After years of academic dedication and early clinical training, the optometry student’s journey culminates in a series of final-year externships, designed to challenge knowledge and hone clinical skills.
Here’s how to make the most of this unique opportunity.
1. Be the consummate professional
An extern’s behavior and demeanor are just as important as their clinical skills. As is true with any physician, maintaining a professional reputation and providing compassionate care is critical to success. As a final-year extern, you are now a representative of the entire optometric profession.
Guidelines for making a professional impression:
Prior to beginning your externship:
- Before your first day, verify the correct location, parking details, equipment requirements, and dress code for each site.
- Complete any required location-specific training and onboarding tasks well in advance of your start date.
During your externship:
- Be on time or preferably early, every day. Being punctual goes a long way.
- Be unfailingly honest: Medical errors contribute to increased healthcare costs, patient disability, erosion of trust in providers, and are the third leading cause of death in the United States.1,2
- Externs are human and make mistakes, but in healthcare, transparency and disclosure of errors are critical to avoid escalating problems.
2. Refine your interpersonal skills
Your interpersonal skills will shape interactions between yourself and everyone you encounter. You should treat preceptors, patients, and office/clinical staff with respect. Do not disparage patients or staff for any reason.
Avoid getting involved in office drama or politics, and do not get personally involved with fellow employees outside of the office to maintain a positive workplace environment.3,4 This goes for patients as well; maintaining an appropriate boundary with patients is a pillar of healthcare professionalism.5
An extern should also commit to cultural competency by being sensitive towards patient populations with different beliefs and behaviors, as not doing so can contribute to further healthcare disparities.6,7
This may involve ensuring the patient can understand your exam findings despite a language barrier, asking about a patient’s beliefs to try to accommodate them in your treatment plans, or simply being respectful of behaviors and attitudes different from your own. Most, if not all, healthcare settings are required to provide language interpretation services when necessary.
Throughout your externships, keep a positive, humble, and curious attitude. Remember, even “failures” or bad experiences can advance learning and provide opportunities for growth.
3. Keep an open mind
One of the advantages of rotating through different clinics is to be exposed to a variety of approaches to patient flow, clinical decision-making, and treatment options. Real-world practice can be quite different from what is taught at optometry school, and the best students will compare differing approaches to patient care to help shape how they practice in the future.
Avoiding bias is important as well. For example, forming opinions on contact lens brands too early (based on relatively little clinical experience) is a disservice to future patients who may benefit from other options. Unless a preceptor feels strongly otherwise, try to fit a variety of contact lens brands and modalities throughout this year to better understand the fitting principles and features of each lens.
Remember that the lowest levels of clinical evidence include opinions and case reports.8 It’s always best to accumulate as much evidence as possible prior to assuming any treatment superiority.
4. Ask questions, but also do your research
Don’t be afraid to ask questions, particularly when they involve thought processes beyond basic management and treatment. However, asking a preceptor every question that arises is an unsustainable habit that will not be possible after graduation.
Lifelong learning is required of all physicians, and externships are the perfect opportunity to embrace evidence-based practice. Find good sources of high-level evidence to reference when a clinical question arises, then ask your preceptor for clarification or advice once you better understand the condition and the research supporting it.
5. Identify and attack your weaknesses
Be proactive in finding your weaknesses, and don’t be afraid to try new or difficult things. While it’s normal to not enjoy certain optometric sub-specialties, it’s still important to get a well-rounded education. For example, some externs dislike seeing pediatric patients, but rather than avoiding these exams, seek them out to boost your confidence and comfort level in this age group.
If there isn’t enough variety in the externship sites assigned, it may be possible to get additional experience by shadowing other practitioners in or near the rotation site. Many preceptors have connections with local ophthalmologists or optometrists in other specialties and can help arrange a few days of shadowing.
This is particularly useful if you haven’t yet observed common ophthalmic surgeries, low vision exams, or other experiences that your sites are otherwise unable to provide. If private practice and/or future business ownership is of interest, learning about the non-clinical details of practice management can be very valuable. These can include billing and coding practices, hiring or training staff, and managing the optical dispensary.
Practice owners and managers are often happy to discuss their challenges and tips regarding the business end of optometry. If there is clinical downtime, offering to help in the dispensary or at the front desk can provide insights likely not found in the optometry school curriculum.
6. Shift your focus forward
Between seeing patients, completing research assignments and case presentations, and studying for boards, externs typically stay very busy. When possible, it is still worth finding some time to work on future career goals and opportunities.
Using this year to build your professional network can pay significant dividends in the long run. Many of your future colleagues and ophthalmic associates can provide information, advice, and references for future jobs, which may include clinical employment or even potential publication, consulting, or other opportunities.
Networking with contact lens, pharmaceutical, and equipment representatives, along with paraoptometric associates and other healthcare professionals, may prove to be beneficial as well. A residency provides advanced clinical experience, but it is also an excellent way to form deeper connections within the optometric community and should be strongly considered.
A study by the Federal Reserve Bank of St. Louis found that employees find jobs faster through networking and experience better job quality, more job satisfaction, and higher wage growth.9
Lastly, enjoy it!
This year will go fast, so try to enjoy the camaraderie of educators and fellow students, and the personal fulfillment that advanced education can provide.
After all, the end of your academic training is only the start of the exciting optometric journey that lies ahead.
