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How do 4th year extern rotations work?

This is a question I get a lot from prospective students. When you're just beginning optometry school, 4th year and clinical rotations seem so far away. It's hard to think past all the course work at the very beginning and to picture yourself seeing patients in a private practice somewhere as a 4th year. But the first three years flew by and now my class is spread out all over the country applying their clinical skills in a real-world setting. It's an exciting time and it makes graduation and becoming licensed optometrists not seem so far away anymore! I'll summarize how these rotations work and how the site selection process is set up. There is a lot that goes into it and the process can be a little complicated at times, but it is all worth it when you finally make it to that first rotation and start to really feel like an eye doctor. :-)

Fourth year at SCO is divided into the three regular semesters - summer, fall, and spring. Our rotations each last one full semester so fourth year is made up of three rotations that are about four months long each. Of these three rotations, one of them has to be in-house at The Eye Center at SCO, one has to be in a private practice setting, and one has to be in an institutional or more "hospital-based" setting. This gives us experience in three different settings so that we can experience them all firsthand to see what setting feels like the best fit for us. The three rotations can go in any order, and of course only one third of the class is on campus for their SCO rotation at a time.

So how does the selection process work? At the beginning of our third year we are provided with a list of sites. As I mentioned before, these sites are all over the country. We then get a few weeks to look into the sites we might be interested in, to read reviews from former students who rotated through those sites, and to decide when and where we would like to go. Some people choose to go to sites in their home state or in the state they plan to practice in, some go to cities they simply want to spend four months living in, and some choose to stay local in the Memphis area for the full year (there are plenty of options in Memphis). Then, the selection process begins. Students are given home state priority first (if you're from Texas, you get first dibs for the Texas sites), then class rank priority kicks in. So if you want a site in a state you aren't from but you're #1 in the class, you'll be next in line after the people from that state. Everybody tries to communicate and work together during this process so that people end up knowing if they will likely be matched with their first choice or not. We then submit our top 3 choices for each rotation and we find out a couple weeks later where we were placed.

My husband and I decided to stay in the Memphis area for our rotations so that we could be more flexible in terms of site and semester selection and not have to be apart right after getting married. I ended up choosing SCO in the summer, Leroy Norton Jr. Family Vision Center (private practice) in the fall, and Olive Branch Eye Care/Charles Retina (institutional) in the spring. Ben chose the Memphis VAMC (institutional) in the summer, Eyecare East (private practice) in the fall, and SCO in the spring. It's been fun being at different places and comparing our experiences so far. Every site is different and provides a different experience for the student, which is why the selection process is so important.

I hope this clears it up a little bit for any prospective students who may be reading this! Externships are a great experience and are so important in building our confidence and clinical skills and in helping us find the right fit for us professionally. I'm learning so much every day at my private practice site (I wrote a post specifically about it in September, you should be able to find it by scrolling down if you're interested!).

Thanks for reading and feel free to comment if you have any questions! Happy Thursday!

at 10/13/16 | 0 comments

Externship plans? Already?

Well, I’ve had two Pumpkin Spice Lattes, but it hardly feels like fall around here! Hopefully soon! I just finished my third week of fall semester and I’m really enjoying it so far. Summer semester was overwhelming, but it thankfully wrapped up nicely and easily.

One of the most exciting (also really stressful!) things to happen at the end of last semester was the finalization of our externship assignments. It is so bizarre for me to think that we only have two semesters left before fourth year, but figuring out our plans for next year definitely made it all much more real.

For those of you who don’t know, your fourth year consists of 3 rotations at different sites, each being 4 months long. One of them is required to be at The Eye Center, one has to be at a private practice, and one has to be at an institution. I will be doing SCO during the summer, a private practice in Pennsylvania (my home state) in the fall, and then the Air Force Academy in Colorado Springs for my spring institution site. I am so excited to have gotten these sites and am thankful that I will get to finish out my schooling in these wonderful locations.

I can’t speak for all of my classmates, but I was lucky enough to get all of my top sites in my preferred semesters, and I think a lot of others were the same way. There weren’t options in every state or area, but there were a lot of different options. The externship office was also willing to let me set up my own site in PA, which is what I eventually ended up doing. You are given preference for your home state, so I was also lucky in the fact that I don’t have anyone else in my home state to compete with for sites here. There aren’t any Colorado students from my class either, so I didn’t really have to fight anyone for the Air Force site, either. That being said, I know that some of the students that wanted the very popular sites were able to work it out between them, and I think the process ended up going smoothly. It was stressful to wait to hear about final decisions, but I think the externship office does a good job overall of making sure everything is fair.

Well, that’s a very long-winded explanation of the externship process! I hope I didn’t make it too confusing for any of you. It’s crazy for me to think that I will be done with my time in Memphis by next fall, but I’m looking forward to all of the challenges and milestones ahead. Now, I think I’ve earned myself another PSL :)

at 9/21/16 | 0 comments

The first few days of my private practice rotation!

Good morning, readers! I hope everyone had a great Labor Day weekend.

I started my private practice externship rotation two weeks ago and just wanted to update all of you on how it's going and how it compares to my internship at The Eye Center. As I mentioned in a previous post, my husband and I decided to stay local in the Memphis area for our externships. I'll be spending the fall semester at Dr. Leroy Norton's private practice in south Memphis. Every private practice site is a little different depending on the specific office or the doctor, so the experience can vary from student to student. Dr. Norton actually practices in a similar way to how we see patients at SCO so the transition is going smoothly for me so far. The main difference is the volume of patients I am seeing each day. At SCO over the summer, I was seeing about 3-6 patients in a day. On my very first day working with Dr. Norton I saw 20! Just like when I was at SCO, I am still doing every part of the exam myself. There are no pre-testing technicians at Dr. Norton's office, there is no auto-refractor or NCT, and we dilate every patient. I love this about this site because it's helping me really reinforce my technical skills while also making me more efficient. At some private practice sites, the extern actually has their own schedule of patients for the day and maybe even their own exam room. Dr. Norton runs his externship a little bit differently: Dr. Norton and I work as a team on the same schedule. For example, we'll both start an exam at the same time. Sometime during the exam I'll step out of my exam room and we'll briefly discuss our findings with each other, then we'll either complete our own exam or switch patients for the remainder of the exam. This setup allows me to work with almost every patient on the schedule while also allowing me to participate in good clinical discussion with the doctor. At the end of the day, Dr. Norton and I sit down and briefly discuss every patient we saw that day. The discussions give me good insight into decision-making, how and why we chose the treatment plan that we did, and how certain things are managed in a private practice setting.

Once I began to feel comfortable with the equipment, computer system, and office itself, the transition started to go very smoothly for me. I love being busy all day and getting to use so many of my clinical skills on a regular basis. We see a lot of ocular and systemic disease, pre-op and post-op care, and comprehensive exams on a regular basis. Seeing 20+ patients on the schedule each day was a little scary at first, but I'm absolutely loving it and I'm learning so much every day! I'm looking forward to spending the rest of the semester at this site and I know I'll be a better clinician for it.

Soon it will be time for me to start preparing for Parts 2 and 3 of my National Boards, so I'll be sure to post an update on how that is going in a month or so! Thanks for reading and feel free to reply or message me if you have any questions about our 4th year externship rotations. Have a great weekend! -Lisa

at 9/8/16 | 0 comments

Still Discovering Optometry

Upon starting at SCO last fall I thought a lot about how involved I wanted to be while here. There were a lot of clubs and activities available outside of the classroom, but I wasn't sure how much I could actually handle. My first thought was, "Does anyone in their right mind even have time for all of this?!" After realizing that there was, indeed, life beyond the classroom, I started looking for ways to get involved. There were a few clubs I knew I wanted to be a part of such as OPP (private practice) and NORA (neuro rehabilitation) because of my interest in those areas. I also signed up for a few intramural teams which kept me both active and sane. I felt like I had a good handle on my schedule and things were going well. However, as the semester grew longer I realized that I was missing something that was very important to my education: perspective. In all honesty, it's very easy to get bogged down beneath the piles of new information, endless quizzes and tiring exam weeks of optometry school and forget the reason of why you went there in the first place. As I searched for ways to regain this perspective, I began to heavily consider applying for the Ambassador Program at SCO. A few things went through my mind over the weeks leading up to the application deadline. Cons: It requires extra hours away from home, It requires extra effort in addition to my current school (and work-study) work load, It is unpaid. Pros: Networking with various optometrists, professionals, and campus guests, Improving communication skills, Working with groups of prospective students, Educating others about optometry, and advocating on behalf of SCO. In a word, the pros could be summed up as "perspective". It was clear that this would be a great opportunity for me.

After applying and being accepted into the Ambassador Program, it didn't take long for me to see this perspective take effect. An example may be useful:

Near the end of June I was involved in Discover Optometry; a day-long event of introducing prospective students to the profession of optometry and SCO. It came during one of the busiest weeks of the mini term nicknamed the "2nd Year Bootcamp." Initially it seemed like a huge sacrifice to break away from studying for the several quizzes and tests we had the following week, but ultimately I found that it was just what I needed. Most of the campus guests were in the process of obtaining their undergraduate degree. Others came from different professions and were looking to see if optometry was a good fit for them. There was an extremely diverse group of students and their families in attendance from all over the country. After greeting the guests and answering questions over lunch, we gave tours of the campus and clinic and discussed all the aspects of the profession. Part of the tour included a brief clinical demonstration by a few faculty and students using the slitlamp. Participants were also able to attend two Q&A sessions with panels of current students and faculty who answered questions ranging from OAT prep to annual starting salary.

One of the main things that stood out to me after participating in this event was how fascinating everything was to those visiting. They asked a lot of questions about the different areas of care within optometry and were excited about the many modes of practice the profession offers. During the clinic tour they were amazed at the level of care the student interns were able to give. Shortly after the event, it occurred to me that it wasn't too long ago that I was the same wide-eyed prospective student that couldn't wait for the chance to work in the clinic at SCO one day. Discover Optometry was just one of the many activities that I've been involved in through the Ambassador Program and it has helped me remember why I love this profession so much. It's comforting to see others share the same passion I have and to work just as hard as I have to move the profession of optometry forward. I haven't once regretted the decision to become an Ambassador and it has been a privilege to share my love of optometry with others. With the new school year upon us I'm looking forward to helping with Orientation and meeting a whole new group of entering students to help give me that much needed perspective!

at 8/30/16 | 0 comments

The best way to learn is to...

...FAIL! I'm referring to my very first patient encounter in The Eye Center, about four months ago. I can still remember that morning very clearly. Three of my classmates and I were gathered around a computer, nervously waiting for our four morning patients to arrive. When the screen indicated that a patient was ready to go, my stomach dropped. I knew that I was going to take the first patient of the day and I got major butterflies in my stomach. It's not that I felt unprepared. SCO does an AMAZING job preparing students to succeed in clinic. It starts during your first year with countless hours in the lab learning and practicing the skills. It continues with RAM trips, SVOSH trips, exams for the homeless in your community, school screenings, and even more hours during second year practicing and refining your skills. I knew that I could perform well in the clinic, but because it was my first official patient of my 3rd year clinic experience, I was petrified.

I jumped into my case history and chair skills, before returning to report to my staff doctor. As I prepared to give my report and plan before beginning refraction and the ocular health exam I noted the time. I had been in there for a VERY long time! Looking back now, I had spent too much time talking with the patient and had lost control of the exam. After getting back on track, I began to proceed through the exam. My patient had significant health challenges which I had never seen before (most of my patient encounters in screenings/labs had been on healthy eyes). Although I knew, on paper, what I should be seeing or looking for, I was amazed at how different some of the findings looked. Besides being very slow, I was very confused by what I was seeing. Only after my staff doctor confirmed the findings did I realize that conditions and diseases can present in many different ways. In other words, there is NO TEXTBOOK PICTURE that can accurately represent what I will see in every patient. The only way I will get comfortable with diagnosing and treating my patients will be for me to see LOTS of eyes. That is why I am SO grateful I came to SCO. We have the largest eye clinic in the country and see hundreds of patients every day!

While I didn't really "fail" in that first patient encounter, I made tons of mistakes in my charting and my time efficiency was atrocious. Now, four months later, I have gotten faster and more confident in my charting ability. Thanks to the dozens of patient encounters I have had this semester (in The Eye Center and nursing homes around Memphis), I have gotten better at identifying abnormalities in the eye. I have gotten better at striking a balance in getting to know my patients and proceeding through the exam at a good pace. While I have improved, I still have many weaknesses which I will improve in the coming months. My clinic experience has been enjoyable, challenging, humbling, and encouraging. The staff doctors at SCO are wonderful! They are there because they want to help us become great doctors. Their advice and counsel has been the secret to making strides in the clinic. I can't wait to see what the next few months have in store!

at 8/22/16 | 0 comments