Exam Pass Notes

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Key takeaways

• GOC Standard 10: registrants must work collaboratively with colleagues to protect patients, ensure coordinated care and make teamwork observable and repeatable.
• Collaboration is a structured clinical method: clear roles, reliable information exchange, escalation rules and inclusive practice reduce error and improve efficiency.
• Use structured handovers (SBAR/SOAPE), agreed escalation triggers (red flags), visible ownership (task boards), and accessible documentation to close the loop internally and externally.
• Cross-boundary referrals must state the clinical question, urgency, salient findings with methods, attachments (images), and access needs; always confirm receipt and record who took the referral.
• Psychological safety, inclusive adjustments and routine reflection (mini-audits, huddles, cross-shadowing) make collaboration sustainable.

Why collaboration matters

• Protects patients by distributing cognitive load and catching blind spots.
• Shortens patient journeys by dividing labour while keeping supervision boundaries clear.
• Increases patient trust through consistent messaging across reception, clinicians and dispensing.
• Makes working practices resilient to staff turnover and locum cover.

Core enablers and behaviours

• Role clarity: publish a scope matrix and display role labels at benches/badges.
• Structured handovers: SBAR / SOAPE for both internal and external communication.
• Escalation rules: agree what triggers same‑day referral, urgent clinician review, or stop routine work.
• Electronic aids: templates, task ownership with due dates, visible recall flags, labelled images.
• Leadership: invite concerns, thank speaking up, debrief conflict privately to protect psychological safety.
• Inclusivity: communication passports, accessible leaflets, and interpreter use where needed.

Practical tools & templates

SBAR (fast handover)

• Situation - one-line problem (who, what, now).
• Background - relevant history and risk factors.
• Assessment - objective findings with method (VA, IOP with method/time, OCT).
• Recommendation - what you want (urgent review, same-day referral, repeat test).

SOAPE (clinical note structure)

• Subjective, Objective, Assessment, Plan, Education/Errors checked.

PACE (raising concerns)

• Probe → Alert → Challenge → Emergency (graded escalation for juniors).

Sample SBAR entry

• Situation: Flashes OS since 22:00.
• Background: High myope, no trauma.
• Assessment: VA 6/9, fundoscopy suggests peripheral retinal tear risk; no view superior-temporal; OCT attached.
• Recommendation: Urgent ophthalmology assessment today. Phone call made to on-call (Dr X), 14:05, advise same-day clinic.

Documentation phrasing (clear instruction example)

• "Repeat IOP by GAT at 15:00, record method and CCT, escalate if ≥25 mmHg. Task owner: DO B. Documented 11:00 by Dr A."

Roles, scope and how they contribute

• Optometrist - clinical assessment, diagnosis, referral decisions, red-flag triage.
• Dispensing Optician (DO) - translate prescription to safe, comfortable appliance, fit and adaptation management.
• Optical Assistant/Technician - pre-tests, measurements, device operation, patient education within competence.
• Reception/Admin - capture presenting complaint, red flags (onset/laterality), manage flow and recalls.

Practical: publish a task/competence matrix that maps tasks to role + required supervision level. Cross-train to cover critical handovers.

Handover & documentation essentials

Include at minimum:

• Patient priorities and consent status.
• Red-flag safety-netting (what to watch for, when to escalate).
• Key findings with method and time (e.g., IOP 24 mmHg by iCare at 09:30; repeat by GAT).
• Clinical question and recommended action with owner and deadline.
• Attachments: labelled OCT/fields, date/time, patient ID and image quality note.
• Record who received external referrals (name/time) and follow-up actions.

Use visible task boards and short end-of-day huddles to confirm completion of urgent items.

Red flags & reception prompts (must-capture items)

• Sudden onset flashes/floaters or curtain/field defect - record onset time & laterality.
• Sudden loss of vision, severe eye pain, chemical exposure (capture exposure time), trauma.
• New diplopia with neurological signs, acute proptosis, suspected orbital cellulitis. Action: flag record, stop routine pre-tests, immediate clinician review, phone hospital if needed.

Referral / cross-professional checklist (minimum dataset)

1. Clinical question and reason for urgency.
2. Onset/time course & laterality.
3. Key positives and pertinent negatives.
4. Objective measures with methods (VA, IOP + method/time, visual fields reliability indices).
5. Relevant history (surgery, high myopia, steroids, anticoagulants).
6. Attach labelled images (OCT/fundus photos) and state quality.
7. Functional impact (driving/work), access needs (interpreter/transport).
8. Patient contact details and who will be notified of outcome.
9. Documented phone call: recipient name, role, time, and advice received.

Always confirm receipt; if e-referral fails, phone and document who accepted the referral.

Inclusive collaboration (practical actions)

• Ask preferred communication style; create "communication passports" for repeat patients.
• Provide accessible assets: large-print, pictorial instructions, captioned videos.
• For neurodiversity: predictable sequence, low sensory environment, literal concise language and extra processing time.
• For D/deaf patients: arrange a professional interpreter, keep mouth visible, supplement with written materials and teach-back.
• Share adjustments with the whole team so adaptations occur end-to-end (reception → pre-test → clinician → dispensing).

Measure inclusivity by auditing missed appointments, repeat explanations and complaint themes.

Involving carers and families (practical rules)

• Address the patient first; invite carer input after patient's account.
• Confirm consent to share information; follow legal frameworks for capacity and Gillick competence where relevant.
• Use carers to support implementation (transport, reminders) but not as interpreters for complex consent.
• Document patient preferences, carer role and any concerns about undue influence.

Practical phrase examples

• "I'd like to hear from you first, then we'll invite [relative] to add anything that helps us."
• "Who would you like me to share the appointment summary with?"

Managing disagreements & conflict

In the moment:

• Use a time-out: "We'll compare notes and come straight back to you."
• Prioritise the patient's safety; remove debate from patient view.

Structured approach:

• Use PACE to escalate concerns respectfully.
• Debrief facts and effects after the event and capture agreed changes in SOPs.

Prevent recurrence:

• Joint training and cross-shadowing.
• Agree red rules (e.g., who clears driving post-dilation, when to escalate flashes/floaters).
• Document third-party opinions and rationale when used.

Continuity of care & closing the loop

• Internal handovers use SBAR/SOAPE with clearly named owners and timelines.
• External continuity: attach images, specify urgency rationale, note access needs, and chase referral acknowledgements.
• Task lists, shared dashboards, and recall systems should be risk‑based and visible.
• End-of-day huddles confirm urgent tasks; weekly reviews find stranded actions.

Continuity proven when another clinician can take over without needing historical context.

Reflection & continuous improvement (practical cycle)

• Short case huddles after complex referrals to test clarity and response.
• Mini-audits (e.g., handover completeness, interpreter use) monthly with feedback.
• Cross-shadowing to build empathy and shared vocabulary.
• Team learning cycle: identify problem → change template/script → brief training → re-audit in ~4 weeks.
• Leaders rotate chairing huddles and thank those who raise concerns to build psychological safety.

Quick scenario prompts and model answers (exam-style)

1. Busy clinic handover (flashes reported)

• Risks: missing time-sensitive retinal tear, delayed referral.
• Action: reception records onset & laterality; flag urgent; SBAR handover; stop routine pre-tests; clinician prioritises assessment; audit compliance.

2. Assistant corrected in front of family

• Risks: loss of confidence, reduced speaking up.
• Action: address patient first with corrected plan; debrief assistant privately using coaching; document training and agreed actions.

3. Urgent hospital referral with slow e-portal

• Action: phone on-call with SBAR, upload images by email/portal if possible, document recipient name/time, give patient written safety-netting and contact details.

4. Suspected neglect (child, broken spectacles)

• Action: consult safeguarding lead, share facts on a need-to-know basis, inform children's social care per protocol, document lawful basis and contacts, continue respectful engagement.

5. Family dominates conversation (hearing loss)

• Action: face and address patient, use written prompts, invite family input after patient, document adjustments and any concerns about undue influence.

6. Neurodiverse patient with unexpected stimuli

• Action: immediately reduce sensory input, stick to agreed sequence, provide concise literal instructions, allow processing time, brief whole team on what worked.

7. D/deaf patient - interpreter dispute

• Action: use a professional interpreter for complex consent, address patient directly, document interpreter details and confirmed understanding.

Exam tips

• Learn and be able to write a concise SBAR and referral dataset from memory.
• Always document recipient name/time for phone referrals and the advice given.
• Remember red-flag items reception must capture (onset time, laterality, floaters/flashes, chemical exposure).
• Emphasise patient-centred language: actions exist to serve patient needs, not departmental boundaries.
• Be ready to cite examples of inclusive adjustments (communication passports, large-print materials, professional interpreters).
• Highlight examples of measurable improvement: mini-audit results, reduced referral bounce-backs, fewer missed appointments.

Keep these notes as a checklist during exams and use the SBAR/Referral templates to structure answers for workplace communication, handover and cross-professional scenarios.