Clinical Experience in First year of School

[HP.]

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Is it me, or is every single college of optometry stating that students in their first year at their college can get clinical experience? I hear people say this is one of the reasons why they chose a certain college over another, but it just seems like every school allows this.

Anyone feel the same way or have evidence to the contrary?

-HP

 

[mathcod]

I'm guessing the clinical experience is just shadowing an upperclassmen. I really doubt first-years would perform any part of the examinations because they have not shown competency in the skill yet [competency being evaluated by successful completion of the clinical skills course]. Plus their knowledge base is way too low. I'm sure most institutions have shadowing as part of their required curriculum.

I probably wouldn't make it a reason to choose one college over another. A good clinical program is one that is modern and fully equipped, has good instructors, and has specialty departments. It also helps if the patient population is lower-income because they tend to have more problems/disease when speaking socioeconomically. But getting into clinic early (when you are likely to be unready) doesn't sound super useful as a make-it-or-break-it deal when deciding schools, and while I'm only speculating, I'm sure the role would be solely shadowing/scribing/joining in on discussions with little physical involvement with an exam.

 

[reesespieces]

I'm guessing the clinical experience is just shadowing an upperclassmen. I really doubt first-years would perform any part of the examinations because they have not shown competency in the skill yet [competency being evaluated by successful completion of the clinical skills course]. Plus their knowledge base is way too low. I'm sure most institutions have shadowing as part of their required curriculum.

I probably wouldn't make it a reason to choose one college over another. A good clinical program is one that is modern and fully equipped, has good instructors, and has specialty departments. It also helps if the patient population is lower-income because they tend to have more problems/disease when speaking socioeconomically. But getting into clinic early (when you are likely to be unready) doesn't sound super useful as a make-it-or-break-it deal when deciding schools, and while I'm only speculating, I'm sure the role would be solely shadowing/scribing/joining in on discussions with little physical involvement with an exam.

I disagree. You are underestimating the power of shadowing and scribing. You learn a lot by shadowing and scribing. When you see it enough times, it helps get not only the process down, but it also helps teach you lots of aspects of care. Not only that, but scribing forces you to learn terms, procedures, etc. Then when you get to clinic and you are doing the things or when you see things in lab or class, it will come easier.

 

[Groucho Marx]

I disagree. You are underestimating the power of shadowing and scribing. You learn a lot by shadowing and scribing. When you see it enough times, it helps get not only the process down, but it also helps teach you lots of aspects of care. Not only that, but scribing forces you to learn terms, procedures, etc. Then when you get to clinic and you are doing the things or when you see things in lab or class, it will come easier.

I can say as an actual student that the shadowing and scribing is not as helpful to most people as you're putting it. Maybe it is to you, and that's fine, but a lot of the first year clinical experience consists of sitting around, feeling a little lost, and wishing that you could be spending that time actually studying. When you don't know what you're looking for or what is really going on, it's hard to take in much information. It's a point that some of the schools are using to try to make their programs seem more appealing, but it's kind of gimmicky, and I wish more emphasis would be placed on learning the material before pushing people into clinic. It's not like the upperclassmen or doctors really have a lot of time to explain what is going on to a first year (and it's not the fault of the upperclassmen or doctors, as the exams are already usually slow). I wouldn't let the "you're in clinic first year!" lines sell you on a school. The truth is that you just won't be able to get that involved...and it's not your fault or the fault of the doctors, it's just that you don't have the knowledge base in the first year. You can watch someone do a technique hundreds of times, but until someone explains the science and reasoning behind the technique, it's kind of like watching a movie in a foreign language. You'll try to piece little bits together, but overall your knowledge will mostly remain scattered, and you'll eventually just wait until the material is actually taught.

 

[steviey2493]

These "clinical experinces" definitely vary from school to school. I know some schools do a year straight of just classes. Some let you shadow. I know PCO you aren't seeing real patients in year 1, but you do get a few hours a week using/practicing with equipment used in an exam room right off the bat. I highly doubt anyone has real patients from the get go.

 

[Commando303]

Is it me, or is every single college of optometry stating that students in their first year at their college can get clinical experience? I hear people say this is one of the reasons why they chose a certain college over another, but it just seems like every school allows this.

Anyone feel the same way or have evidence to the contrary?

-HP

It's meaningless — just a way for schools to make themselves sound more appealing. You know not nearly enough as a first-year student to benefit from being in clinic. If you have the exposure, you'll be there a couple of times a month, watching upperclassmen work, and occasionally nodding your head to lie, when you're invited to look at something, and asked if you see it.

 

[OpticalBlackOut]

You can watch someone do a technique hundreds of times, but until someone explains the science and reasoning behind the technique, it's kind of like watching a movie in a foreign language.

This is a really great analogy, and sums up first year "clinical experience" very nicely

 

[Rain Clouds]

My question is this... How little are first years learning in all your schools that they are all useless in clinic?

By the time a student is done with first year, they are a full third of the way finished with their didactic education. At ICO, what's expected of first years in clinic is proportional to where they are in their coursework. No one expects them to be the best at anything, but no one assumes they're incapable of everything because they're first years either. And everyone thinks they know nothing on their first day walking into the clinic... might as well get over that amount of fear and insecurity early. By next February, our ICO first year class is expected to be able to be able to handle entrance tests for patients in clinic, supervised by a third or fourth year student and the attending doctor. By the very first day of second year ICO students are doing the full exam with the exclusion of the slit lamp exam and the DFE with just an attending doctor.

I know for myself when I was a first year, being in the clinic was waaaaaayyy better than sitting through lectures and studying. Many of the cases I saw even while I was a first year still stick with me now. And effective attending faculty will help even a first year get plenty of education out of a day in clinic when compared to an equal amount of time spent in the classroom.

So, first years in the clinic, I'm certainly in favor of it.

 

[Groucho Marx]

My question is this... How little are first years learning in all your schools that they are all useless in clinic?

By the time a student is done with first year, they are a full third of the way finished with their didactic education. At ICO, what's expected of first years in clinic is proportional to where they are in their coursework. No one expects them to be the best at anything, but no one assumes they're incapable of everything because they're first years either. And everyone thinks they know nothing on their first day walking into the clinic... might as well get over that amount of fear and insecurity early. By next February, our ICO first year class is expected to be able to be able to handle entrance tests for patients in clinic, supervised by a third or fourth year student and the attending doctor. By the very first day of second year ICO students are doing the full exam with the exclusion of the slit lamp exam and the DFE with just an attending doctor.

I know for myself when I was a first year, being in the clinic was waaaaaayyy better than sitting through lectures and studying. Many of the cases I saw even while I was a first year still stick with me now. And effective attending faculty will help even a first year get plenty of education out of a day in clinic when compared to an equal amount of time spent in the classroom.

So, first years in the clinic, I'm certainly in favor of it.

It sounds like ICO has a better handle on it than other schools. I'm glad you found it helpful and rewarding.

 

[mathcod]

Whenever I asked my patient advocate program first-year students to do entrance testing or lensometry, they always declined!

 

[Rain Clouds]

Whenever I asked my patient advocate program first-year students to do entrance testing or lensometry, they always declined!

Which is why now our first years have to get a sheet signed by their upperclassman supervisor proving that they were useful and did entrance testing in clinic. Kids gotta jump in the pool sometime. I heard PAP is a lot more useful now than it used to be. People used to just not show up and everything, so they've been shaking things up past couple years.

 

[Rain Clouds]

You know, there is also something to be said about a behavior that is becoming epidemic in education today. That is, only doing things that you are required to do rather than making the most out of your educational opportunities and doing things just because you can do them. The problem with first years wasting time in clinic isn't that they can't do things, or they don't know things. The problem is that they won't do things, or won't try to recall things they've learned, because there are no consequences to playing dumb, or not even taking the initiative to wait a little longer after the exam to ask the attending to explain the case. If the attending asks the student if she or he has any questions, and the student doesn't, if the student didn't learn anything from clinic that day, that's not on the educational system, that's on the student.

Passive, complacent students go to lecture and say they didn't learn anything, go to clinic and say they didn't learn anything, go to lab and say they didn't learn anything, and then end up wondering why they have to spend so many hours studying outside of class because they didn't "get" what was going on. Sure, everyone has their days where they really can't focus, or maybe there's a certain professor or attending they have trouble understanding, but if students make a *habit* of passivity, they only make it harder on themselves.

Alright, I'm off my soapbox. 🙂

 

[Commando303]

You know, there is also something to be said about a behavior that is becoming epidemic in education today. That is, only doing things that you are required to do rather than making the most out of your educational opportunities and doing things just because you can do them. The problem with first years wasting time in clinic isn't that they can't do things, or they don't know things. The problem is that they won't do things, or won't try to recall things they've learned, because there are no consequences to playing dumb, or not even taking the initiative to wait a little longer after the exam to ask the attending to explain the case. If the attending asks the student if she or he has any questions, and the student doesn't, if the student didn't learn anything from clinic that day, that's not on the educational system, that's on the student.

Passive, complacent students go to lecture and say they didn't learn anything, go to clinic and say they didn't learn anything, go to lab and say they didn't learn anything, and then end up wondering why they have to spend so many hours studying outside of class because they didn't "get" what was going on. Sure, everyone has their days where they really can't focus, or maybe there's a certain professor or attending they have trouble understanding, but if students make a *habit* of passivity, they only make it harder on themselves.

Alright, I'm off my soapbox. 🙂

🙄

 

[Blondiechick919]

A lot of schools say they expose you to clinic early which sounds cool as an applicant but no matter what they say, you aren't ready til sometime between second and third year. Most first year students couldn't tell you the difference between a cornea and a conj, let alone an artery or vein in the retina. So a lot of shadowing is pointless when you don't know what's going on. It's time resented a lot when it's the day before an exam and you need to study. For those like myself who have teched before and wanted to look enthusiastic in my clinic days I either got an attending who told me I was wrong and to shut up because I hadn't learned that in class yet or thanked me and asked me to scribe. Depends I guess.

 

[Groucho Marx]

You know, there is also something to be said about a behavior that is becoming epidemic in education today. That is, only doing things that you are required to do rather than making the most out of your educational opportunities and doing things just because you can do them. The problem with first years wasting time in clinic isn't that they can't do things, or they don't know things. The problem is that they won't do things, or won't try to recall things they've learned, because there are no consequences to playing dumb, or not even taking the initiative to wait a little longer after the exam to ask the attending to explain the case. If the attending asks the student if she or he has any questions, and the student doesn't, if the student didn't learn anything from clinic that day, that's not on the educational system, that's on the student.

Passive, complacent students go to lecture and say they didn't learn anything, go to clinic and say they didn't learn anything, go to lab and say they didn't learn anything, and then end up wondering why they have to spend so many hours studying outside of class because they didn't "get" what was going on. Sure, everyone has their days where they really can't focus, or maybe there's a certain professor or attending they have trouble understanding, but if students make a *habit* of passivity, they only make it harder on themselves.

Alright, I'm off my soapbox. 🙂

Maybe what you're saying is true of some students, but without being closely familiar with the way that every optometry school educates and with the quality of everyone's education, this is merely a blanket statement that can't correctly be made. You're putting the blame solely on the students without taking into account the variability between the programs. To say that the problem with first years wasting time in clinic isn't that they can't do things or don't know how to do things is absurdity with a touch of hubris. When I was a first year in clinic, there were many times when I didn't know what type of questions to be asking or how to do a technique. This was not one of my shortcomings, as I'm rather studious (just like 90% of the class because this is a doctoral program), but rather a direct consequence of my lack of any exposure to the topic at hand. I'm much more a fan of having people learn something first (even a small primer on the topic is fine) and then seeing it in a real setting. I know that some might disagree with me on this, which is completely fine.

I'm not upset with you, Rain Clouds, as I think that we should all respect one another as professionals. However, I do think it's important to try to refrain from blanket, blaming statements. And I do completely disagree with the statement that if students don't learn, then the problem lies with the students and not the educational system. In a broader societal sense, I am rather uncomfortable with statements that try to pin faults on students, rather than institutions, as I think that it affords the institution an exemption from blame for a shortcoming, when in many circumstances blame does in fact lie with the institution. I don't disagree with you that some students waste time or let a learning opportunity pass by, but I think it is important to evaluate the situation from both the perspective of the student and the institution when a student complains of a lack of meaningful learning because one must accept that some schools do have flaws. It is only through this acceptance that helpful changes can be made in favor of the student.

 

[optoapp2012]

Ask the schools for a lot more specific information. What is the clinical exposure? Is it observational or hands on? What skills are students taught by the end of each semester?

I think each school has a slightly different approach and I'm sure they all have their merits. Berkeley students start on the slit lamp in the first week of classes in 1st year. By the end of the first semester, we are expected to know how to perform retinoscopy, a full refraction with balance, some slit lamp examinations, and use the BIO to examine the midperiphery of the fundus. By the end of spring of first year, you are expected to do things like phorias and vergences, tonometry, and a better version of all of the above. There's probably more, but I don't quite remember (I'm in second year now, so it all kind of runs together). We actually start seeing patients in small groups in second semester of second year and then our own patients the summer after 2nd year. I think that's a similar timeline at a lot of schools with regard to when you actually see real patients.

Some schools consider clinical experience to be scribing. I do think there's value in scribing, but that has more to do with learning how to record things. It doesn't necessarily mean you are learning to perform the skills (but I still think it's valuable!). Some schools consider clinical experience to be observation. Again, useful, but you still aren't doing the skills hands on. Some schools define it as actually in a clinic room doing the procedures yourself. Anyway, just ask! I think early exposure to learning the skills hands on is good (you need time to practice and master skills...muscle memory and experimenting around to figure out the technique need time), but I don't necessarily think you need to be working with real patients right away. That's because you might be able to master the skill for performing a test, but like others have said, you are still learning exactly what it all means and how to interpret what you see. You really can't learn that in 1st year. There's too much information you have to learn first!

 

[steviey2493]

I think any of it is good honestly. We are all going to optometry school, I'd hope you know a little bit of the anatomy and functions of the eye, and how a typical exam is run. Of course all of the medical stuff isn't supposed to be known right away. But, I think mentally it is a good change up instead of sitting in a room for a few more hours a week. It def. helps you "keep your eyes on the prize" because this is what I want to do. Being around it keeps me going, I like being in the office. When shadowing before I applied I learned a bunch of stuff, from how to use some of the equipment, some contact lens lessons, to even using the newer electronic health record system. The eye doc even let me put in some eye drops and give field of view tests and colorblind tests after watching him.

It may not seem like a big deal now but it is going to help you get comfortable in the future easier IMO and might seem more "routine" than foreign when you do start clinical. Like optapp said, Berkeley students are using slit lamps in the first year. Same at PCO (they do practicals on different equipment and situations). So you aren't technically sitting there in the corner of a room at a clinic, but they are skills to be used in the clinic.

 

[Rain Clouds]

@Groucho Marx

Of course to be fair, I can only speak of the experience I have at ICO. I do apologize if other schools aren't preparing students for the clinical portion of their education when they get thrown into clinic, but at least at my school, I believe we have ample opportunity to prepare ourselves, and there are too many kids in clinic who just won't do anything until I push them that's all.

But yes, if there is a legitimate complaint about the educational system, you should raise it. When something at ICO isn't up to my idea of what the educational standard should be, I definitely bring it right up to the administration, and I encourage others to do the same.

 

[reesespieces]

For those like myself who have teched before and wanted to look enthusiastic in my clinic days I either got an attending who told me I was wrong and to shut up because I hadn't learned that in class yet

This is where one problem lies. You are at a learning institution. They are supposed to encourage curiosity and question asking. They should not treat you like that, rather they should approach you in a more educational sense whether by Socratic method or explaining it to you.

 

[Blondiechick919]

This is where one problem lies. You are at a learning institution. They are supposed to encourage curiosity and question asking. They should not treat you like that, rather they should approach you in a more educational sense whether by Socratic method or explaining it to you.

I get what you're saying but I'm assuming they thought I was trying to be a know it all because I had worked in the field before. Who knows. Most Attendings aren't like this but not everybody is a ball of sunshine-that's just life I guess.

 

[optoapp2012]

I agree with Blondiechick - tough love can be a good thing. It's good to have a mix of people being caregivers and also showing tough love, because it's hard to be open to learning new things and asking questions if it's all tough love, but it's hard to be independent by the time you graduate and go to work in a real office if it's all rainbows. So both is a healthy mix 🙂

Another thing on clinic preparation that I forgot before...ask how many patients you see by graduation. I think there's a big difference among schools on that. Some Berkeley students get frustrated that we can get assigned Saturdays and Sundays in clinic - we're open 7 days a week. But it's super valuable how much interaction you get with patients. The average number of patients we see by graduation is 2500. We work a LOT in the clinic, which really maximizes the time that we are in school. It might be a little exhausting in 3rd year, but it goes a long way when we graduate and need to rely on that experience to guide us through our first years of practice.