Building Your Staff's OCT Skills

Systems are user-friendly, but techs may need a little outside help for optimal OCT use.

By René Luthe, Senior Associate Editor

Given the proliferation of uses for OCT in ophthalmology practices of all stripes, there's some good news for prospective buyers of the technology: OCT machines are ever more user- and patient-friendly, according to current owners, and device manufacturers receive high marks for the training they provide practice staffs. Image quality is good and device-dependent problems rare. Even so, veteran OCT owners report that staff effort accounts for a substantial component of optimal OCT utilization. Here, experienced practices share the steps they've taken to get the most bang for their OCT buck.

Client-friendly Training Modules

OCT manufacturers offer staff training at the time of installation, which typically runs from one to a few hours, depending on the number of staff being trained. Topcon offers a two-session training process, with the second session occurring about 45 days after installation, according to Robert Gibson, the company's vice president of marketing. “Typically, the technicians and doctors need some time to understand the instrument and get their questions together,” he explains.

OCT users report that manufacturers who provide a one-session initial training are always willing to come back for reviews whenever needed, for either refresher courses, more advanced training or to accommodate staff turnover. But manufacturers don't limit their training to old-fashioned in-the-flesh meetings with their clients. Companies have exploited current technology, including the Internet, to make training more accessible and convenient than ever before.

Carl Zeiss Meditec sends manuals and refers the staff to online learning so that they can familiarize themselves with the instrument before the trainer arrives, says Marianne Whitby, senior marketing manager for retinal OCT at CZM. “A basic understanding of the materials enhances the on-site training experience,” she notes.

CZM trainers provide four-hour in-office instruction. CZM also offers a great deal of training online through its “e-Learning Center” program. It is especially convenient for clients who hire a new technician but don't want to schedule another training session, as well as for technicians who need to brush up on the more advanced uses of OCT. “There are also product demonstrations online that walk step by step through scan, acquisition and analysis,” Ms. Whitby says. The training material is organized in chapters so technicians can tailor the instruction to their individual needs, rather than viewing the entire course. Additionally, clients can access live educational Webinars that CZM archives online.

Topcon also offers Webinars. “That's part of our service agreement,” explains Mr. Gibson. “If a customer has a question, we just go right online with them and jump on their system. A lot of the time, with the technicians it's more personalized. They have individual questions so we deal with them on a one-on-one basis.”

The Education Factor

However, it is not only device training that helps practices get the most out of their OCT instrument, experts agree. The individual technician's understanding of what precisely he or she needs to image and why are just as crucial as knowing how to operate the machine.

Lynne Lawshe, COT, says that the learning curve for OCT at Pepose Vision Institute, in Chesterfield, Mo., where she is clinical manager, was slow. “I'm not sure why that is, because it's very easy. It's very user friendly as far as being able to understand what you're looking at and how to calibrate everything and to use the calipers to check anything that you want on there.”

Topcon's Mr. Gibson attributes such difficulties to a lack of knowledge on the technician's part. “They may not know what they are trying to image.”

Jennifer Meyers, clinical director at Eye Associates and Vision Surgical Center in Jeffersonville, Ind., seconds that interpretation. “We try to make sure that the technicians know what the doctors are looking for,” she says. “For example, if a patient had a corneal dystrophy or a cloudy cornea, does the technician know that the image may be a little more complex and that she has to sort of look for a spot, to move around a little bit to find a clearer image? We strive for them to understand the entire process of the eye that they are working with and therefore they can go after the best image possible based on all the information that they have.”

In an attempt to ensure that technicians have the knowledge they need to obtain the correct image the first time, Ms. Meyers' practice holds monthly “Lunch and Learns” — practice-sponsored luncheons in which a relevant topic is chosen and information updates provided. “It helps them perform a better test if they have some insight and know what the doctors are looking for,” she says.

Yet even with this extra training, Ms. Meyers acknowledges that obtaining a good image is “a bit of an art form.”

“They have to find their spot and find what works well for them. Just as with a refraction, it takes a little finesse,” she says. “Technicians have to learn not to shoot immediately when they think they see what they need. Make sure you really have focused on it and gotten in there and found a really good image.”

Certification level also seems to play a role in OCT proficiency. At Pepose Vision Institute, Ms. Lawshe says that several technicians hold COA certification, one is a COT, and the remainder are uncertified. “They are the ones who have a harder time with OCT imaging.” Also, she notes, the Ophthalmic Photographers' Society offers certification for OCT imaging.

The Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO) agrees. According to JCAHPO president William Ehlers, MD, “Our premise is that having even the basic COA level, the fundamental certification, will give any ophthalmic assistant or technician a basic understanding. Certainly at COT level, they do get into a much higher level of imaging, and at COMT, of course, the highest.”

A level of comfort with computers also tends to be an indicator of OCT success. Ms. Meyers says that she asks staff if they are on the social network Facebook to gauge their level of technological sophistication.

Preparing to Train? Try This

Those familiar with implementing OCT in practices have shared their tips for getting as speedy a return on investment from the device as possible.

1. Dedicate the time. Of primary importance, they agree, is setting aside the time for staff training when the OCT is installed. “Make the staff available to the trainer,” advises Ms. Whitby. “Because that few hours of inconvenience are going to pay for itself in the long-run.” Having all the technicians trained to at least a basic level of OCT operation will make for a more efficient workflow on a day-today basis.
2. Select your trainees. Some practices choose to train all their techs on the OCT, while other practices opt to train only a handful. Whatever the client preference, Mr. Gibson recommends training at least several technicians in order to accommodate inevitable staff turnover and employee vacations. Again, efficiency is less likely to be impeded. Ms. Meyers believes that the entire staff should have some understanding of the services a practice provides, and that the technical staff have a thorough knowledge of each device.
Practices with large staffs may want to follow Ms. Lawshe's advice for making the training session as efficient as possible. She has found it helpful to select the technicians most experienced with imaging, train them to proficiency on OCT, and then have them train the rest of the staff. The quick studies tend to get the hang of OCT within two or three uses, Ms. Lawshe reports.
3. No patients, please. To ensure that staff get that thorough knowledge, Mr. Gibson also advises conducting the training session when patients aren't in the office, to minimize interruptions.
Ms. Whitby agrees. “The instrument is easy to use and technician-friendly, but if the technician wasn't taught because she had to keep stepping out during a training program, then it's going to be harder for her.”
4. Practice makes perfect. One simple and cheap way for staff to attain OCT proficiency is to practice scanning one another. This has the added benefit of helping technicians understand the test from the patient's point of view. “I think it's important that the technician knows what the patient is looking at and seeing and what to look for so that they can explain it to the patient,” explains Ms. Meyers. “We make sure everyone has been on the other side of the machine and experienced it for themselves.”
5. Ask for service. A favorite pearl of Michael Korenfeld, MD, of St. Louis: “When all else fails, have the serviceman come out and clean and service the unit!” When his practice had its OCT serviced after a lengthy break, the company representative upgraded the software and showed them some new tricks. “Our quality scores were doubled” after using these, Dr. Korenfeld says.

Extracurricular Activities

Improving OCT scanning abilities doesn't have to stop with in-office training, however. At both ophthalmic society meetings and its own regional meetings, JCAHPO works with OCT makers to offer education that will help techs make the most of the technology in real-world situations. The courses include lectures on the relevant ocular diseases or conditions, patient cases, and the equipment and its operation; following the lecture is a hands-on workshop. Not only does the technician get to observe the proper handling of the OCT, but each is given time to work with the device and receive input and correction from an instructor. JCAHPO believes these workshops offer significant advantages over the vendor-training-only route.

“While vendor training is important, sometimes stepping out of the vendor training allows the student to gain a greater breadth of understanding, because they are actually taught about other types of equipment, or cases that are out there, and the experience of other people in the field who have been doing this for some time,” Dr. Ehlers explains. “It's that network or that peer experience that they often really learn from.”

And like OCT makers, JCAHPO has used the Internet to provide accessible online learning to its users through the E-learning site www.actioned.org (see Figure 1). In addition to reading material, these online modules involve simulation. “Technicians actually get to practice online in a very interactive mode,” Dr. Ehlers says. The OCT class is in fact one of JCAHPO's most popular online offerings on the site.

Figure 1. JCAHPO's online OCT course.

You Can Keep Up

While the application of OCT in ophthalmology has been expanding, device manufacturers and professional societies have made sure that practices will have ample resources to keep their staffs up to date with the most effective techniques.

“As OCT technologies and techniques continue to evolve, the difficulty of keeping pace with innovation is substantial,” says Dr. Ehlers. “Ophthalmic personnel face the challenge of learning new systems while maintaining high performance and the delivery of quality care to patients. Online courses and hands-on workshops bridge this gap and provide valuable, relevant specialty-training to today's eye-care professionals.” OM