04. November 2013 · Comments Off · Categories: PhD

I googled the word “professionalism” and this is the top definition that appears in the search results: “the competence or skill expected of a professional; ‘the key to quality and efficiency is professionalism.’ ”

I must agree, Google. Competence of the practitioner instills trust, confidence, and builds a strong rapport with the patient. Competence is why there are three separate testing components before an optometrist is National Board Certified. As the OD3s are starting to study for part one of boards, which we take in March 2014, we are shifting to a sense of preparation rather than conventional studying. We are preparing to be skillful clinicians for the benefit of our patients who will rely on us exclusively in the near future. Preparing for the board exams gives a sense of maturity and tangibility to our careers.

I’m sure we have all been to a store or salon where the employees are chatting amongst each other while they work. Chatting can quickly turn into gossiping. While teenagers working at an ice-cream shop, for example, are almost expected to show this behavior, it is totally unprofessional in a structured workplace of adults. Being a professional means checking your personal opinions at the office door and conducting yourself with diplomatic poise.

I have a theory that once you’ve mastered your craft at work, your mind has room to wander because it’s not totally consumed by your tasks anymore. Other thoughts then have room to pop up in your brain, like thinking of a grocery list while still doing your daily routine. But when an employee starts to gossip aloud—whether it is about customers, other employees, or unrelated individuals—that crosses the line into being unprofessional and reflects poorly on the workplace.

I would argue that the most critical profession to maintain professionalism in is the medical field. Clinicians are the role models for the community around them. According to the U.S. Census Bureau in 2012, less than 2% of Americans hold a doctoral degree. As a very small group of lucky individuals providing care to our communities, we should be the best examples of professionalism for our peers.

I will admit it is very tempting to engage in some variation of unprofessional behavior. How can we resist the temptation? Maybe eliminating that extra room in our heads where distracting thoughts arise is the solution. If we keep ourselves constantly challenged by our work, then there should be no tendency to get off course. You can foster a more challenging environment by researching entities you see in clinic that you are not 100% comfortable with yet. This would provide you with a more detailed etiology and new treatment options, for example. Also, taking on projects in collaboration with other practitioners can give you new opportunities for becoming more well-rounded and networking with other clinicians. Comprising new advertisement and patient satisfaction strategies to improve business is a huge additional component to private practice optometry. Acting in terms of bettering your care regimens and your professional knowledge will ensure you are always growing as a clinician.

As Google taught me, professionalism is the key to “quality and efficiency.” If I have learned anything in clinic, it is that quality and efficiency are the two most important things my preceptors want from me in my patient exams. Both of these increase as you become more comfortable with any case that presents to you, along with having a solid foundation of knowledge supporting what you’re doing in your management.

04. October 2013 · Comments Off · Categories: PhD

Scientists say that the brain cannot multitask. Technically true, but you may find yourself frequently multitasking. The brain cannot perform two tasks simultaneously, but must quickly switch between (among) the multiple tasks you are demanding of it. I’ve also read that people do not tend to perform as well when they are multitasking. Let’s ignore that claim for now because in third year, you do a lot of switching gears.

Many older students will tell upcoming third years that being an OD3 feels like a reward or a vacation from the intense second year curriculum. Although in terms of curriculum they are correct, I think that third year is almost as demanding as second year, but in a less focused (more multitasking) way. OD2s are inundated with lectures and labs, where as an OD3 you are constantly switching among seeing patients in clinic, attending lecture (and labs), working for work study, completing research projects in some cases, and studying for your electives you have enrolled in for the semester. I imagine this scatterbrained, multitasking life we are living this year is a foreshadowing of the rest of our lives. That’s what entering the “adult” world is, right? Constantly jumping from project to project to keep up with your work, with family and friends, and with new opportunities you have undertaken.

Not every adult has that “adult” life I just described. It is a great privilege to work at a sort of “self-actualization” level in our lives and careers. Optometry school is overwhelming as a student—you feel like you know very little and there’s a ton of new information in front of you waiting to be learned—but we are some of the luckiest people in the world to be where we are right now. How many obstacles did each classmate of mine overcome to get their one spot out of 120 seats in the class of 2015? What classmates had few difficulties, but seemed to be destined to professional school or always knew what they wanted? Either way, we were all successful. We were probably all lucky enough to have a great support system of family and friends to help us get to where we are today.

Soon we will be providing eye care to patients and become capable of supporting ourselves and our families. Although optometry school is stressful and we may feel like we are working way too hard sometimes, there are many people who would have loved to occupy our spots in the class of 2015 and been given the opportunity we have now.

With that in mind, keep your spirits up during this midterms week, NECO! I know we can all help each other come out on top. Good luck, everyone!

18. September 2013 · Comments Off · Categories: PhD

A very intelligent postdoc (a postdoc is a PhD graduate’s research position working in a lab after graduation) I once knew at my undergrad always had interesting and thought-provoking questions for us to discuss over lunch. One that stands out in my memory is the question, “If your life was a sitcom, what would be the main three rooms that your life is filmed in?” If you think of a familiar TV sitcom, like Seinfeld, their main filming locations were Jerry’s apartment, the Cafe, and probably the streets of New York City. What are your three main filming sets that could concisely encompass your life right now?

In undergrad, my world could have been summarized in my dorm room, the lecture auditoriums with 300 other students, and the docks behind the Student Union where you could watch turtles and ducks and meet up with friends. Life seemed to have more hours in the day at UCF. It was always hot or rainy and everywhere you went on campus you saw unfamiliar faces. The campus was so big you could meet new people everyday.

Then in my first two years at NECO, life was concentrated in the classroom “LH2” with about 100 students, preclinic 1 (where we have labs and spend hours practicing techniques for homework), and Starbucks. Life included many, many hours of lecture, learning how to exam the eyes, and paying rent at Starbucks in the form of a coffee so I could use their wifi and have a place to study.

As a third year optometry student and having selected my lab for my PhD work next year, my film sets now include the patient exam room at clinic where I am interning, the fish lab at Boston University, and the streets of Boston with all the walking I do. We still have plenty of class time at NECO in third year, but the importance of clinic has shifted my focus more onto the patient exams and learning how to be a doctor.

I had a particularly rewarding day in clinic recently. Every optometrist has the job of ruling out (or catching) the presence of something called a “retinal detachment” and this is why getting your eyes dilated is so important. It is just what it sounds like, the thin neural retina can peel away from the back of the eye which serves as the central retina’s source of nourishment. Not only are the optics of your eye a mess (and vision poor) if your retinal is peeling off, but your delicate neurons are being deprived of oxygen when the retina is not against the back of the eye. Permanent vision loss can and will result if the detachment is not treated quickly. The detached retina would be deprived of oxygen for too long, never to regain the same function it once had if you did not get help immediately.

A retinal detachment can manifest as any change in vision. Some people see flashes of light, some see floating dots, but any change is something to tell your eye doctor about. My patient answered my question, “Have you had any changes in your vision?” by describing an arc of light in the right eye that had been seen at least once a day for the last month. We immediately knew to dilate the patient’s eyes and carefully check the retina for any tears, holes, or a true retinal detachment. Luckily the patient only had the beginning stage of a detachment and we could make a referral immediately (same day) to a retinal specialist to decide on a treatment. It was so rewarding to help catch this abnormal retina before the patient had a loss of vision.

By next year when I am a full time student at BU I am sure my life’s film sets will be different once again. I like this mental exercise because it’s like a concise journal of where you’ve been and how different your life is today.

19. August 2013 · Comments Off · Categories: PhD

As the summer is coming to a close, I’ve finished my last week of my third lab rotation at BU. I loved my six weeks in the fish lab and have chosen (and thankfully have been accepted) to stay! This means that I will complete the three years of my PhD work in this lab on the BU medical campus. Working in science is a peculiar thing. It takes a collection of support, mental tools, and clever tactics to successfully complete a research project or degree. Luckily in my lab, I have been training with an amazingly helpful PhD student who has become a mentor to me. With my mentor’s help, these are some of the tools for success I have learned so far:

-Treat everyday as its own accomplishment.

In science, a fifty percent success rate on your experiments is typical and can be a very pleasing statistic. When you are working on something you don’t understand (which is why it is science, you’re the one solving the unknown), of course, it’s not going to go perfectly. Your goals and results are unknown! You are probably going to be surprised by what you find. The trick is to not get down about a failed experiment. Let those twelve hours or three months of preparation roll off your back if something is not going to work out. Daily life in the lab must be treated like a job. You show up every morning, you do your best, and eventually (because you didn’t stop trying) something is going to work.

-Be actively involved in your environment.

This is why doctors and researchers are always reading new journal articles in the field of interest. You have to keep up with new findings, new techniques, and what direction your field is going in. If you read or hear about a technique, a new transgenic model, or any aspect of science you’re unfamiliar with, pursue it. Find out what you don’t know. Admit ignorance. Little bits of great ideas can be pieced together to add to your own project. Take the best of what’s around you and you’ll be a well-rounded professional.

-Like the people around you.

What can make your workday one hundred times better? Working with friends. It’s essentially the same concept as getting along with your roommates. Yes, you all are different, and no, they aren’t going anywhere. Take advantage of the opportunity to learn about other people’s cultures, lives, and personalities. And certainly take advantage of the opportunity to like the people you work with. I am fond of everyone in the fish lab, but even if you are somehow inexplicably opposed to making friends with a particular person you meet, try to get over it. It will be much more enjoyable to work in a friendly and pleasant atmosphere. You will probably discover that everyone can be a great friend and resource at work.

Those are the first of my reflective thoughts on my last summer rotation and future research lab. I think they are applicable to almost anyone in the workplace, though. I hope everyone has a great rest of the summer!

07. August 2013 · Comments Off · Categories: PhD

Even when I get to sleep extremely early (for a 24-year-old’s standards), I still find it extremely hard to get up in the morning. I hit snooze on my multiple alarms for at least 30 minutes every morning before I can drag myself onto my feet. That habit of mine will probably not change. What is new in my life is that once I am up, I LIKE going to work. I cannot recall being happy to go to work before. Granted, I do have limited job experience as I am a perpetual student, but I am sure not everyone likes going to work.

Working in the fish lab is fun. It’s academic oriented, thought-provoking, involves some manual labor, and provides satisfying work. In my previous lab experiences I have always used cell lines, and although you do need to “feed” and clean the environment the cells live in, you obviously cannot see or interact with the cells as you care for them. In the fish lab, I get to observe my model organism, visibly appreciate my work, and find amusement in their behavior.

Typically in labs that use animal models such as mice, the lab has a separate animal care staff that feeds the animals and maintains their health and cleanliness. In our lab, every lab member (undergrads, masters, and PhD students) shares a small part in the total maintenance and feeding responsibilities, so that our fish are easily cared for and expertly handled. One of the clear advantages of this setup is that the people who study and experiment with the fish are actually taking care of their own scientific interests. This most likely leads to better care of our fish because we are personally and professionally invested in their well-being.

Another perk about working with the zebrafish is that I get to keep a very manageable work schedule. When I was working with cell extracts that are simply frozen until needed, I could do my experiments at any time that I was physically in the lab. In the zebrafish lab with an emphasis on circadian rhythms, every fish is kept on a precise light/dark schedule. The lights are precisely set to come on at 8am and go off at 8pm, everyday. This means that unlike working with solutions and machines where I could stay as late as 9:30pm to acquire some data, I am officially on the zebrafish’s sleep schedule. So I can only work (including experiments, feeding, and any maintenance needed) when the fish are “awake,” i.e. lights are on. No late nights, no super early mornings. I must say they are doing good things for my sleep schedule.

This week my mentor, another lab member, and myself started on a new project. Up until this week, I had been completing my training using my mentor’s experiments involving a component of the visual system (the optic tectum) to perfect my new skills, like using the confocal microscope and general handling of the fish for experiments. Now we started exploring a different angle on studying the neurological responses of the zebrafish and I hope to continue to develop this project throughout the rest of my summer rotation here.

02. July 2013 · Comments Off · Categories: PhD

As my summer session at NECO (with a couple courses and clinic time) is coming to an end, I will start working in my third and final lab rotation at the BU med campus. After this rotation, it will be time to official choose/be matched with a lab to complete my PhD at BU. So, the OD/PhD program I’m a part of is slowing transitioning over to the research component. After this fall 2013 and spring 2014, I will officially be at BU as a full-time PhD student.

I have already become decently acquainted with my current lab rotation at BU. I’ve been coming to the lab at least once a week this summer to observe and then started some hands-on involvement. This strategically (credit to my PI) will allow me to jump right into the research once I start full-time on July 8th. So far, I’ve learned how to catch a fish, feed the thousands of fish in the lab, set up fish matings, treat a fish embryo with cocaine, and learned why the zebrafish is an awesome model organism.

Every time I feed the lab’s zebrafish I feel like I’m working at SeaWorld. This is probably due to my many years of SeaWorld experience growing up in Florida where my dad bought us annual passes to the theme park many times. In the fish lab, I grow up shrimp, obtain the most delectable shrimp for fish food, and feed the live shrimp to the zebrafish. These fish literally hunt down the live shrimp. Consistent with a true predator, the zebrafish’s eyes can converge onto their target prey as they hunt for their meal.

The zebrafish is a great model organism for prenatal development, and specifically in this lab they study the effects of prenatal cocaine exposure. The fish are transparent in their first weeks of life, making the internal organs of a live fish visible under the microscope. I’ve seen the heart of the fish pumping, circulating the blood cells through its body. Another great aspect of the zebrafish is its incredibly fast development. You can literally watch the cells divide from two cells to four cells to eight cells, etc. in the microscope if you catch the embryo at the right time.

So as I excitedly look forward to more time in the fish lab, today was my last official clinic day for the rest of the summer. After the end of this week, I will start daily work at BU until the fall. It’s actually a refreshing change to work in science exclusively. Clinic was great experience and I look forward to more, but breaks are welcome, too. Clinic is stressful at times, of course, but that means you’re being challenged and will improve from those experiences. Patients come with chief complaints, risk factors, pre-existing conditions, and long lists of medications. After working exclusively with the pediatric population last year, it has been a very different world with adults and the elderly. I have learned much in my six weeks in clinic this summer and look forward to more experience in the fall.

For now, my fish will be excitedly welcoming me (as they have learned when food is coming) and I will continue my SeaWorld-esque fish life.

05. June 2013 · Comments Off · Categories: PhD

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.

02. May 2013 · Comments Off · Categories: PhD

I may not know the exact quote or who was the first to say it, but I know it’s about perspective. You cannot see the big picture for yourself, for a problem you want to solve, or some other event if you are bogged down by the details. I am perpetually guilty of staring at trees. I have the hardest time finding perspective, figuratively and literally. I get lost in minute details and I also have about zero sense of direction. I usually rely on my closest confidants to point me towards the big picture or the location I’m trying to get to, but there’s always Google Maps for the latter.

NECO had an event this past Thursday where the OD1s, OD2s, OD3s, faculty, administration, and special visitors gathered within the college to appreciate each other’s new ideas and accomplishments. Students are often absorbed in their assignments and other tasks, which are always pressing throughout the semester. This past Thursday, our “Educating the World Leaders of Tomorrow” event, let the college community appreciate the vision health care projects the OD1s made this spring, the research projects the OD/Masters students are currently working on that will be part of their final dissertations, and the business management plans created by the OD3s for a future practice setting. The day was a successful acknowledgment of the optometry students’ accomplishments made throughout the year and how fortunate we all are to have reached this point in academia.

A guest speaker, Jonathan White, PhD, came to give a talk to the OD2s about community involvement, service learning, and Free the Children, an international charity for which Dr. White is a board member. He spoke of startling accounts of child labor, hunger, poverty, populations without access to clean water, and illiteracy both around the world and in the U.S. Some things we knew or recognized and others we were hearing for the first time. He gave us powerful statistics about us humans living in the wealthiest time in the history of the world, yet still being riddled with poverty and unhappiness—the unhappiness not necessarily occurring in the impoverished areas. I learned from Dr. White that the U.S. is in the bottom one-third in self-ratings of overall happiness compared to all the countries in the world. Dr. White attributed this dissatisfaction within us to the lack of compassion we show to others. He showed us pictures of the Free the Children members donating their time and efforts to less fortunate populations in Ghana, West Africa. The volunteers help bring them clean water, build schools, and show them that “knowledge is power.” The happiness and reward the volunteers both spread and received was undeniable.

Dr. White spoke with both striking passion and jovial approachability. If you took nothing else from Dr. White’s lecture, you at least left with the impression that the forest is so much larger than the trees you have been staring at lately. After some particularly well-taught lectures in optometry school, the class will applaud the professor at the end of lecture. Dr. White received the loudest applause I’ve heard so far in my two years at NECO. I think we were all appreciative of the opportunity to learn from someone so worldly yet extremely modest, who has impacted thousands of people across the globe.

01. April 2013 · Comments Off · Categories: PhD

It’s proficiency time for the OD2s right now. We are all tested on the techniques we have learned since the beginning of the semester, so for this proficiency we have to perform techniques that evaluate the angle at the anterior chamber of the eye (gonioscopy) and the retina at the back of the eye (90 D and BIO). The former includes physically placing a lens onto the anesthetized eye and the latter involves dilating your patient’s pupil to get a wide view into the eye. This is our LAST proficiency in our Principles and Practice of Optometry (PPO) course. The next time we will need to perform these techniques under tested conditions will be to pass part III of the national board exam.

The third and final part of the national boards is evaluating your performance on all the skills and techniques you may have to use at some point in your day working as an optometrist. It covers the techniques of every proficiency we have had at NECO (in all and any classes), performed all at once, which is what you will be doing in your optometric exams. We take part III at the end of our 4th year at NECO to complete the process of obtaining our license to practice optometry.

Frankly, I’m glad to have more than two years left to practice my techniques as I work in clinics under licensed preceptors. Experience is the only way I am going to become consistently proficient in all clinical skills, patient communication, and comfortable making my own decisions on how to monitor, treat, refer, or prescribe for patients.

When I was in undergrad and applying to optometry schools, many people were shocked after I answered their question of “how many years is optometry school?” They couldn’t fathom how a doctor of the eye needs four years of school. “There isn’t that much to the eye though,” they would say. Well, there isn’t four years worth of anatomy to the eye, but there is four years worth of what an OD can see in the back of the eye, the techniques it takes to do that, using retinoscopy to objectively find out what glasses prescription a person needs to see without them saying a word, contact lens fittings, recognizing retinal dystrophies, corneal dystrophies, optic nerve head malformation, glaucoma, age-related macular degeneration, amblyopia, strabismus, cataracts, and much more. I will admit that even I did not know the scope of material that optometry encompassed before I started at NECO.

The increase in difficulty of clinical techniques and amount of credit hours taken in second year has been challenging, but OD2 spring semester (which we are in now) is the most difficult semester at NECO. I think my class is seeing the light at the end of the tunnel now. We are already over halfway done with the toughest part of NECO and everything gets more relevant to patient care from here. Third year we will all truly start to feel like clinicians, gaining more independence from our preceptors as we are capable of performing the entire routine, comprehensive eye examination after this proficiency is done! The rest of our time in PPO’s “pre-clinic” will be learning more auxiliary techniques and refining our skills to be able to adapt to any clinical situation in our future.

Excellent job to the OD2s who already had proficiency this week and good luck to all those in next week’s rounds!

28. February 2013 · Comments Off · Categories: PhD

I want to discuss personal happiness with your place in the world. A really great quote that impacted me years ago went something like, “You can either change your situation, or change your reaction.” I don’t remember who said the quote or even where I heard it, but it still rings so true. When you find yourself in an unpleasant situation, you have two options. (1) Change the situation so you are not in it anymore (2) Change your reaction to the situation you are in.

If your current dilemma is truly out of your control, you must choose the second option and then you can be happy with where you are at that point in time. The great part of this kind of life tip is that you are in control of your own happiness. You can defeat any unhappiness by twisting your state of mind, doing some mental push-ups, or whatever gets you to morph into your old happy self.

This technique (a meditation of sorts), although I fortunately do not need to use it often, has really made all the difference in some periods of my day when I feel completely despondent. I can’t help but dwell on my issue at hand, but after some time I need to move on. By changing my reaction or emotional response to a situation, I can choose to be happy again.

The unpleasantness of midterm season is here and I am going to try to apply my technique to studying for my exams.

Why is it that I enjoy knowing things, but I don’t enjoy learning them? I’m a person that likes to learn—I love science, I’m curious about things I observe, but why do I procrastinate in studying? Why does it take extra effort and a double shot of espresso to make me sit down at my desk and read powerpoints? Could I twist around my mentality in order to make studying fun?

A friend of mine once helped motivate me to study in a similar way. This is how he thought about the situation differently (i.e. changed his reaction): a textbook is the highest intellectual compilation of knowledge on a specific subject that exists. It only exists because of the millions of hours of research done by scientists before my time. The enormous workload and endless experiments conducted in the past to discover the intricacies of human physiology are all displayed in front of me in black and white text (and pictures)! All I have to do is read it. A scientist’s life’s work, for example, the elucidation of the structure of DNA, can be taught to me in a few minutes. Rosalind Franklin had to perform x-ray crystallography on DNA helices. All I have to do is read and learn.

I hope this more appreciative perspective will help keep me on task during the next two weeks. I will be doing many hours of studying between now and then, but it is nothing compared to the work done before me to make this information so easily accessible, interpretable, and applicable to human health.

Good luck studying to fellow OD2s!