Fourth Year Life

Hi, all!

I have so many things I want to share with you about the wonderful life of fourth year! Time is just flying by like always, and it is hard to believe we are already one month into our second rotation of fourth year. My class is the first to do three rotations rather than four. I personally like having three because I feel I have the opportunity to really get comfortable in the setting rather than spending time orienting. Fourth year is such a unique time in optometry school because you are applying all your knowledge in the clinical setting, taking board exams, moving every four months, learning new electronic health record (EHR) systems, learning different office/hospital/clinic styles, and pursuing plans for after optometry school. Just like everything in optometry school, once you start feeling comfortable, it is time to move on to something more challenging.

Amidst all of the chaos of fourth year, I am trying to savor every moment. I am trying to soak up every piece of knowledge and advice I can get from my preceptors (doctors who oversee your work while on rotation). I remember very vividly what it felt like my first year of teaching to close the door to my first period physics students knowing that I was the captain of the ship and had no one else to lean on at that point. I know very soon I will close the door to my exam room and will be signing my own charts, my own prescriptions, and have to make medical decisions all on my own. Obviously you are truly never alone, but I know the day is coming where I can’t just step out of the room and get a second opinion. As uncomfortable as it is to have your preceptor ask you how you want to manage a condition you may have never seen or only saw in a book, it is better to go through that uneasiness with an experienced clinician by your side rather than without, in my opinion.

So where am I now? I am currently at the Cincinnati VA along with a classmate. A lot of the VA sites have two students, so you are not alone, but that is not always the case. We also have VA residents at our site, which I find to be a great learning opportunity. We all share an office space, and I enjoy hearing their discussions of patient cases. Typically the residents get more of the challenging cases and do more of the acute care, but truthfully, the VA is full of interesting cases. I am finally at the point of feeling like I can just enjoy my time here. I remember Dr. Goedde telling us that students would call or email her hysterically the first few weeks they were at the VA because it was such a difficult learning curve and then they would suddenly be okay. I have not been hysterical, but I would say I was certainly uncomfortable the past few weeks. It is difficult to adjust from a private practice setting to a government clinic. It is always the little things that get you all sorts of flustered when you first start out in a new clinic. For instance, at the VA, all of your exam room supplies are stored in a locked room, in password protected cases. I ran out of tissues in my room, so I needed to find the right key, then figure out my username and password, then figure out how to operate the case, just to get a box of tissues. I find those little things to be more stressful than the patient care! I am excited to finally be past the orienting phase and really just focusing on learning how to treat and manage ocular disease, which is the focus of this rotation. I felt really well prepared to treat and manage glaucoma when I was taking our glaucoma class last summer, but in reality, it is so much more nuanced. I am thankful that in a typical day I see 3-7 glaucoma patients, so I will hopefully graduate fully prepared to manage glaucoma.

The Cincinnati VA is probably a little unique in that I have a variety of clinics within the VA. I have a half day of contact lens clinic where we only fit contact lenses including specialty fits for things like keratoconus. I have a half day of low vision where we assess various aspects of a person’s visual system with a focus on making a person’s activities of daily life and hobbies more accessible. It is a really impactful experience to be in a low vision clinic where I see patients who are light perception only in an eye from glaucoma. It helps me to realize how critical our decision making is in preventing and treating sight-threatening diseases. I also have a half day of traumatic brain injury (TBI) clinic, which is focused primarily on treating things like double vision and light sensitivity. The rest of my days are primary care where we do full exams either from start to finish or a tech gets the patient worked up to dilation, and then we do the refraction and health exam. One fairly universal thing about VA care is that you typically rotate between patients. At the college, you see the same patient from start to finish and stick with their care the whole time. At the VA you do the exam up to dilation, then while the patient dilates, you get another patient and work them up to dilation before doing the dilated fundus (retina) exam on the first patient. The switching between patients is a common practice in private practice, but it takes some getting used to. I also have the opportunity to go to the ophthalmology grand rounds at the University of Cincinnati every week and we have our own lecture series once a week. I very much enjoy these extra experiences because I find lectures to be more impactful now that I am in clinic. It is nice to get a refresher on a familiar topic or learn something new that you can apply right away.

I have so much more I want to tell you, but I need to go in early to do some chart edits tomorrow. At this VA, we print all of our charts, the doctors edit them, and then you fix the chart. It is a hassle, but I like learning what needs to be in the chart and learning to write things in a more sophisticated way. I can say the extra time has been worth it to learn how to document more like a doctor than a student.

Just in case you are curious, my first rotation this summer was at OSU’s Upper Arlington Outpatient Care facility, which runs like a private practice. I could write for days about how much I loved that site. I truly woke up excited every single day to be there. Unfortunately, I need to go to sleep, but stay tuned for more fourth year updates!