As my class of 2015 finished our second year of optometry school this spring, summertime marks the beginning of our first clinical assignments as third year students, or OD3s. This is an exciting and very challenging transition, or at least I feel this way. The degree of expertise that a preceptor expects from you as an OD2 versus an OD3 is very different. As a third year, you have completed every clinical skills proficiency exam and all major coursework—now all that is left is to start thinking and acting like a doctor. The only way to transition into being a professional clinician is through lots and lots of experience.
For all of second year, we have one day per week of clinic time. My assignment last year was with the pediatric population. That was a very fun patient age to work with and a great way to start off my clinical experience. Now I am happy to report I saw my first elderly patient in these first few weeks of my summer clinical assignment. It was very interesting because you have a lot more information about your patient. Adult patients, especially the elderly, have medications they are taking, pre-existing systemic conditions that are managed with their PCP, and they commonly rely on optometrists to monitor and sometimes treat any diseases of the retina or optic nerve. The dilated fundus examination can present the first signs of systemic pathology, including something as common as hypertension or as serious as HIV. This is why it is very important for adults to be dilated every year.
Several professors have told our class that taking the patient’s case history, basically the interview process between the doctor and the patient, is the most critical part of the exam. Acquiring the case history sets the tone for the exam, establishes rapport with the patient, and should give you a narrow set of differential diagnoses that lead you through the rest of the exam. Instead of doing every test you learned in school, you can selectively perform the pertinent tests that will confirm or eliminate your differentials. This is an important way that a doctor achieves efficiency in the exam. By using what you have learned about your patients as you observed and interviewed them about their chief complaints, and keeping in mind the patient’s age, you can use a mental flowchart to guide you to a suspected diagnosis.
Our skills in taking a good case history and efficiency in the exam are probably the two components of the exam that all the OD3s, myself definitely included, are working on the most this summer. Even after years of experience, there is probably always room for improvement with these skills. They seem to be something that cannot be taught, but only learned through experience. Hence, I have noticed a large gap between mastering the didactic material and clinical techniques and being able to perform like a doctor in clinic. The continuous clinical experience of third year will catch me up eventually, but until then I am trying to improve in each exam in a “just keep swimming” kind of way.