Article Date: 10/1/2004

All Externships Are Not Created Equal
This is your chance to break away from the pack. Here's what to look for in an externship site.
By Michael Cymbor, O.D., State College, Pa., Pennsylvania College of Optometry '96

Until now, you and your classmates have shared similar educational experiences -- the same instructors, the same courses, the same textbooks. But now, you have an excellent opportunity to broaden your clinical experience and differentiate yourself as you seek your practice niche.

Is an externship really all that? Absolutely. Where you spend your externship defines you as a practitioner more than anything you've accomplished so far. You'll gain valuable, real-world experience, usually in private practices, hospitals or group practices specializing in ocular disease. Choose wisely.



You may be wondering, "What's the fuss?" Won't a private practice in Anytown offer the same experiences as a private practice in Somewhereville?

Well, fast-forward to graduation and imagine that you're talking to classmates you haven't seen since you started your externships. Comparing experiences, you're surprised to hear comments like, "I saw a ton of glaucoma," "I didn't fit a single GP lens," or "All I did was watch my preceptor do refractions all day."

It could happen. All externships aren't the same. The choices you make now could have a significant influence on your career in optometry.

So how do you choose?


Your optometric tastes likely will change as your experience broadens. Just because you enjoy contact lenses now doesn't mean you should spend all your time looking for a great contact lens site while ignoring other areas, such as ocular disease or pediatrics. Conversely, just because you can quote data from the Ocular Hypertension Treatment Study in your sleep doesn't mean you should ditch your Brock string.

Some of my classmates put all their eggs in one basket only to regret their choices later. Try to choose sites that are strong in all categories, knowing that your interests might change.


What should you look for in an externship site? Here are six key areas to explore:

Diagnostic instrumentation. Look for a site that has cutting-edge instruments so you can "test drive" the latest technology. Learning how to perform and interpret tests with the GDx VCC, the HRT, the Optomap Exam and the Stratus OCT, for example, will help you hone your diagnostic skills and  expand your knowledge of disease progression and treatment efficacy.

Does the site use digital imaging? Ask your preceptor if you can copy photos to CDs to start your own library of interesting cases. Does the site have a corneal pachymeter? It should if you're going to manage glaucoma and refractive surgery patients.

Any site that claims to have expertise in any of the above areas while lacking the proper diagnostic tools should be suspect.

Contact lens advancements. A contact lens specialty site should have a corneal topographer. You'll need one to help you manage keratoconus and pellucid marginal degeneration, to fit contact lenses on postsurgical patients and to screen refractive surgery candidates. What's more, most corneal topographers have contact lens modules that let you change contact lens parameters and observe theoretical changes in fluorescein patterns. This is a valuable learning tool for most externs.

Silicone hydrogels are quickly displacing older lens materials, and fitting experience is important. Look for a comprehensive diagnostic fitting set of silicone hydrogel lenses at any contact lens specialty site you're considering. And while you're checking out fitting sets, look for a GP fitting set and modification instruments, as well. You'll get the most from a contact lens externship site that gives you experience with all modalities.

Spectacle advancements. Despite advances in ocular disease therapies and contact lens technology, spectacles remain a strong profit center in most eyecare practices. Skipping an opportunity to gain experience in the spectacle lens area could be a costly oversight.

If your externship site uses molding systems or has an on-site finishing lab, ask for some hands-on training in these areas. Does the site use virtual frame fitting software? Give yourself a tutorial. And look for opportunities to try your hand at adjusting frames. While all this may seem ho-hum, you should take the time to learn these skills. Your future patients will thank you.

Access to ophthalmic literature. A good preceptor will encourage you to stay abreast of current research, a task made easier by high-speed Internet access and a reliable printer. A comprehensive library of journals and textbooks on-site is a definite plus.

Geography. Are you thinking about practicing in a particular area? An externship is an excellent opportunity to investigate unfamiliar territory. You'll have some time to check out the local flavor while researching demographic and economic factors.

Quality of learning experience. At the end of any externship, the most important question is: How much did you learn? Did you perform your own exams and make your own diagnoses and treatment plans or were you merely a spectator? Did you see enough glaucoma to be comfortable setting target pressures and choosing therapies? Did you fit any specialty contact lenses? And most importantly, did your preceptor challenge you to think like a clinician every day and bring you closer to being a doctor?

An externship site that has last year's diagnostic equipment or a less-than-perfect geographic location still can offer a quality education by engaging you fully in the optometric experience.


Researching prospective externship sites and asking the right questions can ensure rich learning experiences that will help you realize your full potential.

Dr. Cymbor is a practicing member and director of externship programs at Nittany Eye Associates, State College, Pa. You can reach him at



Narrowing the Field

Want to learn more about the externship sites you're considering? Ask some insiders.

Previous externs. Some of the most reliable and valuable information about externship sites comes from students who've worked there. Most schools will give you a list of previous externs for any given site.

Director of externship programs. Ask your school's director for a list of preferred sites. If he or she skirts the issue with a general "all sites are recommended," rephrase your question. Ask if the site you're considering is one of the top 10 in its category. Press this issue if necessary because these individuals truly know the best sites.

Externship site preceptors. You can learn a lot about an externship site by talking with the site preceptor. Face-to-face meetings are best, but any communication with the preceptor will give you valuable information. Unwillingness to meet with you or failure to return phone calls or e-mails promptly are red flags. They may indicate an organization problem or a lack of interest.

On the plus side, a preceptor who's a member of the American Optometric Association or the American Academy of Optometry is likely committed to the profession with more than a passing interest in the latest clinical advances.

School records. Most optometry schools maintain an information database for each externship site. Use this resource to research a site's technology, hours of operation and the number of procedures (such as gonioscopy or punctal occlusion) that externs are expected to complete.

Site visits. Tour as many sites as possible. Take in your surroundings, making special note of staff morale, technology and the physical environment. A first-hand look can help you decide if a particular site will meet your expectations. 



Optometric Management, Issue: October 2004