Ngaio Crequer talks to four academics about how the National Health Service reforms are affecting their daily work of training students, and finds them largely enthusiastic about the links between practice and ÖйúAƬ.

Lesley Wright is well-qualified to consider the benefits of teaching para-medical subjects in the universities.

She was trained as an orthoptist in Glasgow in the 1960s, worked there when it was NHS-based, and in London at St Thomas' Hospital.

She has spent time in industry, in graphic design, and has worked in providing eye health care in the community.

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Now a senior lecturer in orthoptics at Glasgow Caledonian University she has seen many changes in the way the subject is taught.

"I trained in the NHS and there were tremendous benefits, especially being able to see patients all the time.

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"On the other hand, students going through the university system acquire extra knowledge, and that is of enormous value. No job is now forever, and the more you know, the more opportunities are going to be open. But at the same time, students need practical skills."

Orthoptics is the investigation, diagnosis and treatment of squint and anomalies of vision, ocular motility (eye movement) and binocular vision (the use of the eyes together). In the degree course offered by the university's department of vision sciences, students are required to spend a minimum of 30 weeks during the three-year period on clinical placements.

"That is the problem, trying to balance the clinical against the theoretical. They can come out with a huge amount of knowledge but not be able to relate it to actual problems when it comes to everyday orthoptic practice."

There are only about 1,000 practices in the United Kingdom. "Many of the jobs are part-time. The practices are small and lots of people work single-handed. This means that they could go out and work single-handed as soon as they qualify. It is a big worry for the profession."

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One source of conflict identified by Dr Wright is the question of who should be the ultimate arbiter of standards. The Council for Professions Supplementary to Medicine is the statutory regulatory body, and validates the course. But the course is also subject to the university's own validating procedures.

"I think it is difficult to get the balance right. When I changed the course to a modular one the council wanted to revalidate it. They feel they should have complete power and the university feels it should have responsibility. It is a difficult issue of balancing the educational and clinical input."

Because the profession is a small one, it is often difficult to find clinical placements for students, and 75 per cent have to go south to England to find a venue. "It would be nice if we did not have to work within the university's semester system. It would be easier if we could place them throughout the year, instead of in a 12-week block period," Dr Wright says.

She is concerned also at the attitude displayed by the health trusts. "I think the trusts do not see their role in education in the way the NHS used to. They are far more money-oriented. If they are going to help with the education of our students, they want paying for it. They are going to purchase the most number of squint operations at the cheapest price.

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"They are interested in charters, logos, corporate identities, bits of paper on the wall, rather than patient care. We can educate students in the universities but in the end they are going to work for the trusts. The trusts therefore have to carry some responsibility for making them clinically competent. They ought to have an education budget and look seriously at this issue. Otherwise our students will not be able to fulfil the criteria the hospital is looking for."