IGOEE
Participant
Guide
Updated May 8, 2017 Internationally
Graduated
Optometrist
Evaluating
Exam (IGOEE)
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Introduction
Touchstone Institute is honoured to be the national administrator of the Internationally Graduated
Optometrist Evaluating Examination (IGOEE). This standardized examination tests the knowledge, skill
and judgement of internationally graduated optometrists (IGOs).
Registrants of the IGOEE will complete the three-part examination:
1- MCQ Examination – up to 140 questions (2.5 hours of writing time)
2- Long case station OSCE – 3 stations (32 minutes each)
3- Short case station OSCE – 9 stations (17 minutes each)
We reserve the right to modify the configuration of OSCE tracks based on candidate numbers
The blueprint for the IGOEE is consistent with the Optometry Examining Board of Canada's National
Competency Profile for Entry-Level Optometry (2015).
We have created this participant guide to assist IGOs as they prepare for assessment at our facility. While
it is our hope that this guide will answer important questions about the IGOEE, registrants should seek
out other study resources as they prepare for the examination.
We look forward to welcoming all referred registrants to Touchstone Institute.
Sincerely,
Touchstone Institute
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Written component
The multiple choice question (MCQ) exam consists of up to 140 questions. It assesses the following
professional competencies:
Role 1: Provide Comprehensive Eye and Vision Care
Optometrists meet their clients’ eye and vision care–related needs with the objectives of achieving appropriate outcomes and maintaining or improving their clients’ quality of life.
Role 2: Collaborate
Optometrists support an integrated health care system by collaborating with other health care professionals and service providers to facilitate the management of the overall health needs and to encourage the well-being of their clients.
Role 3: Manage
Optometrists apply management skills to optimize the care of their clients and make efficient use of health resources.
Role 4: Educate
Optometrists provide education with the goal of encouraging appropriate, effective, comprehensive eye and vision care.
The written component will assess:
Client assessment and diagnosis – particularly relating to glaucoma, macular degeneration, diabetes, hypertension, vascular diseases and other causes of visual impediments, including refractive error and binocular vision anomalies
Vision therapies – including eyeglasses, contact lenses, low-vision therapies, binocular-vision therapies and peri‐surgical care
Drug therapies – particularly those currently authorized to optometrists in Ontario
Prevention of visual disability, morbidity and mortality
Pediatrics
Geriatrics
Collaborative care
Format
Each MCQ begins with a case description, which may contain information about the client, main complaint, ocular history, medical history and clinical data. Visuals may also be provided for the candidate to interpret. Each case description is followed by up to four questions. Candidates are required to choose the correct or best answer from a list of four responses. Candidates will have 2.5 hours to complete the written component of the IGOEE.
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Sample MCQ Question
Demographics
42-year-old white female; computer programmer
Chief complaint red right eye
History of present illness Character/signs/symptoms Location Severity Nature of onset Duration Frequency Exacerbations/remissions Relationship to activity or function Secondary complaints/symptoms
none redness worse in the inner corner OD moderate, getting worse sudden 2 days constant none mild discomfort, slight tearing none
Client ocular history last comprehensive eye exam 1 year ago; wears PALs
Family ocular history mother: cataract surgery at age 55
Client medical history Medications taken by Client Client allergy history Family medical history General health
inflammatory bowel disease diagnosed 5 years ago artificial tears four times per day for the past 2 days; oral prednisone; ibuprofen; multivitamin dust; pollen; NKDA mother: type 2 diabetes mellitus occasional malaise
Clinical findings BVA Pupils EOMs Confrontation fields Slit lamp
Distance OD: 20/20 /OS: 20/20 PERRL, negative APD full, no restrictions full to finger counting OD, OS lids/lashes/adnexa: unremarkable OD, OS conjunctiva: see Image 1 OD, normal OS cornea: clear OD, OS anterior chamber: deep and quiet OD, OS iris: normal OD, OS lens: trace NS OD, OS vitreous: clear OD, OS
IOPs Fundus OD Fundus OS
24 mmHg OD, 25 mmHg OS @ 9:30 AM by applanation tonometry C/D, macula, posterior pole: see Image 2 periphery: unremarkable C/D, macula, posterior pole: see Image 3 periphery: unremarkable
Blood pressure Pulse
124/88 mmHg, right arm, sitting 72 bpm, regular
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Image 1: OD right gaze
Image 2
Image 3
1. Which of the following is the MOST likely diagnosis of this client’s anterior segment condition OD?
a. Nodular episcleritis b. Phlyctenular keratoconjunctivitis c. Conjunctival abrasion d. Inflamed pingueculum
2. Which of the following is the MOST likely extra-intestinal manifestation of idiopathic inflammatory bowel disease?
a. joint inflammation b. pulmonary infections c. orthostatic hypotension d. cardiac arrhythmia e. weight gain
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3. Which of the following is the MOST appropriate treatment for this client’s anterior segment condition OD?
a. Polytrim® solution every 3 hours b. Natamycin suspension every 4 hours c. Viroptic® solution every 2 hours d. Erythromycin ointment twice per day e. FML® suspension 4 times per day
4. After initiating treatment, which of the following is the MOST appropriate follow-up interval?
a. 24 hours b. 4 days c. 4 weeks d. 3 months e. 6 months f. 1 year
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Performance Component – The OSCE
The objective standardized clinical examination, or OSCE, is a performance test that evaluates a
candidate’s clinical proficiency while participating in a series of standardized client encounters. OSCEs
are a highly valid assessment tool in measuring a candidate’s clinical performance ability.
IGOEE candidates are being tested at the competency level of recent Canadian optometric graduate who
is ready to challenge the licensing examination.
The OSCE stations for this evaluating examination and represent common workplace examples of the
content areas. Candidates should manage each presenting case as they would in a real life practice
setting. There are no hidden surprises or tricks.
Role 1: Provide Comprehensive Eye and Vision Care
Candidates will be assessed on their ability to meet their clients’ eye and vision care needs with the objective of achieving appropriate outcomes and maintaining or improving their clients’ quality of life.
Role 2: Collaborate
Candidates will need to demonstrate their ability to work within an integrated healthcare system by collaborating with other health care professionals and service providers to facilitate the management of the overall health needs and to encourage the well-being of their clients. The OSCE will assess a candidate’s:
Knowledge integration
Clinical skills
Behaviour
Attitude
Values
OSCE stations will assess content from the following areas:
Refractive errors and presbyopia
Diabetes
Binocular vision
Retinal vascular disease
Cataract glaucoma or glaucoma suspects
Anterior segment disease
Macular disease
Format
The OSCE assessment is divided into two parts:
1- Three long case stations with standardized clients and examiner questions 2- Nine short case stations with standardized clients and examiner questions
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Long Case OSCE Information
Three of the 12 OSCE stations fall within the long case category. Each long case is 32 minutes.
Timing
Candidate Instructions – 2 minutes reading time
On the wall outside each clinical station there is a written statement (candidate instructions) that may
include the following information:
Client’s name
Client’s age
Task you are being asked to perform (i.e., physical examination, history taking, etc.)
Candidates will have two minutes to read the candidate instructions outside the stations. Candidates may
make notes in their note booklet (provided). An announcement will indicate when candidates may enter
the station. A copy of the candidate instructions will also be available in the examination room for the
candidate to reference.
Equipment Check/Positioning – 2 minutes
After entering the station candidates will have 2 minutes to view equipment and position themselves appropriately. An announcement will indicate when they can begin their client interaction. Candidates may NOT begin the client interaction before the announcement.
Client Encounter – 22 minutes total interaction time with the standardized client
After the starting announcement, candidates will have 22 minutes to interact with the standardized client
and complete the required task(s) listed on the candidate instructions. Candidates should take some time
to familiarize themselves with the equipment and introduce themselves to the client.
During the client encounter candidates will be assessed on the following:
History and data collection
Physical examination skills
Communication skills
Planning
Implementation
Organization
Time management
Evaluation (of client understanding)
A standardized client is an actor trained to replicate a client’s signs and symptoms in a reliable and
consistent manner. Treat them as you would a real client in a real clinical environment.
Candidates are required to explain to the station examiner exactly what they are doing during the
assessment of the client. Remain focused and don’t forget that the examiner will be scoring your clinical
skills and process. Successful candidates will be able to demonstrate their clinical ability with the client in
a natural, focused, professional manner.
Examiners may move around the room to get the best view while you demonstrate your skills. Examiners
may also provide candidates additional information related to the client during the encounter.
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At the 21-minute mark, candidates will hear an announcement indicating that they have 1 minute
remaining with the standardized client. This is a good time to provide a summary of the points covered
with the client.
Examiner Questions – 6 minutes
The client encounter is followed by a structured oral interview during which the examiner may ask up to
10 questions about the presenting case and may present visual photographs or data for interpretation.
During this time, the standardized client will no longer engage with the candidate.
Time is up – Exit and proceed to next station
An announcement will be made to indicate when time is up. Candidates will be asked to leave the station
immediately, move to the next station and begin reading the candidate instructions for that station.
Candidates are not allowed to enter or leave a station before they are told to do so.
Candidates should note that they will be expected to perform the following optometric procedures on
standardized clients:
Dilated fundus exam
Binocular indirect ophthalmoscopy
Contact Tonometry
Gonioscopy with fundus lenses
Failure to identify your inexperience in these procedures could place the client at risk. Candidates will be
required to complete an acknowledgment form on the day of the exam attesting that they have the
training and experience to perform these procedures on standardized clients in a safe manner.
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Sample Performance (OSCE) Senario Long Case
CANDIDATE INSTRUCTIONS
• Julia is a 70-year-old female. • Referred by her family doctor after complaining of blurred
vision for the past month. Also complains of seeing double while getting out of bed in the morning.
• Has not had an eye exam for the last 8 years.
IN THE NEXT 22 MINUTES:
OBTAIN A HISTORY OF THE PRESENTING COMPLAINT
CONDUCT A FOCUSED AND RELEVANT PHYSICAL EXAMINATION
ADDRESS CLIENT CONCERNS
As you proceed with the physical examination, EXPLAIN TO THE EXAMINER what you are doing and DESCRIBE ANY FINDINGS.
After the 22-minute warning signal, you will have six minutes to answer the examiner’s questions related to the scenario.
Once you enter the station you will have 2 minutes to view equipment and position yourself appropriately. An announcement will indicate when you can begin your client interaction. You may NOT begin your client interaction before the announcement.
Please hand one (1) barcode to examiner
Total station time = 32 minutes
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Short Case OSCE Information
Nine of the 12 OSCE stations are short cases. Each short case station is 17 minutes in length.
Timing
Candidate Instructions – 2 minutes reading time
On the wall outside each clinical station there is a written statement (candidate instructions) that may
include the following information:
Client’s name
Client’s age
Task you are being asked to perform (i.e., history taking)
Candidates will have two minutes to read the candidate instructions outside the stations. Candidates may
make notes in their note booklet (provided). An announcement will indicate when candidates may enter
the station to begin their interaction with the standardized client. A copy of the candidate instructions will
also be available in the examination room for the candidate to reference.
Client Encounter – 5 minutes total interaction time with the standardized client
Upon entering the station, candidates will have five minutes to interact with the standardized client and
complete the required task(s) listed on the candidate instructions. Candidates should take some time to
introduce themselves to the client.
During the client encounter, candidates will not be required to perform a physical examination but will be
assessed on the following:
History and data collection
Communication skills
Planning
Implementation
Organization
Time management
Evaluation (of client understanding)
A standardized client is an actor trained to replicate a client’s signs and symptoms in a reliable and
consistent manner. Treat them as you would a real client in a real clinical environment.
At the four-minute mark, candidates will hear an announcement indicating that they have one minute
remaining with the standardized client. This time should be used by the candidate to summarize the
encounter for the client, if possible.
Examiner Questions – 10 minutes
The client encounter is followed by a structured oral interview. The examiner may ask up to 10 questions
about the presenting case and may present visual photographs or data for interpretation. During this time,
the standardized client will no longer engage with the candidate.
Time is up – Exit and proceed to next station
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An announcement will be made to indicate when time is up. Candidates will be asked to leave the station
immediately, move to the next station and begin reading the candidate instructions. Candidates are not
allowed to enter or leave a station before they are told to do so.
Sample Performance (OSCE) Scenario Short Case
CANDIDATE INSTRUCTIONS
• Alex is a 65-year-old male. • Referred by his family doctor to rule out diabetic
complications and vascular pathologies. • Has not had an eye exam for the last 5 years. • You have just completed your fundus exam. There is 1
image of the relevant clinical findings OD in the room for your reference.
IN THE NEXT 5 MINUTES:
OBTAIN A HISTORY OF THE PRESENTING COMPLAINT
FORMULATE YOUR DIAGNOSIS TO ADDRESS CLFIENT CONCERNS AND SUGGEST MANAGEMENT
Do not conduct a physical examination.
After the 5-minute warning signal, you will have ten (10) minutes to answer the examiner’s questions related to the scenario.
You have fifteen (15) minutes for this station.
Please hand one (1) barcode to examiner
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Long Case Station Equipment List
Room 1
S4 Optik Combo Chair and Stand
Nidek Manual Refractor – Model Sly – 100
Nidek CP770 Auto Projector With Remote
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Mirror – Shadow Box – Single
Heine BETA 200 Streak Retinoscope
Heine Beta NT Lithium Handle – AV
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Reliance 4240 Pneumatic Stool
Black Occluder Long Handle
Prism Set Luneau Loose 16 Prisms
Prisms Bar Set Berens Luneau
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Children’s Fixation Bar
Card Nearpoint Reading – Bilingual
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Room 2
S4 Optik Combo Chair and Stand
S4Optik Z2 LED Lamp
Nidek CP770 Auto Projector With Remote
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Mirror – Shadowbox – Single
Applaination Tonometer For Z2 Slit Lamp
Volk 78D Slit Lamp Lens Clear
Volk 90D Slit Lamp Lens Clear
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Volk G4 4-Mirror Goniolaser Lens – Flange
Reliance 4240 Pneumatic Stool
Black Occluder Long Handle
LED Penlight Disposable 6 pack
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Haag Streit Tonometer Measuring Prism Tip
Volk 4-mirror Hi-Mag Lens – Flange
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Room 3
S40PTIK COMBO Chair/Stand
S40PTIK Z2 Led Slit Lamp
Applaination Tonometer for Z2 Slit Lamp
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Heine Omega 500 BIO
VOLK 20D BIO LENS
Reliance 4246 Pneumatic Stool
VOLK 78D Slit Lamp Lens Clear
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VOLK 90D Slit Lamp Lens Clear