The Optometry Student's Guide to Your First Patient Encounter

Feb 27, 2020
7 min read
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What you should know for your first days in clinic—what not to do, what to do, and what to expect.

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“Why are you so nervous?”

These were the dreaded words spoken to me by my patient on my first clinic day. No intern wants to hear this from a patient—but there I was, unsure how to continue and even more nervous than before. How do you recover from a moment like this? Unbeknownst to me, I had been shaking my leg out of stress, due to my fear of not finishing my exam on time. Why did they have to call me out?

Most optometry students will be nervous in their first patient encounter—I certainly was! But it’s crucial to recognize that this is normal. We’re learning and growing, and each new patient is an opportunity to grow our skillset. For those of you on track to complete your first full eye exam, that day is coming even sooner than you think. Whether or not you’re nervous, here are some tips and tricks on how to make the most of your first patient encounters.

1) Ask questions

Ask for help: Often, we students steer towards the mentality of “fake it ‘til you make it” in an attempt to impress our supervisors. However, this leads to lost opportunities for learning. You will find out that the earlier you learn from your mistakes or ask for clarification, the earlier you will grasp how to accurately do a technique or complete an analysis of a case. This avoids the awkward situation of fearing to ask a question later on in your optometry education. Ask now when it is easily understandable why something is confusing to you. We are students at the beginning of our journey!

Ask for feedback at each break: this is key for improving. Often our supervisors get busy, and they forget about certain issues they noticed throughout the day. The earlier you can get a chance to discuss your performance with them, the more detailed their responses will be. Remember to be specific when you ask for feedback. Narrow it down because a vague response will not be helpful to you in the long run. On the other hand, although you thought your performance was perfect, a supervisor may pick up on areas for improvement that you may not have considered. Leave some time at the end of your day to discuss any concerns with them. They will be a great resource for you.

2) Breathe

Mistakes happen, and that is why we have supervisors to help us along the way. If there is a hiccup during your exam, take a second to stop, breathe and start again. At any point in the exam, you can always choose to “start again.” This doesn’t mean redo all your testing but rather to take a second to compose yourself and continue on with a new attitude. Don’t get caught up with how many mistakes you have made so far.

Don’t let one patient’s attitude affect the rest of your day. In my instance above, I had to take a step back and recognize that I am a new intern and it is okay for me to feel nervous. With each exam, my nerves calm down more and more. This patient taught me the importance of a steady hand and body language and I will keep that in mind for the future. Show confidence in your skills and discuss your areas for improvement with your supervisor when it is appropriate.

3) Challenge yourself

Each clinic day, try and set a goal for yourself to try something new OR perfect a common technique. Perhaps you are having issues with your fundus biomicroscopy views and want to set a goal of getting great views while avoiding glare. Read up on tips and tricks for this technique the night before and write down some notes you can quickly review. Having a supervisor nearby makes the clinic a great place to test out a new technique. They may provide you with tips on how to do it or help you troubleshoot if it doesn’t go as planned. Walk into each new day without fear of failing. This is the best time to fail and the safest place to do it.

As a professor at my school always suggested, keep a small notebook in your back pocket. As students, there is a lot of knowledge for us to absorb. We don’t always have time to look into a topic right away so keep a small book to jot down points to be researched later on. For example, if an unfamiliar medication is brought up, write down the name and look up the purpose, mechanism of action, and possible side effects at a later time, even if it may not make a huge difference in your assessment. Learn from every opportunity.

BONUS: What NOT to do

1. DON’T copy down all the data from the past exam

Errors from previous students are often carried out for years from this mistake. Trust your measurements or ask your supervisor to recheck it!

2. DON’T pretend like you’re getting good views

If you aren’t seeing something, ask. Better to learn now than be confused at a later stage when you definitely should be seeing it well.

3. DON’T spend too long stuck on one technique

If the patient is not cooperating, move on. They may be better at a technique after some rest.

4. DON’T wear uncomfortable clothes

These are not the perfect days to whip out those brand new heels. Your discomfort may distract you from completing the best exam possible. Don’t worry, you will work your way up to comfortably strutting down the hall in no time.

5. DON’T get there BARELY on time

Leave 30 minutes before your patient’s appointment time to settle in, set up your equipment (if needed) and read over their file. You need this time to quiet your mind and get into the right headspace. The last thing you want to be is flustered by barely making it in time.

No one is immune to mistakes and nerves. The most important part is how we recover and learn from them. We can either choose to get caught up in the moment and berate ourselves on our lack of knowledge OR see it as an opportunity to grow. Each patient we see while under supervision is a chance to practice a new skill, test out a new communication strategy or increase our speed.

For those of you who have yet to experience completing a full eye exam, your first day will be here sooner than you think. You will be out of the pre-clinic and into an exam room in no time. The first few exams may not be easy, but you will surprise yourself with how fast you can grow and learn from your mistakes.

Maybe you’ve already experienced your first day in clinic, sitting in the swivel “doctor” stool with a patient in front of you. Perhaps it was nerve-wracking and you weren’t sure what to do next, looking hopefully over your shoulder for a supervisor to tell you what to do. Or, maybe it felt like a relief to be finally able to do an exam on your own. Regardless of how you felt back then, you have come a long way and now it is your turn to pass on your wisdom. Share your most treasured pieces of advice by leaving a comment below.

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About Cindy Shan, OD/s

Cindy Shan is a student at the University of Waterloo School of Optometry and Vision Science. She is the Class President for the Class of 2021 and the Director of Internal Affairs for the UW chapter of AOSA. She has a special interest in practice management, specialty contact lens and myopia control. When not engrossed in building a career in optometry, Cindy loves to travel and explore other parts of the world, test her skills at DIY projects and hike the beautiful mountains in British Columbia.


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