Trends in Optometric Education and Clinical Training
Interview commissioned by the Massachusetts League of Community Health Centers and conducted by James Hooley.
See also:
Dr. Charles F. Mullen – Clinical Architect is also available in .pdf format.
Today’s optometry students take for granted their ability to train at settings including neighborhood health centers and Department of Veterans Affairs (VA) facilities as part of their clinical education. Yet, these doors were not always open to them. While there were many people who contributed to this welcome change, the man with the vision to know where the profession was going and how to get there is Dr. Charles F. Mullen ’69.
Dr. Mullen, who recently retired as President of the Illinois College of Optometry, spent his entire career designing and reshaping the delivery of clinical education for optometry students and residents. He has advanced clinical education with his keen foresight and forceful leadership. In doing so, he has opened up eye care services to many previously underserved patients.
From 1970-1976 Dr. Mullen served President William Baldwin at The New England College of Optometry (then Massachusetts College of Optometry) as Special Assistant for Clinical Development. Baldwin appointed him shortly after his 1969 graduation.
Between 1976-1990, Dr. Mullen served as executive director of the Eye Institute at the Pennsylvania College of Optometry (PCO). He then directed the Optometry Service at the Department of Veterans Affairs in Washington, DC, from 1990-1996 and in 1996 was selected president of the Illinois College of Optometry (ICO).
Beginning with NECO, Dr. Mullen was able to plant the seeds of moving optometry into the forefront of primary eye care by developing a system that optimally served patients. Perhaps best known for clearly seeing the potential of expanding the scope of the practice of optometry, Dr. Mullen recognized in the early 1970’s that optometrists would be treating eye disease and the necessity for students in the clinical system of NECO to develop new skills. Think of how difficult this was without a single diagnostic or therapeutic drug law in place…
Working to implement new clinical protocols, Dr. Mullen creatively developed teaching affiliations with Boston’s system of neighborhood health centers and other multidisciplinary settings. He did this by partnering with a progressive team of optometrists and ophthalmologists in caring for patients in special and underserved populations as a way of enhancing the education of future doctors of all disciplines.
In the words of Dr. Mullen, “We had a need and wanted to enrich the students’ clinical experience and give them more exposure… we also saw an opportunity to provide eye care services to those who were underserved in the Boston area.”
Breaking Down the Barriers
To reflect back on the 1970s, when Dr. Mullen began his career in optometry, is to see a radically different time than today. Co-management was not the norm, as it is today. Diagnostics and therapeutic pharmaceuticals were the sole province of the medical profession.
Early in his career, Dr. Mullen understood that ophthalmology and optometry were complementary. However, integrating a different model in a resistant health care field would require both conviction and persistence. He and other clinicians saw an opportunity to introduce a primary care system into clinical education and, in 1970, circumstances allowed him to begin his mission.
In 1972, the College was commissioned by the State of Rhode Island to develop the clinical curriculum and certify its Optometric State Board in the use of diagnostic and pharmaceutical agents. Dr. Mullen directed the implementation of the clinical component for the first diagnostic pharmaceutical course and along with Dr. Matt Garston ’66 certified the first diagnostic pharmaceutical certified optometrist in the United States.
Following that milestone, Dr. Mullen collaborated with a team of neighborhood health care and public policy leaders: Tres Blake of the South End Community Heath Center; Bob Morgan of Dimock Community Health Center and the Harvard School of Public Health; Mark Richman, M.D. of Boston University and the South End Community Health Centers; and David Miller, M.D., of Beth Israel and Harvard Medical School. All were committed to enhancing ophthalmologic clinical education and services.
The ophthalmic community and private optometric practitioners were skeptical, but the group stayed the course. Over time, local neighborhood health centers formed partnerships with the College and integrated optometric services and students into their clinical programs. Dr. Mullen is still viewed as the architect of the local model used in Boston and duplicated elsewhere to this day.
Dr. Barry J. Barresi ’77, Vice President for Clinical Care and Services at New England Eye Institute (NEEI), testifies to that fact. “Even today as we meet with Boston’s health care leaders to further expand the NEEI system of community-based clinical sites, many of them vividly recall the innovative leadership of Dr. Mullen some 30 years ago. With his colleagues, he built a strong foundation of community health partnerships. Today these collaborations are fueling continued innovation and growth in the College’s mission of excellence in patient care, clinical education and research.”
Dr. Gerald Selvin ’73, Professor of Optometry at NECO and National Education Chair for the Optometry Service Field Advisory Group of VA Central Office considers Dr. Mullen to have had the largest impact on his development than anyone else in optometry. While still a student, he remembers two particular proclamations made in 1972 which not only greatly influence his practice life but all of optometry.
“Optometrists will be treating eye disease routinely, so we are going to start to teach you how now.”;
“There are no welfare patients, no poor patients, no rich patients… there are only patients, and each individual will be treated with dignity and respect.”
These principles are what Dr. Charles Mullen has always placed above all else…take care of patients compassionately and with expertise. Never having lost sight of these principles is what made Dr. Mullen the visionary he is. And those optometrists who have had the good fortune to be directly influenced by him can imprint these values on a new generation of doctors, continuing his legacy.
The Eye Institute
Then it was time for another professional challenge. In 1976, Dr. Norman Wallis, former president of Pennsylvania College of Optometry (PCO) and now executive director of the National Board of Examiners, approached him about developing an integrated clinical system at PCO for the soon to be built Eye Institute. Dr. Wallis felt that Dr. Mullen was the only person capable of handling this daunting assignment. Dr. Wallis explained to Perspective that PCO’s objective was to establish an enterprise that resembled an “eye hospital.” It would combine the three O’s (opticianry, optometry, and ophthalmology) under one roof. This innovation in eye care education would completely change the character of the clinic, and – ultimately – eye care delivery.
With his characteristic methodical approach, Dr. Mullen set out to implement the model, which would greatly expand the scope of educational and training resources available at PCO. Dr. Wallis recalls why it was so successful.
“Charlie organized the clinic like a military campaign. Every aspect was covered to the greatest detail. It was like Operation Desert Storm.”
In the 1980’s, Dr. Mullen saw changes taking place in the profession and made great efforts to merge the interests between optometry and the medical community. He wrote that, “the impetus comes from outside parties – particularly third-party payers, health care policymakers and legislators – who will attempt to define the roles each profession will play in the future of eye care provision if the two professions do not actively define the roles themselves.”
He knew that the mutual interests could form a bond. Therefore, he initiated several affiliations with medical facilities in the Philadelphia region. The hallmark would be PCO’s affiliation with Hahnemann University, a Philadelphia-based medical college. The two combined their resources and worked to develop “unique approaches to ophthalmic education, eye care provision, and optometric research.”
Meeting More Professional Challenges
In 1990 Dr. Mullen left PCO to head the Optometry Service of the Department of Veterans Affairs in Washington, DC. With this post, he became the highest-ranking civilian optometrist employed by the government. A former Navy officer himself, he was familiar with the need for change in the VA system. True to from, he began a process of systematic restructuring. Under his stewardship, he implemented protocols for clinical privileging and standardized the educational component system-wide at the VHA. These guidelines are the principle force driving policy decisions today. He was also responsible for the sizable growth of the student and residency programs.
Many colleagues, including those at the Department of Veterans Affairs, feel that he was a perfect representative for the optometric profession in Washington. Described as a “visionary,” a “poised ambassador,” and an “executive’s executive,” he based his entire career on teamwork. When asked about his leadership style, Charles Mullen credits Dr. Wallis. “Norman taught me the ability to empower the people who work for you – to trust them and how to delegate authority.”
Another term that is often used in reference to Charles Mullen is “turn-around specialist.” In 1996, he accepted the challenge of the presidency at the Illinois College of Optometry. The institution had gone through a difficult time and needed to be restored to its previous stature.
Dr. Mullen confronted the issues head on, turning ICO into a thriving and stable institution. He implemented a strategic management plan, “Commitment to Excellence,” which restructured the college to address the challenges of the future.
Commenting on what he views as the most significant transformation at ICO during his tenure, Dr. Mullen is quick to state that “it has been the institutional culture. We initiated the process by focusing on the CORE four-year program and utilized tools to evaluate outcome assessment and national board performance. Change has permeated the institution.”
The list of accomplishments at ICO is noteworthy. ICO has increased its endowment, raised its clinical revenues, significantly improved student national board performance, frozen tuition, improved its student retention rate and increased student and faculty involvement in institutional governance. The outcome of Dr. Mullen’s taking charge is remarkable.
You can also see his trademark in the clinical programs at ICO. When he arrived there were only nine clinical affiliates. That number has grown to 137 sites throughout the United States and abroad. This has significantly impacted students’ access to patient encounters. In 1997, ICO formed an affiliation with the University of Chicago that has strengthened both institutions. ICO is now in the process of expanding that relationship further and plans are underway to move the University of Chicago’s ophthalmic surgical practice to the ICO campus.
With his retirement recently from ICO, you might expect Dr. Mullen to contemplate his golf handicap or other hobbies. But instead, he is thinking of returning to federal service. You can expect that wherever he heads next, his vision and leadership will do nothing short of transforming that entity.
The New England College of Optometry
Perspective Magazine. Spring 2002.
ICO President Shares Vision of the Future at Installation of Incoming New England College of Optometry President.
On June 10th ICO President Dr. Charles Mullen represented the Deans and Presidents of America’s Schools and Colleges of Optometry and spoke at the installation of Alan Laird Lewis, O.D., Ph.D., as incoming President of the New England College of Optometry (NECO). Inasmuch as the challenges and opportunities envisioned apply to ICO as well as NECO, Alumni Matters is pleased to reproduce Dr. Mullen’s brief remarks in their entirety.
Dr. Lewis, Chairman Spector, members of the Board of Trustees, distinguished members of the New England College of Optometry faculty and administration, colleagues and honored guests.
It is indeed a pleasure and a privilege for me to be here today as the representative of the Deans and Presidents of America’s Schools and Colleges of Optometry, as a friend and colleague of Dr. Lewis, and to return to my Alma Mater.
Over the years Dr. Lewis and I, to some extent, followed similar paths. We are both graduates of the New England College of Optometry. We both served as officers in the United States Navy and we both pursued careers in optometric education.
As Director of the Optometry Service at the Veterans Health Administration, I had the opportunity to work with Dr. Lewis while he was Dean at the Michigan College of Optometry. We worked closely during those years to expand clinical training for optometric students at various Department of Veterans Affairs medical facilities.
I have the greatest respect for Dr. Lewis’ abilities as an administrator and as an educator. He possesses those rare and most desirable talents of a keen intellect with the ability to comprehend and act on the larger issues, challenges and opportunities along with an appreciation for the importance of detail.
The challenges and opportunities all of us in optometric education will face during Dr. Lewis’ tenure as president are numerous.
We will see a lessening of our dependency upon campus-based facilities for the clinical education of students. Perhaps initially driven by economic considerations, the greater diversity of educational experiences provided by externships will increase pressure for more community-based training sites. The New England College of Optometry maintains a leadership role in the development and management of community-based sites and is already meeting this challenge.
College based clinics will play a significant role, however, as faculty practice becomes more important as a means for enhancing faculty income and improving our ability to recruit and retain highly qualified clinicians.
We will see a movement away from traditional classroom teaching toward more technology assisted self-learning through the rapid advances being made in communications and computer-based technology.
There will be an increased recognition that the function of a school or college of optometry is to prepare graduates for a lifetime of learning. We will redefine the entry-level attributes of our students and modify our curriculum to emphasize a lifelong commitment to learning. Students will learn to commit to a philosophy that emphasizes the acquisition of knowledge over mere information absorption and memorization.
We will recognize our responsibility to expose our students to a wide variety of practice opportunities.
We must also be prepared to offer meaningful advanced competency education to practicing optometrists as a core value of institutions of optometric education.
And, we must be ready to assist our faculty in adapting their teaching strategies to reflect this new paradigm.
And, finally we must find ways to reduce the level of indebtedness students face upon graduation, perhaps by controlling tuition increases and by providing increased scholarship support.
I also believe that the future direction of optometry will be fueled more than ever by the economics of the managed care marketplace. Quality assurance programs, appropriate advanced competency certifications and accreditation of clinical facilities will become increasingly important.
Consultation among professionals and the national academic eye centers of excellence will take advantage of advanced technology to become a standard practice. Precise retinal images and other data will be instantly transmitted from one point to another in real time.
We will see the development and utilization of a national faculty in several disciplines linked through developing technology. Schools and colleges of optometry will be able to access a faculty of our finest educators.
In such an environment, made possible by advances in technology and made necessary by economic imperative to be as efficient as possible, there will be unprecedented pressures to work together in a cooperative spirit. In this environment Dr. Alan Lewis, who has earned the respect and admiration of his peers will be indispensable as a leader.
I am confident that his contributions to the College, optometric education and the profession will be numerous and his leadership exceptional.
I pledge to Dr. Lewis my personal support and that of his fellow Deans and Presidents of Schools and Colleges of Optometry, and I wish him continued success as the President of The New England College of Optometry.
Thank you.
Alumni Matters – Summer 2000
Illinois College of Optometry
Charles F. Mullen O.D.
Three years have passed since Charles F. Mullen, O.D. assumed the presidency of the Illinois College of Optometry (ICO), the oldest and largest educational facility dedicated solely to the teaching of optometrists. This fall, ICO concludes its year-long celebration of its 125th anniversary. In response to the Editor’s questions, Dr. Mullen shares his responsibilities at ICO, his objectives for the college, and to what degree they have been achieved. He also discusses the future direction of ICO, optometric education, and the profession of optometry.
Why did you accept the position of President of the Illinois College of Optometry?
Given ICO’s historical position of prominence within optometric education, I was concerned when I learned of the difficulties the college was experiencing in 1996. I believed these difficulties had the potential to harm not only ICO, but possibly even the profession of optometry itself. When approached by the Search Committee, I felt a responsibility to my profession of thirty years to interview for the position. Since I had extensive experience in health care management and clinical education, I felt confident that with the support of the Board of Trustees, faculty, and staff, we could redirect the resources and energies of the college toward programmatic improvements and that in a fairly short time we could create an institutional culture in which faculty, staff, and students were positively engaged in strengthening the institution.
The interview process for the presidency began in the summer of 1996. I met with the faculty. The faculty provided anonymous evaluations of my potential as ICO’s new president. The returns were favorable. By November, I was commuting between Washington, D.C. and Chicago. In December 1996, I assumed the presidency of the Illinois College of Optometry.
What were your expectations and initial objectives when you arrived at ICO?
Although I found there was an understandable sense of uncertainty regarding the immediate future of the College, morale was surprisingly good. It was my perspective that faculty and staff were not only willing, but eager, to “right the ship” and to positively engage in strengthening and improving the institution. I felt confident I could immediately assemble a capable administrative team from the existing faculty and staff.
My initial objectives included:
I believed that it was vital that our planning process promote open avenues of dialog with internal and external constituencies. I knew from my PCO experiences that each graduate of ICO is important to the college. I needed their perspective, but – even more importantly – I had to make them part of the decision-making process. I commissioned a survey of alumni/alumnae needs and concerns that not only had an immediate impact on our strategic planning, but led to the creation of ongoing communication channels that continue to affect our strategic planning. One very dramatic outcome of alumni input was ICO’s recent decision to freeze tuition, increase scholarship funding, and reduce the entering class size.
We also brought the broader community into the planning process. The Illinois Eye Institute had a long and well-recognized record of serving the community and we wanted to be even better neighbors. We appointed a Community Advisory Board (CAB). This Board includes leaders of neighborhood organizations, school principals, representatives of government agencies serving the community, clergymen, and members of ICO’s senior administration. We deal with various issues of mutual interest to ICO and the community, such as employment opportunities, construction projects, real estate transactions, and minority student recruitment.
It was now our task to channel these processes into a tangible plan of action. With input generated through countless meetings, reviews, evaluations, and reevaluations, we created a 70-page document, the Prescription for Excellence. It contains five major goals, each with detailed, quantifiable action steps and completion dates. Thee action steps also identified the department responsible for their implementation. Regular monthly meetings were scheduled to evaluate our progress. These meetings – which continue today – are open to all members of the ICO community.
The Prescription for Excellence was immediately effective. The goals and directions we established continue to be important, but even more important is the process we created whereby each member of every ICO constituency has the opportunity to be meaningfully involved in the planning process. The Prescription for Excellence is now in its second generation, as the Journey to Excellence.
Several important themes emerged during the planning process that have helped created a new culture at ICO. Through the planning process, five major goals were crystallized:
These goals are now the basis for the performance agreements that exist between every member of senior administration and the President, as well as an agreement between the Board of Trustees and the President. These agreements are what each of us is measured by; they are the basis for budgeting and for departmental planning.
What progress have you made in addressing your objectives and have your expectations been met?
Strategic planning has been very successful at ICO and not just by our own measurement. Nearly 70% of the initial action items contained in the original plan have been completed. The following are all the direct outgrowth of ICO’s planning process:
I can honestly say that my expectations have been greatly exceeded. I attribute this to the dedication, hard work, and perseverance of ICO’s Board of Trustees, faculty, staff, and student leadership for their support and willingness to adjust to my management style.
I am very proud of our affiliation with the Department of Ophthalmology and Visual Sciences at the University of Chicago. It came about, in part, as a result of the account of my earlier experiences with cooperative efforts between optometry and ophthalmology that had appeared in Archives of Ophthalmology. Terrance Ernest, M.D., Ph.D., chairman of the Department of Ophthalmology and Visual Sciences at the University of Chicago, had read the article I co-authored with Myron Yanoff, M.D. in 1990 on the affiliation between Hahnemann University and PCO. Dr. Ernest believes – as I do – that there is tremendous potential for further cooperation between optometry and ophthalmology. Now that I was at ICO, Dr. Ernest approached me with the possibility of a similar agreement with the University of Chicago. The proposed affiliation quickly became part of our planning process. In October 1997, Dr. Ernest and I signed the affiliation agreement as one event of my inaugural-week activities. The affiliation continues to be highly successful as the relationship expands and new elements are added to the basic agreement.
What is the future direction of ICO, optometric education, and the profession of optometry?
Although in retrospect I believe I may have underestimated the complexity of the issues facing optometric education when I assumed the presidency of ICO, I remain as optimistic of the future as I did on my arrival. But I do see changes ahead for ICO and optometric education. Indeed, my optimism is grounded in the belief these changes are not only necessary, but inevitable. I believe for ICO to continue to excel, we must:
The challenges facing ICO – to a greater or lesser extent – are the same issues that face many of the schools and colleges of optometry. In general, I see the following trends in optometric education:
We live, learn, teach, and practice in tremendously exciting times. I believe the future of optometry is as great as our ability to translate our vision for the profession into strategic and tactical plans of action – and as promising as our courage and tenacity to implement those plans.
Charles F. Mullen, O.D.
Journal of the American Optometric Association.
September 1999. Volume 70. Number 9.