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As a practice owner who hires associate optometrists, I've noticed a way to improve the basic clinical skills of new ODs, especially in the area of refraction. Students are typically first taught clinical procedures and refraction techniques in a laboratory setting where they practice the test procedures on fellow students. Instructors observe the activity, provide hands-on training and correct errors made by the students. After proving proficiency in clinical procedures, the student is permitted to examine real patients in an eye clinic setting associated with the school. These eye exams are monitored closely by clinical faculty who teach the finer points of the art and science of vision care. As students reach their final year of training, they are assigned to clinical externship sites all over the country, ranging from major eye hospitals to private optometric practices. Once again, an experienced optometrist observes the student, reviews the data and teaches how to exercise professional judgment.
I believe the quality of optometric education is at an all time high and the process described above results in top caliber graduating clinicians, but here is what would make it better. I think the students should spend more time observing experienced optometrists at work. As basic as that might seem, it rarely happens in our present system. Highly skilled ODs observe students all the time, but rarely is it the other way around. Students often observe fellow students, including those a year or two ahead in the curriculum, but so much more could be learned by watching a veteran OD. Students who have mastered the mechanics of refractive testing with the phoroptor stand to gain more from the observations than the uninitiated. If you don't know how to refract it does little good to watch an OD fog and unfog, select various lines of acuity, use the JCC, obtain reversals and perform a binocular balance.
Much of the value of observing a veteran OD in action comes from the communicative and interpersonal skills that are so closely tied to the testing procedures. This is how one becomes an excellent doctor. Expanding on the case history, relating the exam findings to the complaints, explaining the tests and treatment recommendations without overdoing it, and confirming tests with the use of hand-held trial lenses are all examples of how patient communication is critical to a good outcome.
If you are an experienced optometrist who works with students, consider inviting (requiring?) them to observe you in the examination of patients.
Here is a technique that I've used in my practice to help new associate optometrists improve their clinical skills while training them on the policies and procedures that are unique to our office. If you hire a new graduate right out of school, he or she generally graduates in May but will not receive a state license until July or August. Consider hiring the new doc to work as a technician in your practice until the license is official. I would pay the doctor-tech a generous wage at the high end of the tech scale and I would expect the same work as any tech, but include scribing even if that is not typically done in your practice. Recording for the senior OD should be easy and the observational training occurs automatically. Additionally, the new grad will learn real-world skills in optical dispensing, automated instrumentation and insurance calculations.
This “learn-from-the-ground-up” approach will make the new associate a better doctor. With the right attitude, he or she will form a strong bond with the other staff members while working as one of them. If the new doc acts like he is too important to do technician work or dispense eyewear, I would question if this is the right associate for your practice.
Why don't we ever talk about refraction?
At the risk of sounding like Andy Rooney on 60 Minutes, did you ever notice how optometrists never seem to talk about refractive testing? Why is that? When was the last time you saw a continuing education lecture or journal article on the topic of refraction, or the art of prescribing glasses? ODs seem quite comfortable sharing knowledge about diagnostic procedures for ocular disease, why not refraction and lens prescriptions? It seems to me that we all spend considerable time doing refractions and interpreting the data, one would think we would have some ideas to share.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
Dr. Gailmard's new book, Practice Management in Optometry: A Blueprint for Success Based on the Optometric Management Tip of the Week, is now available on Amazon.