Chairs Missing by Joe, resident at the New England College of Optometry

1Nov/12Off

Frankenpost Part 2: Eye of the Storm

Part 2 of this double post: blogging during the super hurricane of 2012; or what I did to waste my day off while everyone had to deal with more serious things.

During 4th year rotations, rare is it that you ever get a day off; pretty much a natural disaster would have to occur in order to get a non-federal holiday off (and in some clinics you don't even get those off).  Unfortunately, that's what happened today; Sandy has made landfall.  I woke up to find out clinic is cancelled.  Boston seems to be just outside the area of major damage, but just enough wind and rain to knock out power intermittently and cause local pockets of flooded roads.  I lost power intermittently throughout the day, but it's back on for now.  Many friends at rotations south of here in NYC, DC, Philly and New Jersey are facing a fierce storm with likely many days without power, damaged homes or worse.  Hopefully it all shakes out to be good.  As for us here in Boston, cancelled clinic and classes, the subway closing for a day, and cheesy blog puns seem like nothing in comparison.

With my day off, I had planned to get a ton of stuff done. Highest priority: start really studying for Part 2, which is rapidly approaching in less than 6 weeks.  I was also going to do laundry, work out, do a quick grocery run, learn to play the harpsichord and finish writing this post.  I only got about two of those things started today.  It’s been a very distracting day, with a lot of being glued to weather updates and reading random stuff on the internets.  The NBA season is so close I can taste it and I feel like a kid the day before Christmas waiting for the presents under the tree (incidentally, the Celtics are going to be really good, even dark horse contenders this year, you heard it here first).  So while I didn't really touch Part 2 material at all, I did get the chance to reflect on my second rotation, as it is quickly coming to a close; T-minus 3 weeks until we switch again.

This rotation has been challenging and a learning experience in ways unexpected.  In many ways, it's a clinic experience unlike anything I've ever had, and probably unlike anything I ever will be do in my career.  As I've mentioned, I'm in Special Populations.  Instead of being at just one clinical site, I’m at three different ones, each with its own type of specialization.  On Mondays, it's pediatric ophthalmology.  On Thursday and Fridays, it's specialty contact lenses.

On Tuesdays and Wednesdays, I am at Perkins School for the Blind, made famous by the story of Helen Keller over a century ago.  Here we do low vision and functional vision exams on patients with impaired vision, blindness, deaf-blindness, rare congenital diseases and developmental or cognitive impairment.  We work to meet our patients' visual needs rather than focus on discovering disease or correcting them to perfect "20/20" vision.  The doctors provide education, feedback and future referrals to the patients and their caregivers.  It is a team based exam with myself helping the attending doctor, the (fabulous) Dr. Kran, along with a resident doctor, and another 4th year intern. We also get to observe Dr. Mayer who works next door, doing amazing work with visual field testing, helping to monitor brain tumor growth in children, sometimes before even an MRI can pick it up. The clinic coordinator, Darick, is both a clinical orientation and mobility specialist and low vision therapist and helps direct the patients toward goals in these areas.  This includes a wide range of things, whether its figuring out how to teach them to navigate in unfamiliar environments (such as learning to use a white cane) or obtaining and using magnifying devices (such as to read small print in a book).

At Perkins, some of the most difficult parts of the exam are figuring out what exactly I need to do to engage the patients in order to take vision and basic entrance tests.  We need to use toys, colored lights, cartoons, or music in order to reach them.  We are on the floor playing with toys while at the same time trying to sneak a peek at whether their eyes are crossing.  Sometimes sign language is needed, other times matching of basic symbols is the best we can use.  When we are able to make what might seem like a small inroad into completing an exam where others cannot, even just proving that the patient is using some part of their vision and nothing else, it is a feeling of accomplishment that has been unmatched in any other clinic experience thus far.

For some of the patients, we are able to achieve results in glasses correction where other providers simply did not have the luxury of time to help the patient provide this data.  Other patients get much needed referential to O&M services or other educational services, such as a teacher for the visual impaired.  Other times the patient is visually impaired to the point where there is little to do other than provide education on their condition.  In fact, the thing I've learned the most is the importance of communicating with patients and caregivers.  Often times the thing that is needed the most is being able to just sit for an hour and talk to an expert about what exactly their condition is and what it will mean going forward in their lives.  And so that is what I will take away from this the most; while I may not be able to fully examine such patients totally on my own, I know more fully the value of taking the proper time to talk to patients and caregivers, as both a means to put them on the road to find the services they need, and as well as an end in and of itself.

And with that, I take my leave.  The storm is beginning to let up here in Boston and hopefully everyone makes it out in one piece.  While the storm is over, the last surge to finish boards is on the horizon.  Next time: Boards Part 2 and reflections on the (hopefully) last high stakes multiple choice exam in my life, ever.

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1Nov/12Off

Frakenpost Part 1: The Magic Number

Well, you’re in luck, a double post!  Thanks to a generous deadline extension (on account of my being away on a business trip), here are two posts on two totally different subjects.  Up first: taking boards out of sequence.

Some background first.  Last year represented a bold step forward for board certification in optometry.  There was a change in the way Parts 2 and 3 of Boards are administered.  Part 2 is switching from paper based to computer based exams, which makes it somewhat similar to taking the OAT.  Really not a huge change, it just makes it a little more convenient for us.  It allows the examiners to show higher quality photos for diagnosis of ocular diseases and I imagine the new format will also help the turnaround time on scoring.  Additionally, we can take it at any location of a national chain of testing centers throughout the US, which may reduce travel time to a testing site.  Part 3 on the other hand received the greatest change in terms of how students have to plan, study and budget for that exam.

Part 3 traditionally has tested students’ clinical skills on real patients, in real time.  That component hasn’t changed at all.  What has changed is the when and the where.  Previously, the exam was held twice a year at each of the 20-something schools’ clinical sites, with patients and examiners plucked from the local community.  But now, in order to standardize the process and make us more similar to other health professions (or so they say, I’m actually not sure what other types of health schools do for boards), the NBEO opened a centralized testing center in Charlotte, NC, and requires all students to make the trip out there to take the exam.  This might seem a bit unfair.  After all, the added expense of flying and having to get a hotel room easily adds at least an extra $500 to the cost of becoming an optometrist.  But as the NBEO correctly points out, the cost of registration to take the exam has actually remained flat over the last 10 years or so, thus adjusted for inflation, we actually pay about $175 less than folks in 2001 paid to take the exam locally.  Not an obvious consolation right now in 2012, but true nonetheless.

In losing the ability to take it locally, we gain the ability to take the exam at practically any time throughout our fourth year, 5 days a week, 50ish weeks a year.  You can even, as I have chosen to do, take it out of sequence prior to taking part 2.  Therefore it is possible now to finish all three parts of boards just as the third rotation starts. That, in my mind, is fantastic.  The convenience of being able to take it whenever I want, and repeat it if something went wrong, as many times as needed, is more than worth what really is only a minor gripe over money.  An extra $500 is a small price to pay to advance the profession into the 21st century.

Travelogue

So now that I’m all done, I can report that the whole of my experience could not have been any more positive or gone more smoothly.  I spent the month in the lead up to my exam date, a weekday morning in mid-October, practicing in a room that NECO built to match the layout and equipment of the exam room in Charlotte.  There are four “stations” on the exam, each broken into skills for a total of 20 skills total.  The first station is case history and basic entrance exams, measuring glasses power and so forth, another is the dilated health part of the exam, another contact lenses and refraction for glasses prescription and so forth.  I found that I really didn’t have to practice as much as I anticipated; in reality, every day of my rotations this far was like practicing for Part 3 little by little.  Additionally, NECO’s lab proficiencies over the last 3 years (where we are tested in real time on clinic techniques in lab) helped more than I realized in setting up the mindset for this sort of test.

As far as the traveling part, flying from Boston to Charlotte was simple and stress free.  We are allowed 3 days off from clinic, a travel day there, the test day and a travel day back.  Luckily for students currently in the Boston area, Logan is a great airport to fly out of.  You can get to it quickly from almost anywhere in the city for the cost of a 2 dollar subway ride.  There are tons of cheap carriers with direct flights from Boston to Charlotte; mine was about 79 bucks each way.  Other than waking up at 4:30 in the morning to catch the flight, it was a breeze; the air time was about an hour and a half.  Once on the ground, you can opt to take a cheap shuttle that brings you directly from the airport to the center of downtown, which is exactly where the testing center and the major hotels are located.  And the ride is only about 10 or 15 minutes, too.

It is easy now to see why the NBEO chose Charlotte; it’s a great little city.  Its downtown is smaller than Boston’s, and it’s on a grid so it’s easy to navigate.  It’s a very clean and safe area, and there are tons of shops and eateries within a block to make it as easy as possible to arrive and get comfortable in order to focus solely on the impending task at hand.  And we get a super cheap corporate rate on most of the downtown hotels.  For a moderately fancy hotel room that I split with my buddy Petar (who was taking it at the same time), I ended up paying about 90 bucks for two nights.

The night before the exam, we spent most of the time going over the elements of each of the stations on the exam; making sure to get down the exact order of when to do what and what to say when. Then, we did some mock run-throughs on IV injections using rubber bands, socks and pens (tourniquets, fake “arm” and needle respectively).  Oh, did I mention we also have to pass an IV injection test as part of the whole exam?  Well, there’s that too, and it was really the only part I felt shaky about prior; we don’t exactly do this on a regular basis on patients in clinic.  It turned out to be just fine for me on the actual exam, but it was stressful in the lead up.  On the exam, it’s on a fake arm and while we got a chance to try it in lab third year, it wasn’t something we do repeatedly like using a slit lamp every single day in clinic.  So then this begs the question:  why it’s on the exam at all?  Well, it’s all for the potential future direction of optometry.  The future, Conan?  That’s right, optometry student, the future!  (And the present, it turns out.  Little by little, states in the south are expanding the scope of optometry to allow IV and even lasers!)

After some frustration watching the presidential debates, we went to bed.  In the morning after some quick eats, we made the five minute walk over to the exam center.  Now I can’t really talk at all about the exam and how it proceeded, short of reiterating what’s already open knowledge to the public through the NBEO website anyway.  All I will say is that everyone working at the exam center itself there was very nice, and the time there was well managed and organized.  You even get almost an hour to play around with sample equipment such as the fake injections arm and so forth.  Needless to say, save for a few minor flubs, I feel it went well.

As we were sitting in the Charlotte airport, our flight slightly delayed, myself and Pete agreed it couldn’t have gone any better.  We were relaxed and considerably less stressed than when we emerged from the testing center post-Part 1.  Maybe it was because we were well prepared, but I think that’s only part of it.  A little touch of southern hospitality and the convenience of Charlotte as a destination made all the difference, almost like we were on vacation.  Hopefully someday I will come back, not on business, but to explore the city more properly.

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