Is eyecare education trapped in a comfortable delusion? For decades, optometry and ophthalmology faculties have relied on the traditional model of teaching with the use of PowerPoint slides, encouraging rote memorization and using multiple-choice tests to test knowledge. In the process, this convinces everyone that their teaching models are working simply because “enough” students pass board exams.
Well, these models are simply not working. And maybe the question we need to be asking, “Is the goal to pass board exams, or is the goal to provide great doctors?”
Board scores may mask a deeper systemic failure: are we producing graduates who are unprepared for the realities of modern clinical practice? Now, this article may cause discomfort to infuriation to some who read this. However, this is an important conversation about problems that need to be addressed.
It’s also important to note that faculty are being asked to teach more and more in the same amount of time. With medical knowledge doubling every 73 days according to an NIH paper, academia is faced with an impossible task. But instead of just “guttin through it because this is the way it has always been done,” maybe it is time to re-examine not just how we teach, but what we teach.
Some academics might feel that clinical pathology is the only subject worth teaching or that teaching business skills is not the responsibility of the institution. This philosophy often leads to a dismissal of business management in core curriculum. But elements of management like workflow engineering, interprofessional communication and data management are fundamental aspects of clinical care delivery. Private equity continues to devour clinical care facilities at every level and that may in part be because most doctors graduate with zero understanding of business management, leaving them helpless against corporate consolidation.
The Death of Rote Memorization and the Aviation Model
PowerPoint lectures and fact regurgitation are approaching extinction. The next generation of practitioners will have much of the raw data and diagnostic processing handled pre-emptively by AI. The modern provider’s role is shifting from a data gatherer to a high-level interpreter and communicator.
To survive this shift, we must abandon rigid, time-based, “butts in the seat” hours and adopt an aviation-style check ride system. Just as commercial aviation replaced classroom clock hours with rigorous, scenario-based simulations, eyecare education must move towards these same risk-free interactive simulations. Students need simulated clinical care environments where they can make mistakes, experience and work through diagnostic discrepancies and learn through continuous knowledge gap-correction rather than a one-and-done test that doesn’t match today’s clinical demands. They need the opportunity to see multiple versions of a single diagnosis, at their own pace, in an environment that doesn’t depend on the knowledge of a single mentor, professor or type of clinical setting. It is impossible to provide to teach what they really need to know in our current teaching environment.
Grading must also evolve to match this reality. When students navigate complex simulations with multiple correct pathways, we shouldn’t penalize them for taking different clinical routes. Instead, we should award points based on operational efficiency, resource utilization and human capital management. The way clinical care works today!
Rewiring Faculty and Overcoming Institutional Inertia
This also requires stripping away the archaic evaluation metrics used for professors as well. We can no longer grade educators on passive lecture delivery or attendance. Instead, faculty must be evaluated on student competency velocity, the ability and speed at which students achieve mastery over clinical care, not didactic data. I might propose that faculty instead act as master coaches who guide learners through complex problem-solving, measuring how well they unmask cognitive and automation biases and make sound clinical decisions. I want to highlight a key word there: “Coach.” Not professor, not teacher. The goal of education is learning, not teaching! We need to focus on what people learn, not what they are taught!
Academia often discuss administrative hurdles and institutional tradition, insisting they cannot be told how to teach or this is just the way it is. But the market likely tells a different story. Whichever institutions build these dynamic, simulation-driven programs is likely to hold an extremely competitive advantage in recruitment. The next generation wants to learn efficiently, and whichever school gives them what they want will win the war for talent.
The status quo is a slow-motion death march for academic medicine. You cannot insulate ivory towers from an evolving world. If this article made you uncomfortable or irritated, GOOD. This is where change begins. And in the eyecare industry, we need change! (Look out for my upcoming feature on revolutionizing learning for future eyecare professionals, as we look at what the future could and might look like.)
Before I sign off this month, I want each of you to ask yourself this question and reflect on your answer: Can you afford not to change as the world changes around you?
Evolution is not something you can escape. You either evolve, or you slowly perish. We need to adapt our curriculum, teach the full spectrum of practice reality, or face the consequences. But we can’t complain about it when we have the choice to fix it now. The clinical landscape is changing—how you handle it is your choice.
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