4th year optometry

[SMC123]

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I was wondering what the optometry clinicals are like 4th year? Are there anything such as being on call? What tasks are you doing while at work? Seems like most OD just kind of perscribe lenses and glasses.. ? How does it compare to medical school rotations?

 

[SMC123]

any thoughts? Would really like to know what an optometry may be doing that I may not know of...

 

[Shnurek]

I'm pretty sure all optometry schools require rotations through VA Hospitals so you'll have to do that. I'd say being on call for 4th year rotations is either non-existent or rare but I'm only answering you because no one else has and my knowledge is limited on this topic. For ocular disease residencies or when you are employed there are opportunities (or burdens) to be on-call.

Most students I believe do rotations in pediatrics, contact lenses (not just soft ones but fitting medically necessary hard lenses for people that have keratoconus or other forms of ectasia to hold their eye in shape for example), vision therapy to treat convergence insufficiency for example, ocular disease (diagnose and treat diseases of the eye by prescribing medications, conducting minor surgical procedures, referring out etc.)
Our school in particular has an area for traumatic brain injury and finally of course, general practice where a lot of what you do is fit people with soft contacts/glasses.

How does it compare to medical school rotations? Well there seems to be a lot less scut work and less arrogance in general but like I said this is just my guess. They are not as time intensive and obviously not as broad in what you learn. All the rotations are tailored to eye care vs. medical school rotations are tailored to the different specialties and more for general body health.

 

[aarlan]

What tasks are you doing while at work? Seems like most OD just kind of perscribe lenses and glasses.. ? How does it compare to medical school rotations?

My 4 rotations consisted of:

1. community health center, (exceptional number of glaucoma and diabetic patients...comanaged w/ ophthalmologist w/ glaucoma due to state restrictions). saw just about everything there, traumatic injuries, diabetic retinopathy, macular degen, infections, (even had to deal with a raging scabies infestation...not cool), etc.

2 and 3 . Both VA rotations, again mostly geriatric and an inordinate amount of ocular pathology. Glaucoma (No MDs at either clinic, all ODs), Diabetes, Macular degeneration, corneal issues galore, Uveitis, you name it we saw it. Learned what we could do vs what truly needed to be referred to specialists.

4. last rotation was a low vision (actually at yet another VA), primarily last resort stuff. Saw all the bad outcomes (failed RD surgeries, uncontrolled diabetic issues, end stage glaucoma, profound macular degeneration, etc). despite some very good care (MD and OD alike). This center had a working relation with the Eye clinic (OD AND OMD) and their residents.

Not sure where the "prescribe lenses and glasses" part from your post came from, at least in my case. actually, if I hadn't been and Optician for years prior to going back to school, I wouldn't be very good at the whole ctl and glasses thing. Optometry spends a profound amount of time on the medical eye care, and my rotations spent virtually NO time on lenses or glasses. I actually had an OD professor go so far as to tell me the reason that they don't spend as much time with the ophthalmic end of things as they did in years past was that you'll, "learn all that stuff on the job". Many OD schools in my opinion don't spend ENOUGH time on the ophthalmic optics and related subjects, since they spend the majority on the medical aspect of our training.


AA

 

[Colonel Mitchel]

My experience in my fourth year (and for some of my third year) was very similar to what Schnurek and Aarlan describe. Most of what we learned in class and did in clinic and on rotations was the "medical model." We did have a lot of specialty contact lens training (keratoconus options, presbyopic fits, ortho-k, and sclerals), vision therapy (including sports vision, developmental vision, behavioral vision, and traumatic brain injury), and low vision.

 

[KHE]

I'm pretty sure all optometry schools require rotations through VA Hospitals so you'll have to do that. I'd say being on call for 4th year rotations is either non-existent or rare but I'm only answering you because no one else has and my knowledge is limited on this topic. For ocular disease residencies or when you are employed there are opportunities (or burdens) to be on-call.

I know of no school that requires a VA rotation, let alone all of them. There aren't enough VA hospitals in the country to accommodate that many optometric interns.

 

[Tippytoe]

I know of no school that requires a VA rotation, let alone all of them. There aren't enough VA hospitals in the country to accommodate that many optometric interns.

Shnurek running his uninformed mouth as usual. I imagine everyone has learned to ignore him by now. But just in case you are new here-- ignore him. He knows virtually nothing about Optometry and it shows in most every post he makes on this and the MD forums.

My 4th year was like this: 2 semesters at the school. We rotated each day of the week. One day doing contact lenses, one day in vision therapy, one day in (s)low vision, one day in primary care and the last day in ocular disease. Each day, we were lucky to see ONE patient. On rare occasions we might see two (not enough pts for all the students). Someone time we saw no patients.

- Primary care day we did a 2 hour exam on a welfare recepient that had nothing else to do.

- In vision therapy, we immediately saw it for what it was, a slow, silly con game that does very little for people except take their money.

- Low vision was also hated. We took turns trying to refract 20/400 old ladies and then tried to make them understand they are not 25 again and will never see like they once did with macula degeneration. Then we listened to them say 14 times "if you could just put a little mo' medicine in my glasses, I think I could see".

-In contact lens clinic we had to fit 3 or 5 people in soft contact lenses (about as hard as peeing) over the entire semester!!. We also had to sucker an underclassman into letting us fit them in RGP lenses for at least 1 month. Usually had to bribe them with money to do so.

-In ocular disease, we'd see our one patient with conjunctivitis, retinopathy or cornea problem. The instructor would yell at us for nothing to make herself feel good and then we'd (almost always) rx Tobradex. We rarely saw any patient in follow up so we never knew if they healed or not.

So like I say, we might see 5-7 patients per week! Hardly enough to become competent as an eye doctor. This is yet another reason optometry school is a joke.

Now the 2nd half of the year (2 semesters) we were allowed to pick 2 external extern sites. I picked an army hospital and a rural private practice. Lukcy for me, although I didn't know it at the time, the rural private practice taught me virtually everything. It was a large welfare office (like most rural places are) and people came in with all sorts of stuff. I saw 30-40 patients per day there and the OD had 2 OMDs come in once a week and I learned alot from them. It was there I actually learned to see 'cells and flare'.

The army hospital was a joke and a waste of my time. I refracted healthy 20 year olds all day. Nice relaxed pace. 1 patient every hour or so. My chief was rarely there so I was on my own most of the time. Anything remotely related to ocular disease (even simple conjunctivitis) was given to one of the OMD residents there were there to boost their numbers.

So as you can see, optometry school could be improved GREATLY. If you don't luck up (or find out from somoene else) and get a good extern site, you could graduate having seen approximately 50 patients total and never see 90% of the disease you learn about. I know people that picked a military base (refractions all day) and a little old man refracting optomery office. They got very little experience and likely ended up in a commercial office. I believe many school allow the students to get more outside experience now. But even that is hit or miss, as it relates to experience and number of patients.

 

[QueenieCSS]

I was wondering what the optometry clinicals are like 4th year? Are there anything such as being on call? What tasks are you doing while at work? Seems like most OD just kind of perscribe lenses and glasses.. ? How does it compare to medical school rotations?

At PUCO we do 4 rotations, about 1/3 of the class has to do an internal, the rest get all externals. I have a private practice, a hospital based setting, a pediatric practice, and a military base.

So far the private practice was good - saw 8-9 patients a day ranging from routine exams to glaucoma/AMD followups, pediatrics, CLs, and some infections, trauma, etc. The hospital based one I am working with an ophthalmologist so there is some call involved when he is on call, which is about 3 full weeks out of the 11 I am here. We see a lot of older patients with AMD, glaucoma, diabetic ret, and I get to sit in on the surgeries that are done (mostly cataract but some occasional lid procedures and blepheroplasty ones). Kind of what you would expect in a hospital setting - most people don't go to the hospital for a routine check-up when they are 2.00D myopes.

Don't have any experience yet for the other two but I hear the military site is all healthy people in their 20's and 30's, pretty boring/standard and the pediatric site supposedly has a lot of amblyopia, strabs, and some special needs populations.

Each school is a little different so it is hard to compare sometimes. We don't have to do a specific type of site (like a VA or private practice) but we do have to do one ocular disease site (which are mostly VA's and a few hospital based ones), one primary care (IHS, private practice, military), and one specialty or co-management site. The last one we can do a repeat type but not the exact same mode (so not two VA's or two military).

Can't speak to medical school rotations since I didn't go to med school.

 

[hello07]

You never are on "call" neither in Optometry school rotations nor after graduating no matter what optometric setting you practice in even in a hospital VA based or clinic with ophthalmology. OMDs are on call if they work hospital base.
Don't ever tell people you will be on call or are on call after telling them you are an optometrist. You are asking for pity.
Maybe P. Ajamian and few other bigwigs are on call evry 3rd night LOL but not the rest of us appx 40,000 ODs out there.

 

[Tippytoe]

You never are on "call" neither in Optometry school rotations nor after graduating no matter what optometric setting you practice in even in a hospital VA based or clinic with ophthalmology. OMDs are on call if they work hospital base.
Don't ever tell people you will be on call or are on call after telling them you are an optometrist. You are asking for pity.
Maybe P. Ajamian and few other bigwigs are on call evry 3rd night LOL but not the rest of us appx 40,000 ODs out there.

Technically that's correct. However, if you are trying to build a private practice, you really are on call 24/7 if you want to build the practice up.

I remember one time many years ago I went in for an idiot with a central CL induced corneal ulcer. I went in on Christmas Eve and left my 2 and 4 year olds in front of the Christmas tree to see her again on Christmas morning. I helped her. Made her better. This 23 year old came in with mommy and daddy who refused to pay me a penny because they had BCBS. I finally wrestled $20 out of them as an 'emergency visit' and they complained to the insurance company until I paid them back. Insurance paid me about $80 total. Not worth it to miss time with my kids on the biggest holiday of the year.

That was the last time I went in on Christmas. But I do still go in at night and weekends occasionally. I just don't have the conscience to tell them to go to an urgent care or ER where the doc or PA will try to dig stuff out of the eye with a q-tip with no anesthestic (even when there is nothing there). I've fixed up enough urgent care screw ups that I just can't send them there unless I really, really dislike them. So I just come in and see them and hope they appreciate what I'm doing for them (20 mile round trip--the gas alone cost me $10).

 

[pudgie84]

hey tippy toe, just out of curiousity, which school did you go to?

 

[Tippytoe]

hey tippy toe, just out of curiousity, which school did you go to?

Southern College of Optometry (SCO). Memphis, TN

 

[Shnurek]

You never are on "call" neither in Optometry school rotations nor after graduating no matter what optometric setting you practice in even in a hospital VA based or clinic with ophthalmology. OMDs are on call if they work hospital base.
Don't ever tell people you will be on call or are on call after telling them you are an optometrist. You are asking for pity.
Maybe P. Ajamian and few other bigwigs are on call evry 3rd night LOL but not the rest of us appx 40,000 ODs out there.

WRONG, there are optometry residencies where you are on call.

Example: http://optometry.nsuok.edu/LinkClick.aspx?fileticket=GdY6MkWOuB8=&tabid=1960

"The Cornea and Contact Lenses resident participates in evening and weekend
call for emergency eye care one week per month at Hastings Indian Medical
Center on a rotating basis with the Family Practice residents. The resident needs
to be within 15 minutes of the hospital during evenings, nights, and weekends
while on call."

Also in private practice emergency care you can be on call.

Now having said that. Doesn't mean I'd like to be on call.

 

[CL Doc]

I don't know about retail, never done it, but every OD with their own practice is "on call".

Like Tippytoe I've sacrificed family time for this profession.

Like it or not, it comes with the doctor title.

I would guess the majority of residents have to do call on a rotating basis.

 

[pudgie84]

so is there a general list of externship locations for which students from any school can apply? or does each school have their own list? also, is it possible to arrange an externship at a location that doesn't currently offer externship positions (if you know a doctor there or perhaps go through a formal process to initiate a position at a new site)?

 

[hmarie224]

Shnurek running his uninformed mouth as usual. I imagine everyone has learned to ignore him by now. But just in case you are new here-- ignore him. He knows virtually nothing about Optometry and it shows in most every post he makes on this and the MD forums.

My 4th year was like this: 2 semesters at the school. We rotated each day of the week. One day doing contact lenses, one day in vision therapy, one day in (s)low vision, one day in primary care and the last day in ocular disease. Each day, we were lucky to see ONE patient. On rare occasions we might see two (not enough pts for all the students). Someone time we saw no patients.

- Primary care day we did a 2 hour exam on a welfare recepient that had nothing else to do.

- In vision therapy, we immediately saw it for what it was, a slow, silly con game that does very little for people except take their money.

- Low vision was also hated. We took turns trying to refract 20/400 old ladies and then tried to make them understand they are not 25 again and will never see like they once did with macula degeneration. Then we listened to them say 14 times "if you could just put a little mo' medicine in my glasses, I think I could see".

-In contact lens clinic we had to fit 3 or 5 people in soft contact lenses (about as hard as peeing) over the entire semester!!. We also had to sucker an underclassman into letting us fit them in RGP lenses for at least 1 month. Usually had to bribe them with money to do so.

-In ocular disease, we'd see our one patient with conjunctivitis, retinopathy or cornea problem. The instructor would yell at us for nothing to make herself feel good and then we'd (almost always) rx Tobradex. We rarely saw any patient in follow up so we never knew if they healed or not.

So like I say, we might see 5-7 patients per week! Hardly enough to become competent as an eye doctor. This is yet another reason optometry school is a joke.

Now the 2nd half of the year (2 semesters) we were allowed to pick 2 external extern sites. I picked an army hospital and a rural private practice. Lukcy for me, although I didn't know it at the time, the rural private practice taught me virtually everything. It was a large welfare office (like most rural places are) and people came in with all sorts of stuff. I saw 30-40 patients per day there and the OD had 2 OMDs come in once a week and I learned alot from them. It was there I actually learned to see 'cells and flare'.

The army hospital was a joke and a waste of my time. I refracted healthy 20 year olds all day. Nice relaxed pace. 1 patient every hour or so. My chief was rarely there so I was on my own most of the time. Anything remotely related to ocular disease (even simple conjunctivitis) was given to one of the OMD residents there were there to boost their numbers.

So as you can see, optometry school could be improved GREATLY. If you don't luck up (or find out from somoene else) and get a good extern site, you could graduate having seen approximately 50 patients total and never see 90% of the disease you learn about. I know people that picked a military base (refractions all day) and a little old man refracting optomery office. They got very little experience and likely ended up in a commercial office. I believe many school allow the students to get more outside experience now. But even that is hit or miss, as it relates to experience and number of patients.

Southern College of Optometry (SCO). Memphis, TN

Southern College of Optometry (SCO). Memphis, TN

I would just like to reply to the previous post about your experience as a 4th year at SCO. I'm not sure when you were in school, but I am currently a 4th year student at SCO and I have to say that my experience at the school was much different than yours. We are still required to spend one semester at the school, one at an institutional setting (VA, referral center, military, etc.) and one at a private practice.

I just finished my first rotation at the school and there was not a single day this summer that I did not see a patient. We do still rotate through each clinic: Primary Care, VT/Low Vision, Contact Lens, Ocular Disease, and Pediatrics. I saw up to 6 patients a day, but I do know of other classmates who saw more. We did a lot of ortho-k fits, RGPs, sclerals, mini-sclerals, hybrid lenses, etc. in addition to your basic soft lenses. Our ocular disease day was always super busy. There were many days that we were so busy that we didn't get to eat lunch. I even got to help do a fluorescein angiography on one of my primary care patients.

Granted, I'm sure I still saw a lot less patients at the school than I will see at my other external rotations, but I still feel like I had a good learning experience being there this summer, and I feel more confident going into my next rotation.

 

[Tippytoe]

I would just like to reply to the previous post about your experience as a 4th year at SCO. I'm not sure when you were in school, but I am currently a 4th year student at SCO and I have to say that my experience at the school was much different than yours. We are still required to spend one semester at the school, one at an institutional setting (VA, referral center, military, etc.) and one at a private practice.

I just finished my first rotation at the school and there was not a single day this summer that I did not see a patient. We do still rotate through each clinic: Primary Care, VT/Low Vision, Contact Lens, Ocular Disease, and Pediatrics. I saw up to 6 patients a day, but I do know of other classmates who saw more. We did a lot of ortho-k fits, RGPs, sclerals, mini-sclerals, hybrid lenses, etc. in addition to your basic soft lenses. Our ocular disease day was always super busy. There were many days that we were so busy that we didn't get to eat lunch. I even got to help do a fluorescein angiography on one of my primary care patients.

Granted, I'm sure I still saw a lot less patients at the school than I will see at my other external rotations, but I still feel like I had a good learning experience being there this summer, and I feel more confident going into my next rotation.

That's great. I'm happy to see SCO moving into the 21st century.

 

[QueenieCSS]

so is there a general list of externship locations for which students from any school can apply? or does each school have their own list? also, is it possible to arrange an externship at a location that doesn't currently offer externship positions (if you know a doctor there or perhaps go through a formal process to initiate a position at a new site)?

I can't speak to other schools but at PUCO we have our own list that has spots for us. I know that later in the game there are some places that, if still open, will take us when they are initially for other schools (like VAs, IHS sites, etc.), but that is usually only if one of our sites has to cancel on us for some reason or another.

I know of at least one student in my class that set up a site but there was a long formal process for that. Usually they have to agree to take on more students in future years. But every school is different so some of the other ones may not have quite the same process.

 

[Colonel Mitchel]

I just want to add that my 4th year was at SCO. My previous post described the experience there to some degree. I want to echo hmarie224's comments regarding SCO fourth year. It sounds a lot like how mine was. I also want to add that my low vision patients were all very grateful for any help we could offer them. Also, we did quite a few bioptic fits while there. In oc dz, in addition to rarely even getting 10 mins for lunch, we were often in that clinic from 8:30-6:30 (sometimes later) seeing pts.
I especially want to add that for me, the VT clinic really illustrated for me the benefits it can have on patients. I saw many pts demonstrate marked improvements in the weeks I was there.

 

[caitsiex]

At ICO we are required to fulfill a certain number of hours in 4 rotations in the areas of primary care, low vision, VT/Peds, CL and AC. We are also required to do one of our rotations at ICO and one at a VA. We are also allowed to select more than one of our rotations at a VA if we choose.

Also, I know for a fact that at least one ICO ocular disease resident is always on call on the weekends.