American Academy of Ophthalmology Web Site: www.aao.org
Practice Perfect: Coding & Reimbursement
Boost Practice Efficiency, Part Five: Training the Technician-to-Be
While adding a technician can be key to improving your practice’s efficiency, hiring one can be a frustrating process since trained techs are so few and far between. If you are fortunate enough to find them, trained techs can hit the ground running and often will be performing independently within a few weeks. Many practices, however, have to train technicians themselves. This is an involved process, and it often takes a year before such trainees can truly function independently.
When You Need to Cross-Train
While many practices prefer candidates who have been through some formal training, what if you have staff in the front office who are keen to become techs? What’s the best way to institute cross-training?
Evaluate potential trainees. For the best results, potential trainees should be evaluated before training begins to assess their skills, abilities and willingness to learn. “Those who should be cross-trained earliest are those who have an understanding of the processes needed to make the clinic flow smoothly,” said Jane Shuman, president of Eyetechs, which is based in Boston. “Personnel with some clinical understanding should be trained to do a thorough work-up before learning other aspects of the clinic. Those with minimal or no clinical experience will require the longest amount of training time. And the office must train staff to replace the person who is next to be cross-trained,” said Ms. Shuman, whose company, Eyetechs, provides continuing education to technicians and develops in-house training plans for new techs.
Personalize the training regimen. When beginning cross-training, it’s important to determine the level and skill of the trainee and match the training regimen accordingly. You should have weekly goals, which set out what you want the student to achieve.
Begin with ophthalmology 101. If the trainee has little clinical background, training should start with the anatomy and physiology of the eye, as well as eye diseases and their treatment. “You have to have a foundation before you can impart skills,” said Ms. Shuman.
When teaching tasks, start with the easiest ones. The early phase of the training program might include automated refractometry and lensometry, and the principles behind checking vision, said Ms. Shuman. History-taking with each patient should be emphasized as the cornerstone of patient care. Teach the new techs to describe patient complaints qualitatively and descriptively.
Eventually, the trainees will have to move on to perform the most technical procedures handled by ophthalmology techs, including refraction and applanation tension. “Expect new techs to be somewhat intimidated by these tasks,” said Ms. Shuman. She advises starting a formalized class within the office to teach these skills, perhaps after hours. Students should be given ample time to practice on each other before proceeding to patients.
Another intimidating task for the trainee is measuring intraocular pressure because of the concern about causing a corneal abrasion. So students should first practice on a model eye, then other staff members. When the new tech goes on to perform intraocular pressure on actual patients, it’s a good idea to start out with glaucoma patients or patients who wear contact lenses. These patients may be the least likely to flinch, said Ms. Shuman.
Monitor their progress, and don’t ask them to do tasks they’re not ready for. The new employee may feel pressure to perform beyond his or her ability if training is not paced appropriately. And putting a technician trainee in a clinical situation for which he or she is not prepared jeopardizes the training as well as patient care. “You want to minimize the risk to the practice by slowing down training if it looks like the tech is having trouble keeping up. At that point, you should go back to teaching the basics and correcting any problems,” said Ms. Shuman.
Give Them a Mentor to Shadow
It’s best to have a trainee work with one mentor who has been with the practice for an extended period and who has proved to be competent and trustworthy. This practice is called “shadowing” and is quite important to on-the-job training.
How mentoring should work. Shadowing a well-trained and trusted tech is the ideal. There should be a real partnership between the new employee and the trainer. The new employee has the task of learning new skills. But the trainer has the job of observing the new tech closely and providing competency testing.
Ideally the trainer should be relieved of his or her own duties during the training process.
The pitfalls of shadowing. Can this approach result in inefficiency or poor patient care? Unfortunately, in some circumstances, the answer is yes. “Usually techs trained on the job are only as good as the information they’re given,” said Dianna Graves, clinical services manager at St. Paul Eye Clinic in Woodbury, Minn. One problem that can occur when colleagues train each other is that processes may not be taught correctly.
“The trainer has learned a shortcut method to do an exam, for instance, and then teaches that method to the new tech. But the new tech may not have the skill level to understand the shortcut. This type of training doesn’t serve patients well,” said Lynn Anderson, PhD, executive director of the Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO).
There should be written procedures for all tasks. To avoid the problem of trainees being taught shortcut methods, it’s important to have good supporting documents for all processes performed at the office—whether they’re performed by an ophthalmic technician or front office staff. There should be an agreed-upon checklist that documents how processes are performed, especially those pertaining to clinical care. And these processes should be taught correctly, without shortcuts, said Ms. Anderson.
Keep an eye on patient flow. Although training the tech is important, patient flow through the office takes precedence. Training may have to be interrupted if there’s a problem with patient care. “The most important thing is to get patients through the office in a timely and qualitative manner,” said Ms. Shuman.
How long will cross-training take? Still, cross-training can take as much as a year or even two years. Factors such as leave of absence, vacation and varying patient loads can interrupt the process. Traci Fritz is the administrator for the Fite Eye Center in Detroit, a small practice that employs four techs. When she cross-trains techs, it takes nine months to a year. As well as learning skills such as how to check vision and muscle balance, the techs are required to do reading at night that teaches them about ocular disease and anatomy of the eye. They are tested every two or three weeks. Typically a new tech will shadow the lead tech in the office to learn new skills and processes. Ms. Fritz considers the shadowing process vital to training a competent tech.
To learn the basics of ophthalmology, many practices advocate home study, night classes or distance learning.
Home study can be accomplished through the Allied Health On-the-Job Training Kit, available at the American Academy of Ophthalmic Executives Web site. The training kit includes an ophthalmology textbook that teaches all the fundamentals of eye disease and eye anatomy, and discusses what it’s like to work in an ophthalmology office. It also includes a primer on how to perform a variety of basic tests, as well as an interactive software video that allows ophthalmic professionals to manipulate equipment and view patient response in real time. And it provides a detailed guidebook that physicians and administrators can use to train ophthalmic technicians.
Distance learning, on the other hand, is provided through two accredited programs, Centennial College Ophthalmic Medical Personnel Program and the Southern Alberta Institute of Technology Ophthalmic Assistant and Distance Learning Program. The distance learning option is a good one for motivated employees who want to cross-train and expand their skills.
Schools often provide realistic training with state-of-the-art equipment. As well as teaching about anatomy and physiology of the body and eye, and treatments for eye diseases, the schools help the student learn the skills necessary to be a highly competent ophthalmic technician. The schools provide a focused learning environment that helps the student learn the latest and best standards of care in ophthalmology. Once they graduate, they can sit for a certification exam.
“The best ‘technical’ technicians have already gone through some sort of formal educational training, preferably at an accredited program or school. The schools not only teach the skills, but the why behind the skills,” said Ms. Graves, who is a faculty member at the School of Ophthalmic Technology in St. Paul, which is a two-year program. As well as one year of solid didactic training, the students there work in an internship in an eye clinic.
Should Techs Get Certified?
There are three levels of certification—COA, COT and COMT. Certification is very important in training a tech, according to many practice managers. It’s the icing on the cake of tech training. “It provides added self-confidence to the technician and assures the patient, as well as the doctors in the practice, that the technicians have met a national standard,” said Ms. Graves.