In December 2014, Adam Bussells was hired as an ophthalmic technician assistant in the float pool at Wilmer Eye Institute, Johns Hopkins Medicine. Bussells always knew he wanted a career in eye care. He has a family history of glaucoma, wears glasses and has been seeing an optometrist since childhood. Those factors, coupled with Wilmer’s and Johns Hopkins Medicine’s reputation for commitment to training and cultivating talent, are what attracted him to the organization.
“I knew I wanted to be involved with health care but wasn't sure what my path would be,” says Bussells. “I always enjoyed my visits with the eye doctor, so I decided to look into possibly working in an eye clinic. I came across many openings at Wilmer and knew Johns Hopkins would be one of the best places out there to gain experience in health care.”
Bussells joined the float pool without any prior experience in medicine — which is exactly what Mike Hartnett, clinical supervisor of Wilmer’s float pool, looks for when hiring candidates. “It’s hard to find experienced ophthalmic technicians. So, we train our own — we grow our own. We look for people with solid work history, not necessarily medicine, but people with a customer service background who have worked with the public,” says Hartnett.
About 20 years ago, Hartnett along with Cathy DiBernardo, former associate professor of ophthalmology, director of echography and technician faculty advisor to then-director Morton Goldberg, the Joseph Green Professor of Ophthalmology, established the technician training program. At the time, there was a shortage of technicians across the institution. Hartnett and DiBernardo’s solution was to hire and train a group of ophthalmic technician assistants who could travel to Wilmer divisions and screen patients.
“We thought of a float pool to cover absences within the divisions, and Mike became the driving force behind this idea,” recalls DiBernardo. “She had to be sure that the ‘floaters’ were well-versed in all aspects of ‘teching’ for each of the divisions. Some divisions required more intensive technician involvement than others. From there, we started thinking that a tech training program would be useful, and we started the process.”
The extensive training includes studying and comprehending eye anatomy; measuring visual acuity at near and far distance; determining intraocular pressure using tools such as the Goldmann applanation tonometer and the iCare (a portable, handheld tonometry device that can be used at home); assessing pupillary response and looking for any abnormal reactions; instilling eye drops correctly and understanding their purpose; and learning and practicing refractometry techniques to correct patients' vision.
Trainees also learn how to operate and perform diagnostic testing on equipment such as the Humphrey field analyzer, which detects vision loss, glaucoma and neurological disorders, and the optical coherence tomography machine, which captures images of the optic nerve, macula and anterior segment.
Hartnett says they model the program after the American Academy of Ophthalmology’s independent ophthalmic medical assistant study course and use a refractometry guide developed by Richard Kolker, a comprehensive eye specialist and assistant professor of ophthalmology at Wilmer. Hartnett stresses the importance of technicians understanding the theory behind the techniques.
“I tell people all the time I don't want to teach you the Mike Hartnett method of anything. We want to do this by the book. Often times [ophthalmic technicians] are unaware of why they do what they do,” Hartnett adds. “Why is the room dimly lit when assessing visual acuity? Why should a patient look into the distance when checking pupillary reaction? We’ve got to show them how to do ophthalmic stuff, so they really understand why they do it this way.”
She emphasizes that understanding the why increases technician accuracy and proficiency, which leads to better patient outcomes, boosts job satisfaction and promotes higher retention.
Over the years the program has evolved to require ophthalmic assistants to earn certification from the Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO) within 18 months of employment, a stipulation set by Peter McDonnell, director of the Wilmer Eye Institute and the William Holland Wilmer Professor of Ophthalmology.
“To me, it was completely logical to make this decision. Wilmer will only be excellent if we who work here learn from each other, do our best every day for our patients and strive to contribute to our profession,” says McDonnell. “Just as Wilmer’s doctors and nurses are all certified and find joy in keeping up with the latest advances in our fields, so do all of us at Wilmer take pride in the training and expertise of our ophthalmic technicians.”
Wilmer offers its technicians many opportunities to earn continuing education credits toward the renewal of their certification, including a recent partnership with JCHAPO to offer continuing-education courses to technicians at no cost.
Recently, Hartnett and her team moved into a larger training area. Wilmer administrator Cathy Kowalewski was instrumental in acquiring the space which she says will provide an optimal training environment that will further the success and sustainability of the program.
“The creation of this program was one of the first in the country and has been a successful initiative not only from the standpoint of developmental opportunity for [existing] employees but for individuals wishing to enter into a career in clinical support care,” says Kowalewski. She points out that the technician training pool has equipped Wilmer with many skilled technicians throughout the institution. “Many of our trainees and float techs have moved to other roles of interest in the organization and [since] have been promoted to higher level roles. We’ve also had a few go on to optometry and PA (physician’s assistant) school. This is a testament to the utility of such a program, not only to Wilmer but to the employees themselves who go through this program.”
Two years into an ophthalmic technician career, Bussells decided to expand his horizons and enroll in PA school. He attributes his decision—and ultimate success—to the extensive training and overall learning experience at Wilmer.
After completing the program and earning his certification, Bussells had the opportunity to return to the institution. He accepted a job working alongside Wilmer residents with the ophthalmology consult service. As part of the team, he examines adult and pediatric emergency room patients, conducts routine screenings in Wilmer’s Patient Access Center for the Eye (PACE), and services all of Johns Hopkins’ inpatient units in east Baltimore.