Evaluations of refraction competencies of ophthalmic technicians in Mozambique / Evaluaciones de las competencias sobre refracción de los técnicos oftálmicos en Mozambique

Purpose: Ophthalmic technicians (OT) work at health facilities in Mozambique and are trained to provide primary and secondary eye care services including basic refraction. This study was designed to assess OT competence and confidence in refraction, and investigate whether an upskilling programme is effective in developing their competence and confidence at refraction. Methods: Thirty-one trainee OTs and 16 qualified OTs were recruited to the study. A background questionnaire was administered to determine the demographic profile of the OTs. A confidence levels questionnaire explored their self-reported skills. Clinical competencies were assessed in relation to knowledge (theory exam) and clinical skills (patient exams). 11 OTs were upskilled and the clinical evaluations carried out post training. Results: Initial evaluations demonstrated that confidence and competence levels varied depending on the OTs training (location and duration), and their location of work (clinical load, availability of equipment and other eye care personnel). The qualified OTs were more competent than trainee OTs in most of the evaluations. Post upskilling results demonstrated significant positive impact on confidence and competence levels. Conclusion: These evaluations identified factors affecting the refraction competencies of the OTs and demonstrated that upskilling is effective in improving confidence and competence levels for refraction. They demonstrate the need for a refraction competency framework. The overarching aim of this research was to inform the development of a nationwide programme of OT mentoring, upskilling and leading to the establishment of clinical competency standards for the new OT curricula, relevant to the professional demands (AU)

Objetivo: Los Técnicos Oftálmicos (TO) trabajan en los centros sanitarios de Mozambique, y están formados para aportar servicios de cuidados oculares primarios y secundarios que incluyen la refracción básica. Este estudio fue diseñado para evaluar la competencia y seguridad de los TO en cuanto a refracción, así como investigar la eficacia de un programa para incrementar sus conocimientos para desarrollar la competencia y seguridad en la refracción. Métodos: Para el estudio se reclutó a treinta y un TO en formación y a dieciséis TO cualificados. Se les proporcionó un cuestionario de antecedentes, para determinar el perfil demográfico de los TO. Un cuestionario sobre los niveles de seguridad exploró sus técnicas auto-reportadas. Las competencias clínicas se evaluaron en relación al conocimiento (examen teórico) y las habilidades clínicas (evaluación de los pacientes). Se incrementaron los conocimientos de 11 TO, realizándose la evaluación clínica tras su formación. Resultados: Las evaluaciones iniciales demostraron que los niveles de seguridad y competencia variaban dependiendo de la formación del TO (emplazamiento y duración), y de su emplazamiento de trabajo (carga clínica, disponibilidad de equipos y de personal adicional de cuidados oculares). Los TO cualificados fueron más competentes que los TO en formación en la mayoría de las evaluaciones. Los resultados tras el incremento de conocimientos demostró un impacto considerablemente positivo sobre los niveles de seguridad y competencia. Conclusión: Estas evaluaciones identificaron aquellos factores que afectan a las competencias sobre refracción de los TO, y demostraron que el incremento de conocimientos es eficaz para mejorar los niveles de seguridad y competencia en cuanto a refracción. Demostraron la necesidad de un marco de competencias en refracción. El objetivo más importante de esta investigación fue el de informar sobre el desarrollo de un programa nacional de tutelaje e incremento de conocimientos de los TO, encaminado a establecer los estándares de competencia clínica para los currículum de los nuevos TO, que sean relevantes para las demandas profesionales (AU)

Responsibilities to plan for ancillary care pose ethical challenges for nutrition research in the community setting.

Investigators who conduct nutrition research in the community setting, particularly among underserved populations, face the ethical question of whether and how to respond to participants' unmet health needs. The research ethics literature conceptualizes this question as one of ancillary care (AC): what is the nature and extent of researchers' ethical responsibilities, if any, to provide or facilitate health care that research participants need but that is not necessary to ensure the safety or scientific validity of the research? In this paper, we highlight 3 ethical challenges involved in the planning of AC responses for nutrition research conducted in the community setting: influence of provision of AC on primary study outcomes as an issue of trial design; whether to extend the provision of AC beyond research participants to nonparticipants with the same health needs; and how best to train field workers who may be the most likely members of the study team to encounter the health needs anticipated among participants. Although the global ethical discussion of AC is gaining in depth, breadth, and practical influence, it remains relatively uninformed by perspectives specific to nutrition research. Our objective is to encourage nutrition researchers to engage proactively in the emerging ethical discussion of AC, so that their relevant experiences and concerns can be taken into account in the eventual formation of ethical guidelines and policies.

Ancillary care in public health intervention research in low-resource settings: researchers' practices and decision-making.

Little is known about researchers' practices regarding the provision of ancillary care (AC) in public health intervention studies they have conducted and the factors that influence their decisions about whether to provide ancillary care in low-resource settings. We conducted 52 in-person in-depth interviews with public health researchers. Data analysis was iterative and led to the identification of themes and patterns among themes. We found that researchers who conduct their research in the community setting are more likely to identify and plan for the AC needs of potential research subjects before a study begins, whereas those affiliated with a permanent facility are more likely to deliver AC to research subjects on an ad hoc basis. Our findings suggest that on the whole, at least for public health intervention research in low-resource settings, researchers conducting research in the community setting confront more complex ethical and operational challenges in their decision-making about AC than do researchers conducting facility-based studies.

Ancillary care duties: the demands of justice.

Ancillary care is care that research participants need that is not essential to make the research safe or scientifically valid and is not needed to remedy injuries that eventuate as a result of the research project itself. Ancillary care duties have recently been defended on the grounds of beneficence, entrustment, utility and consent. Justice has also been mentioned as a possible basis of ancillary care duties, but little attention has been paid to this approach. In this paper, the author seeks to rectify this omission by arguing that ancillary care duties can be based on a principle of justice as rectification.