you have an eye turn (among other things). Pupil testing, Near Point of Convergence - to see how well you turn your eyes together and more). These are the most basic of optometric tests. We were taught them the first month of OD school.

It surprised me when on Sunday four students mentioned that they were going to a school to do a screening today. I mentioned to them that: i) They didn't know how to do most of the tests - we were going to learn them on Monday (today). ii) They didn't have any equipment (They said they would take the school equipment. I said "No, the second year class has lab today.") iii) They didn't have a professional to go with them iv) They didn't have a recording form and v) They didn't KNOW HOW TO DO THE TESTS.

They said; "No problem, we thought you could show us now and we'll get one of the teaching assistants to go with us."

Swell immediately jumped out of her chair and phoned our dean (she is not there on Sundays). The students at the same time realized the silliness of their plan and my lack of enthusiasm and postponed the screening by a week. The Dean didn't seem overly concerned but agreed that it would be best to postpone (although she was unaware of the whole plan).

Today, Monday, I taught the Entrance Skills/Vision Screening tests. I had one of the teaching assistants come to the class/lab to make sure she knew what to do when she was supervising the students. I had a set of notes and started on the first topic; case history. They were taught this a lot last year. They knew nothing. I spent 25 minutes on it when I had planned on 5. I had them conduct a case history on a partner. I looked at their recording. They didn't do a thing I told them to. They simply wrote down: "Blurry vision" when I specifically and multiple times told them whenever a patient tells you something you must ask further questions (I told them an acronym to remember 6 questions) they ignored me. They understand they simply ignore me. I then told them that they arranged this screening and needed to be ready for it. They said that they were working with children who couldn't answer the questions. I stood there in disbelief. They just don't get it. We're not solely working on one screening this is their future profession, in addition I am sure a child no matter how old can tell you if his/her vision is blurry in the distance or at near. I admit I yelled a little bit.

I continued on and covered 1/3 of what I wanted. In fact for part of the practicing I had them stand in two rows facing each other. Half of them were the patient the other half the optometrist. I told them exactly what to do at what time to do it. It was like teaching kindergarten kids. This is something that Swell was taught to do in 5 minutes when she was in undergrad so that she could help on a vision camp in Romania. It is not difficult. I'm not even asking them to understand why the results happen just how to do the test and record the results. I asked if they would be able to do this test on Sunday with a child who had never had the test done before. They said they only wanted to do Visual acuity at this screening. I said: "Why? The teacher could do that." It is not worth my time or theirs to have them go and do something so simple. There is no reward from a public health standpoint or from an educational standpoint. They see themselves as the refracting opticians that already exist here.

I broke for a 30 minute lunch. I told them I would start at 12:15 exactly. I began the lecture at 12:16 to 3 of 13 students. The others arrived 10 minutes later. I then told them that the diagram I drew on the board would be on the test. No one copied it down. (the three on time had already copied it down. The others....?)

The UNLICENSED teaching assitant of course left after 15 minutes of the first session and never returned. I have no idea if she knows what to do but the screening on Sunday will be a nightmare. Good thing I won't be there. I'll finish the other 2/3 of entrance skills tomorrow and Friday - further delyaing other classes. These students will not be ready to graduate next year. They will not. They don't listen and they don't care. It's disappointing. The second years - they are a different story.

See I think I tied it all together. If not. Boo hoo.