Mastering efficient exam flow can prove difficult for many new student clinicians. This article will provide insight into how to effectively prepare for your patient encounters to make your exams run more smoothly.
Patient encounters can start as soon as the second year in optometry school, which may seem overwhelming in the midst of academic demands and personal goals. Nevertheless, it’s important to remember that this is a very important milestone on your journey to earning your title of optometric physician!
Being face-to-face with real patients (yes, the ones you read about in those case examples in class) makes everything you've been working for seem attainable and within reach. It helps you connect the dots between your didactic coursework and real-life ocular conditions. The primary goal is to maximize your time and your patient’s time while they’re in your exam chair.
Here, you will learn effective ways to prepare for your patient’s arrival and important things to consider before and after your exam.
Setting yourself up for success with patient encounters
There are three things you should do the day before the encounter to ensure you are ready when the time comes to see your first patient.
1. Check your schedule.
How many patients will you see that day? What types of exams will you be performing? Are you primarily seeing pediatric patients or adults? Are these appointments mainly follow-ups for glaucoma or red eyes? Or are they routine exams?
These questions will help gauge how much time you will be spending with your patient and what you need to do beforehand to make the most efficient use of your time. Depending on your school, your attending doctor may assign patients to you; however, it’s always a good idea to skim through each patient’s chart in your cohort in case anything changes.
2. If needed, gather the necessary instruments and materials for your exam.
Having to run out and grab additional supplies in the middle of your exam can hinder your flow and efficiency. Take a look at the type of exam you’re performing and prepare accordingly.
For example, if there is a contact lens fit scheduled, grab the patient’s trial contact lenses and lens flippers for over-refraction. If you’re seeing a child that can’t sit behind the phoropter—which includes most children under 5 years old—you may need your retinoscope, skiascopy bars, and an engaging fixation target(s) at the ready.
3. Make sure your exam lane is prepared.
Having 2 to 3 minutes of prep time before the patient is in your chair can make a huge difference in exam flow. Adjust your slit lamp oculars to your desired distance and make sure everything that will contact the patient is disinfected.
Also, if your patient has an existing glasses prescription in the system, dial the numbers into the phoropter before you pick up your patient. This will save you from what feels like an eternity of awkward silence!
Download the Self Evaluation for Patient Encounters Cheat Sheet here!
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Self Evaluation for Patient Encounters Cheat Sheet
This self-evaluation form was designed to help optometry students practice and reflect on the assessment criteria of the patient encounter portion of the NBEO Part III PEPS exam.
2 tips for the day of the encounter
On the day of the encounter, it is important to give yourself time to breathe, mentally prepare yourself, and make certain you are making the right first impression.
1. Arrive early to talk to your preceptor about any additional elements of the exam.
Often, your preceptor will have extra tidbits of information to share with you regarding your upcoming exam, especially if they’ve seen the patient before. Let them know beforehand what you plan to accomplish in the exam and if they have any suggestions.
Don’t forget to ask questions—remember that this is a learning experience, and they are there to help you through any challenging situations you may encounter.
2. Make the mirror your friend.
Too many times, I’d find my nametag rotated 90°, my white coat collar turned up, and food stuck in my teeth from lunch before an exam. Take 10 seconds to be sure you look professional and equipped to take care of your patients.
5 steps for acing the actual patient encounter
Follow the five pieces of advice below to improve your chances of having an extraordinary encounter and enhancing your skills.
1. When picking up your patient, try your best to gauge what mood they're in.
Emotional intelligence is very important when interacting with multiple patients per day. Studies show that today’s students and new physicians are more concerned with the technical aspects of their profession than the emotional aspects.1
This can sometimes do more harm than good when it comes to empathy and patient care. As expected, all individuals will have different personalities and moods at the time of their visit with you. It’s important to be mindful of verbal and non-verbal cues and adjust to each scenario.
It’s also important to remember that you are not responsible for your patient’s grumpy or awkward mood. Getting comfortable with extended periods of silence or rude and snarky comments from patients is all a part of the process.
2. Continue your case history throughout the entire exam.
The case history is one of the most important aspects of an exam, and it never stops! Be sure to figure out the main reason for the patient’s visit and continue to ask questions as your findings grow to come to the most accurate diagnosis.
Even if patients deny certain aspects of their ocular history (e.g., previous ocular trauma or eye surgery), it is fine to double back and repeat questions later in the exam, or even ask the question in a different way.
3. Keep your chart updated.
Your preceptor will usually keep up with your exam with the information you put in the chart. Having a checkpoint system to document findings is a great way to keep track without having abrupt stops during your exam.
- Checkpoint 1: After case history, entrance testing, and refraction
- Checkpoint 2: After slit lamp exam
- Checkpoint 3: After your dilated fundus exam (if applicable)
Any additional information can be added at any time.
When patients’ eyes need to be dilated for the encounter, exams tend to flow more efficiently the sooner the drops go in. Therefore it may be useful to chart after the patient’s eyes have been dilated but before the dilated fundus examination (DFE) itself.
4. Be confident when presenting to your preceptor.
Attending doctors appreciate confidence in students, even if you are not sure of some of your findings. They want to see that you are applying your knowledge and improving your clinical decision-making. Be sure to present your findings in a concise and organized fashion.
Here are other ways to engage in conversation with your preceptor:
- Give your differential diagnoses for the case.
- Try not to include every single detail in your presentation. Instead of stating the entire manifest refraction, tell your attending how much the refraction changed from last year.
- Instead of cycling through every anterior and posterior segment finding one-by-one, let your preceptor know of any abnormal findings.
- If you’re unsure of a particular clinical finding, try your best to describe what you’re seeing.
- Ask them about techniques for any skills you may struggle with (e.g., scleral depression, gonioscopy, blood pressure measurement). All doctors have different ways of doing things, and it may prove beneficial to you to familiarize yourself with a different approach.
- Listen to your preceptor’s patient education. Some attending doctors will expect you to begin educating patients after you’ve had some experience, so it is beneficial to hear the rapport between them and the patient.
- Make note of how specific conditions are described, as it’s important to convey complex ocular conditions in simple terms for patients, often using analogies or metaphors.
5. Reflect on ways you can improve your future exams.
A small habit that helped me in the long run was using reference materials like class notes and textbooks to research different conditions I encountered in clinic. This helped me solidify information I already knew about the condition as well as refresh my memory on smaller details I’d forgotten.
Try your best to set intentions for each exam; doing a faster refraction, spotting more findings in the eye, or simply getting clearer views with your 90-diopter lens are small examples of goals to set for yourself.
Reflect on the good things you did as well! Though there are aspects to improve on, be proud of the things you did right and work hard to stay consistent.
To help with the self reflection portion of the encounter, we have developed a DOWNLOADABLE CHEAT SHEET based on the assessment criteria of the patient encounter portion of the NBEO Part III PEPS exam.
In conclusion
As a student clinician, you will make more mistakes than you are comfortable with; however, this is the best time to make those mistakes! These setbacks are integral to your growth and development as a Doctor of Optometry.
In your corner are intelligent professors and physicians who want to give their time to help you be successful. All you must do is apply yourself and improve daily, and you’ll be on your way to becoming a confident doctor.
