Letters to the Editor
Assessment of learning versus competence
Dr Prozesky has expertly described why and how learning should be assessed (J Comm Eye Health 2001; 14: 27-28). It should be emphasised that assessing competence in a workplace situation follows the same designs although this assessment is often summative and based on the principles of evidence. In assessing competence, one is concerned with whether the evidence collected (through observation, MCQ, checklists, or oral examination) is current, authentic and sufficient to declare a candidate competent in performing a specific task. That is when the use of OSPE/OSCE is very helpful for the purpose of assessment because it is possible to assess in a given scenario the knowledge, the skills and the attitude of candidates. Historical evidence (reports, testimonials, work history) is also considered in the assessment of competence but its value is limited by its authenticity which can be questionable. As teachers move from didactic to problem-based learning methodology, the assessment of competence becomes a critical issue. Assessment skills will then become not only necessary but also a specialised area with qualified assessors, moderators and verifiers working alongside teachers or trainers as partners. This is the system that is already implemented to some extent in countries including UK, Australia, Singapore and the United States, to name but a few.
I did not know that there was room for arguments on whether or not to do ICCE. I thought that all efforts are towards IOL after lens extraction, preferably by the ECCE method. Sadly, in those regions where no surgeon exists to do ECCE with IOL or he/she exists but there is no relevant equipment, ICCE may be performed.
I will restrict myself to the Africa that I know and have worked in – East, West and Central. In all these regions, I have found that there exists a backlog of unoperated cataracts (according to surveys and epidemiological projections)) but there are no (or insignificant) surgery waiting lists in eye departments. The pressure is not on surgery time but community awareness and mobilisation campaigns to increase cataract surgery uptake. Backlog or no backlog, Africa or Asia, I would rather take 15 minutes on ECCE with PC IOL than 3 minutes on ICCE with no implant (and no sutures).
With proper distribution of existing resources within countries in our region – human resources and equipment – every patient needing and willing to have cataract surgery should have lens extraction with IOL inserted.
To increase cataract surgery uptake we need to demonstrate improved quality of service. In my catchment area we used to get resistance to surgery because nearly every elder could name somebody who was blinded by cataract surgery – over a decade ago! Today, nearly every other patient who comes for cataract surgery is on recommendation of our former, satisfied cataract patient. There was a change from ICCE to ECCE with PC IOL. Cataract surgical uptake is increasing by about 20% every year.
I agree with my old friend and ICEH classmate, Dr Mmbaga, that some vast regions still do not have microscopes or surgeons trained in ECCE with IOL and that ICCE may therefore be a good solution. But we must sing the song how inappropriate the technique is and how the relevant local NGOs and Ministries of Health must make acquisition of the very affordable equipment a top priority.
Internally, within the countries, we should retrain ICCE surgeons in ECCE with PC IOL technique.