Guide to Fourth Year Externships & Rotations

Fourth year is an exciting time in optometry school because it’s your last year before entering the real world as an OD! While every school differs in their externship selection process, externships available, number of externships required, etc., – the goal is the same. The ultimate goal of fourth year and being on externships is to gain clinical experience in various specialties and practice settings in preparation for the start of your career as an optometrist.

Three current fourth years – Jessica Chan (ICO), Chris Lopez (UHCO), and Marcus Noyes (UHCO) teamed up to put together this guide to help you choose and prepare for externships. If we knew then what we know now!

Things to consider when choosing your externships:

Expectations and goals of the externship: What duties/responsibilities will you have at the externship site? Some sites allow for more autonomy whereas others may involve more oversight. What are the demographics of the patient population? You may see many different diseases based on the patient base. Plan your externships to help you develop your skills and knowledge base, and choose sites that will challenge you.

Your interests: You may want to consider choosing sites that resonate with your interests. For example, Chris says, “I absolutely DREAD specialty pediatric clinic. I just don’t enjoy working with kids, and that’s okay. So I’m not going to choose an externship site that performs a lot of exams on children, because that’s not what I want. However, I have a deep passion for specialty contact lenses. Therefore, one of my externship rotations will be at a widely respected private practice in Houston that deals almost exclusively in specialty contact lens fittings on patients referred from offices all over Texas. It’s good to know what you like and want!” However, Jessica likes pediatrics and contact lenses so she chose her first two sites and extra clinical hours to be in these areas to hone her interests and plans after graduation.

Residency: Are you considering applying for a residency after graduation? Consider selecting a site in the specialty you’re interested in for earlier quarters (e.g. summer or fall) so that you can have a better idea of your interests by the time residency applications open (usually around October). You may also consider choosing sites that have residency programs that you may be interested in.

Practice modality: Are you looking to gain experience in certain modes of practice? Externships are available in VA hospitals, private practice, multidisciplinary group practices, and even corporate settings. Don’t be afraid to try different types of clinics! For example, even though Marcus is definitely going to be going into private practice after graduation, he chose a government hospital/clinic for one of his sites to gain extra experience in pathology.

Location: How important is location to you? Maybe you want to pick a site where you can have easier housing, such as living with family or friends. Will you have to drive far to the site or is it within walking distance? You may also want to find a site in an area where you want to practice because you will make some great connections in the area.

Special circumstances: We are adults and life happens! Do you have important dates that you want to take into consideration? At the very least, you will be taking Parts 2 and 3 of the NBEO and traveling to Charlotte, NC. And don’t forget about conferences!

Many schools have their students choose externships with a lottery system, and you should be prepared when it is your turn to pick. Do your research on the externships available by visiting the websites of the externship sites, reading evaluations (if available), and asking previous students about their experiences at the sites. Take notes on the specifics of the sites you are interested in and jot down pros and cons so that you don’t have to go back and do the work twice. Be organized and create a list ranking your sites so that you aren’t blindsided if one of your classmates picks your top choices. If one or more of you favorite sites gets selected, you will need to have backup options ready to go.

Things to consider while on your externships:

Your personal goals: What are your goals at each rotation? Are there certain areas where you want to gain more knowledge or improve in such as skills, efficiency, patient education, etc.? Use this time to help you and learn more about yourself as a clinician. Your patients are no longer optometry students with normal eyes, and you no longer have to sit for others in order to practice. You are basically in clinic all day everyday so take advantage of it! Additionally, what is your plan after graduation? Use your externship experience to help answer any questions and uncertainties you may have.

Use your time wisely: Being on externships means that you won’t have to study for exams or practicals, leaving you with more free time and (hopefully) less stress. Use this time for yourself – whether that means picking up a new hobby, exercising, researching jobs, researching residencies, studying for Parts 2 and 3 of boards, etc. Use it or lose it!

Be prepared for your next site: You may want to review pertinent notes, articles, textbooks, etc. before your next externship begins. Start early so that you aren’t stressing out during a break week when you have to move out.

Allocate funds wisely: Being on externships makes it difficult to continue working if you have been, and you may have to factor in traveling. While you may be in a new city that you want to explore, don’t overdo it and spend too much! Also, don’t forget that you will have to sign up for Parts 2 and 3 of boards.

Sunset Through Truck Rear View Mirror on the HighwayMake the most out of each experience: Your fourth year of optometry school is all about building confidence. Something we hear over and over again from different preceptors at various externship sites is that students tend to remain tentative and lack confidence in our diagnosis, management, and treatment strategies for treating ocular conditions. Remember we’ll all be doctors in less than a year, so use your externship sites to enhance your clinical skills, absorb information like a sponge, and improve your confidence. It is through uncomfortable situations and wrong decisions that we continually learn. Don’t be afraid to ask questions, and take away something from each experience. Asking questions teaches us how to think, not what to think. This is your time to learn; you are paying tuition after all!!

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