Article Date: 10/1/2008

Getting the Most Out of Externships and Residencies

Getting the Most Out of Externships and Residencies

Gain the confidence you need that only comes from real-world experience.

By Jamie J. Casper, OD, PhD, Wilmington, NC

YOU'VE ROTATED through clinics for every specialty, and now you're ready to walk out that door for a while. Your externships will give you hands-on experience in the field and build your confidence. And when you've completed your externship, the ultimate professional preparation awaits you in an optometric residency.

Choosing an Externship

As part of your optometric college curriculum, you may need to choose two or three externships, 3- to 6-month rotations typically completed during your third and fourth years. This is your first opportunity to gain field experience. Although these externships are assigned, some preference is given to students who have suggestions. Here are some benefits an externship can offer.

Expanded learning: Externships can help you get handson experience in different specialties, such as ocular disease, contact lenses or primary care. You can request a primary care private practice or a specialty clinic, or you might choose a tertiary center, combination ophthalmology-optometry practice, or VA hospital to learn more about ocular disease. In some cases, it's possible to do on-site externships at your university eye clinic.

Be prepared to demonstrate your learning. Colleges usually ask you to keep patient logs and attend lunchtime meetings where externs present interesting patients to each other.

Expanded circles: In addition to offering additional areas of practice, externships can help you step outside the confines of your colleagues and school. When I was at Ohio State, I enrolled in a primary care externship off-site at a private practice, and I did my disease externship at a VA hospital.

I wanted to live in a different part of the country for 3 months and work with students from other schools. The VA hospital in Salisbury, N.C., had students from 4 other schools, and working together gave us an idea of where we stood in terms of education. We had different backgrounds. I was experienced and comfortable working with children, whereas another student had a stronger ocular disease background. We learned from each other, and we remain friends today.

Expanded horizons: Of course, location is another factor in choosing an externship. If you want to stay near your school because you're married or have family close by, you'll find opportunities that will suit you. I was open to new experiences, and my number one goal was to find a place where I wanted to live. And it worked. My externship in North Carolina motivated me to move there permanently. However, if there aren't many externship choices near your school, you may have to go out of state.

Reap the Rewards of Residency

My residency made me a better doctor. I liked my disease externship, and I wanted an emphasis in ocular disease. I started thinking about doing a residency during my second year after a fourth-year student told me about the benefits it had to offer. Optometrists told me that doing a residency was one of the best decisions they ever made, and I whole-heartedly agree.

The experience and confidence that you gain from a residency are unsurpassed. I felt that I wanted to see more patients to enhance what I'd learned in school. The residency gave me the opportunity to see a high volume of patients with someone more experienced beside me to provide immediate feedback. This kind of learning is hard to find in practice right after school. Now that I'm in practice, I'd say that 1 year of residency is equivalent to 2 to 5 years of private practice experience.

I did my residency at a tertiary referral eye center where optometrists referred patients for medical and surgical care. For an entire year, I worked with optometrists and ophthalmologists treating ocular disease and trauma. I didn't fit contact lenses, and I didn't write many spectacle prescriptions. I was focused on treating ocular disease and learning about surgical management.

When it was over, I felt there weren't many conditions I hadn't seen. I had confidence treating patients with diabetes or post-op LASIK and cataract patients. I'd seen hundreds of patients with the same problems in my residency. I'd watched foreign body removal hundreds of times in workers from a local Jeep plant, and I did it in practice without a single worry.

As long as a patient doesn't require surgery, I can treat with confidence. It would have taken me many more years to achieve that confidence and comfort level without a residency.

Finally, you'll find that if you're looking for professional contacts, your residency will help tremendously. I came to know many of the optometrists and surgeons through the referral network. Because I enjoy lecturing, I lectured with other doctors as well. Now, those doctors are friends and colleagues, and they would be excellent contacts if I were looking for a new opportunity in a different area.

The residency director is a wonderful employment contact because doctors often call the director for leads when they have an opening. I've even taken professional trips to Haiti with my residency director, and I called him recently to discuss a rare tumor I detected in a patient.

How Residencies Work
After you graduate, you can go into the workforce, pursue a higher academic degree like an MS or PhD, or go into academics. Or you can choose a residency.
You'll get more experience and confidence out of a 1-year residency than you'd get in 1 year working almost anywhere else. You also get enough pay to live on and be self-sufficient, and some residencies permit you to work weekends in private practices, which I did. Even if you've already been practicing for years, you can always go back and do a residency in your area of interest — or area of deficiency. Here's how:
Choose: Residencies typically take place at VA hospitals, large, multidoctor tertiary centers and schools. Most pediatrics or contact lens residencies are associated with optometry schools, where residents might do some teaching as well as treating.
You can find a full list of accredited residency locations at the Optometric Residency Matching Service (ORMS) website, but most residency programs are affiliated through schools, so check your school's list, too. At the end of my second year and beginning of my third, I started visiting the residency sites that interested me, talking to residents and interviewing with residency directors.
Apply: After you interview at possible residency sites, you apply to them through the ORMS website. You rank your choices 1 to 5, and the residency directors rank their applicants in the same way. The ORMS service matches residents to institutions by comparing these rankings. A perfect match is 1 to 1 — you want them the most, and they want you the most. The process is a little stressful because you might not get a slot, but it's fast.
Complete the residency and show off your work: The year of experience is priceless. You'll work hard and learn a great deal. You're typically expected to produce research projects, write papers or posters, or create continuing education (CE) courses. I put together about 6 hours of CE courses for doctors in the area. At the end of year, you must do case reports for the university, which you present to residents and residency faculty to demonstrate that you've increased your proficiency. You'll also earn points toward fellowship in the American Academy of Optometry.

On the Road to Professional Success

Your residency won't be easy, but it will be one of your most rewarding educational years. The experiences are invaluable and hard to find elsewhere, and the personal and professional connections are a welcome — and priceless — luxury. nOD

Dr. Casper is a graduate of the College of Optometry at The Ohio State University in Columbus. He works in two private practices in Wilmington and Southport, N.C. You can reach him at

Optometric Management, Issue: October 2008