The third year in optometry school is one of the most exciting times for students. The grueling work of 2nd year has passed, VOSH trips take place, and schedules become more flexible as students gear up for the mammoth NBEO part 1 exam. This is also a time when students are brainstorming and selecting their final year clinical externship sites.
In this article we’ll dive into the clinical externship selection process and how to go about choosing sites that best suit you. We’ll also discuss some other factors to consider when deciding how you’ll spend your final year in optometry school.
Final Year Externships
There are myriad reasons fourth year externship rotations are an exciting time for students. This is the chapter in optometry school where the rubber hits the road, as students transition to clinic full time. After spending countless hours studying for exams, labs, proficiencies and boards, the final year externships provide the opportunity to bring all the didactic coursework into the real clinic world as students see patients and build their clinical tool box. As students know, learning about a particular ocular disease or condition for an exam is only part of the process. Seeing clinical cases of real patients in a supervised setting provides a unique learning opportunity that is not possible in the classroom alone.
Towards the end of third year, students will be required to review and rank their top choices for 4th year externship sites, one site per season. Externship sites are typically broken down by category (eg. ocular disease, primary care, contact lens/specialty, etc). Students will be required to select and rank several choices per rotation, however, most do end up getting a few of their top choices.
Students will typically have access to in-depth descriptions of each potential externship site, as well as preceptor contact information to help answer any questions they have. Students can also network and discuss prior clinical experiences with recent grads in the class above them. Having conversations with other colleagues can be a great way to further narrow down the task of site ranking and facilitate the decision making process.
What questions should I ask about optometry externship sites?
- What type of practice modality would you consider this site?
- What types of patients will I see?
- What is the main thing I’ll learn there?
- How many hours/week are students in clinic?
- What are my housing options?
- Do I need a car?
- Are there multiple clinic locations?
- Will it be it easy to get time off for that wedding/trip/board exam?
- Any advice on preparing for this particular rotation?
Things to Consider When Selecting Your Sites
Setting proper goals and expectations
Students should focus on aligning their professional goals with the clinical experiences they’ll walk away with after each externship, and rank their sites as such. While it can be tempting to choose rotations in Beverly Hills or Miami for the parties and celebrities, students should prioritize their clinical education over their status on social media.
Students should choose sites with the expectation that they will be challenged during each rotation. Some rotations may give students more autonomy and independence while others provide closer oversight from preceptors. This may be a factor to consider.
Being aware of the particular patient demographic at each site is also important. For instance, a private practice that sees predominantly pediatric and specialty contact lens patients may not provide the best clinical experience for students looking to build a strong ocular disease knowledge base. Ranking sites that align with your future career goals is crucial.
Students can also use their externships to help further elucidate whether or not they’d like to pursue additional residency training after graduation. For example, those contemplating an ocular disease residency will be pleased to see abundant opportunities for rotations through a VA or IHS hospital as a 4th-year student. For students who seek to pursue a residency, final year rotations can provide great opportunities for networking with preceptors, and visiting/applying/interviewing at various programs of interest.
Students should choose externship sites that “test the waters” for residency during the early rotations (eg. Summer and Fall) to provide ample time for contemplation, submitting applications, and interviewing.
Some students already have a good idea of which optometric niche they’d like to pursue after graduation/residency and will tailor their externships accordingly. Other students may remain uncertain. Students should also remember that while a certain clinical focus within optometry may not be their primary interest, they could still benefit from choosing an externship in that niche. For instance, students who may be set for rural private practice after graduation may benefit from one or several ocular disease rotations, as referring patients out in their area may be logistically more difficult.
Some schools will offer externship sites that offer somewhat of a rapid-fire immersion experience. These rotations expose students to myriad niches within the profession (eg. low vision, pediatrics, and vision therapy) all in one externship. For various reasons, some externship rotations may even be 6 months in duration, another potential factor to consider.
It is also important to remember that after graduation, most new grad ODs will continue to have myriad clinical/professional opportunities (whether or not they pursue a residency). Most optometrists do tend to change career settings several times before landing on their long-term “dream” career path. Knowing this may help avoid overcomplicating things and take some of the pressure off of choosing the “perfect” externship site for each rotation.
Location, Location, Location
Final year rotations can be a unique opportunity to travel and see different parts of the country (or world!) while also providing further clinical exposure to certain areas of interest in optometry. Whether you want to travel to China or Alaska, or stay local with friends and family, final year externships make for a great opportunity to explore while also showing students what practice modalities could best suit their career goals. It is not uncommon for some students to stay local for various personal reasons. Given the robust network of externship sites that most schools have vetted, students can rely on a quality 4th-year experience, regardless of where their sites are.
This is also the time during optometry school where students may need to coordinate having a vehicle or access to transportation. While some urban settings may provide public transportation, students should anticipate having access to a vehicle at some point during their final year rotations.
While students are off completing their rotations, life is still happening outside of the exam room. Being upfront with expected time off is important before beginning each externship rotation. For example, students who are planning to attend their best friend’s wedding across the country should notify their preceptors of their expectations ASAP.
Students will also be taking parts 2 and 3 of the NBEO exam during their final year externships as well. Taking clinic time off for these exams is important to coordinate with preceptors. While this shouldn’t necessarily dictate what sites to choose, studying for boards should remain a priority as students transition into 4th-year rotations. The beauty of these exams is that they can be scheduled at a time convenient for students’ schedules (unlike part 1 NBEO).
Creating Your Own Site
Students can also approach their academic leadership and propose adding new externship sites when applicable, especially if their school has limited site affiliations in a particular category. For instance, maybe a student’s hometown optometrist has a large specialty contact lens practice and already has students from other OD schools rotate there. In this case, it may be relatively easy to have their school also become affiliated with this office as well. For various reasons, externship sites are dynamic and may change from year to year. This may work to students’ advantage in proposing new externship locations that fall into certain clinical categories desired by the school.
Things to Consider During Your Externship Rotations
Personal or Clinical Goals
Students should consider one or several goals they’d like to accomplish during each externship experience. Whether it's to improve their scleral depression technique, patient education skills, or optimizing exam efficiency, having a list of goals going into final year rotations will help students better select and rank their sites. These goals are also likely subject to change and evolve throughout their externships and that is ok.
Students should expect personal interests and hobbies to take a back seat during their externship rotations. However, this is not to say that some work/life balance isn’t necessary despite how hectic things get during your final year. It is important to allow time to unplug and recharge (not to mention study for parts 2 and 3 of the NBEO exam!) during externships.
Students will benefit from creating a consistent routine soon after settling into each rotation. Having the discipline to allocate each hour/day/week to a specific task will ensure students stay on course with their clinical education while also allowing time to somewhat balance social life and hobbies outside of optometry.
Preparing for your next site
If possible, students should try and prepare themselves for their next rotation in advance. Understanding clinical expectations and preparing accordingly is crucial. Whether it's a particular set of articles, studies, or a textbook that students use to prepare for a site, knowing this in advance will help incoming students hit the ground running.
Also understanding various non-clinical things like preceptor personalities, work schedules, and time-off policies may also help students better transition into each externship rotation as well.
While it may be tempting to splurge and explore the sights and sounds of each new location, students should resist the urge. In addition to tuition and typical costs of living, students will also be required to allocate funds for study materials, potential travel/lodging, and exam fees for parts 2 and 3 NBEO exams.
Making the most of each experience
Students should take full advantage of what each rotation has to offer and should never be afraid to speak up if they are uncertain about a clinical technique, diagnosis, or treatment. Now is the time to make mistakes and build confidence as part of the learning experience.
During their rotations, students may also have access to leaders in optometry, ophthalmology, and/or research and should seize the opportunity to learn from them. Students may also have the opportunity to observe in various other clinical and surgical settings such as retina or neuro-ophthalmology and should take full advantage of these moments as well.
Final year rotations are a time in each student’s academic journey where they must build the confidence necessary to become a doctor of optometry, ultimately making clinical decisions and managing patients on their own (in less than 12 months!). As students are choosing their sites (after much deliberation and research!) it’s important to remember that regardless of where they end up, they’re going to have a unique and diverse clinical experience.
While final year rotations play an integral role in students’ transition to clinicians, it is one of many stepping stones in the journey of life-long learning within the optometric profession.