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  • Writer's pictureLFaits

A Guide to Externship Selection

As a prospective student, I was always curious to know how externship selection worked. All my life, the best everything was awarded to those with the highest grades (or “marks,” for my fellow Canadians) or standardized test score. Personally, I think they deserve it. I expected externships to be no different–students would be ranked by their GPA, clinical skills, perhaps leadership involvement, and then allowed to select accordingly. The top-ranked students would get to choose whatever their heart desired. Seriously, if you have a 4.0 at ICO, I think you freaking deserve top choice, you smarty pants, you. Actually, I’ve heard rumors that this is how it happens at some other optometry schools, and even at ICO in the past.

But that’s not how it happened for the class of 2015. So friends, get ready to hear all about the most draining, complicated, twisted mind game ever invented. As blogger Michelle once observed, it’s almost like a fantasy football draft. Except this affects your future for the next year, and possibly longer, depending on the type of experience you have.

Disclaimer: This guide reflects the experience of my class only. It may change for your class, depending on what style you vote for and ideas from your class reps. Here’s a neat little diagram in case you get lost:


Plan ahead, but not too far

So I was a keener, and I started looking up externship sites way too early. Yeah, first-year early. I’ll tell you this, I got none of the sites I intended to get in first year. What did I know in first year? Anatomy, physiology, I miss home, I want to see my friends, California is warm, etc. In first year, I thought I was going back to Toronto or close by if it were humanly possible. I’m Canadian afterall, I can’t practice most things I’m taught here anyway, so why bother? Right?

Totally wrong.

Actually, all the sites I wanted to go to closed down. It didn’t matter though. Why? As I saw more patients and learned more optometry, my experience during my last year of ICO mattered. My friends will be there when I get back to Toronto, I made new friends while I was at ICO, and optometry is what I forked out $200,000 to learn here. Before I leave, I want my last moments at ICO to be nothing less than all about me learning to be the best doctor I can be.

Sites can change even in the month leading up to selection, so be prepared. Sites close, new ones open, and you just have to have faith that you’ll get a good learning experience.  Don’t get too caught up with where you go. Have some back-ups. And remember, whether you love it or hate it, externships only last three months.

Read the memos–all of them As we get closer to selection, we had a short meeting about what to expect: 35 credit hours of primary care, 10 hours of contact lens, 10 hours of binocular vision/pediatrics, 5 hours of low vision, 10 hours of advanced care. We also get a ton of emails. My suggestion is to read them all carefully. If you ask a question that’s already answered in the memos, you will get called out on it. It doesn’t matter if the memo is 16 pages long. The memos can change your mind about where to go and when for your selection, so it’s pretty darn important. 

The diluted version of the draft This is probably the most confusing post I’ve ever written. I can’t guarantee my explanation of how it works will make sense, but I’ll give it my best shot. Our class is divided randomly (computer-generated, no particular order) into three groups; top, middle, and bottom third. Within the three groups, we’re assigned random numbers. My class had roughly 160 people; 30 of them opted to stay in Chicago for all their sites, leaving 130 students to split in groups. For simplicity’s sake, let’s say we had 150 students. Top tier would be numbers 1-50, middle is 51 – 100, and bottom is 101 – 150. My first number was 77, so I was in the middle tier.

        Round 1: IEI

  1. Our first round of selection was for ICO’s clinic, the IEI. Everybody has to do at least one rotation here. We went in order from number first to last, and each of us called out which quarter we wished to stay at the IEI, and how many credit hours of each requirement we want to complete there. Each quarter had a limited quantity of credit hours for each specialty. So, if you were planning to complete binocular vision hours at a different site, you would try to guarantee a spot with other requirements (advanced care,low vision, etc.) in the quarter of your choice. If you wanted to secure 10 advanced care hours at the IEI in the summer, and it was filled up, you must pick a different quarter. For my class, and for most classes, summer and spring were the most popular choices (Chicago is cold in the winter!).

  2. At the end of this selection night, congratulations, you’re a quarter of the way finished. You may now choose all your other sites based on whatever other hours you’re not completing at the IEI. You have one week to plan out your other sites.

        Round 2: Veterans Affairs Hospital

  1. Every student must also complete an externship at a VA hospital. The tricky part is to figure out which site is, indeed, considered a part of the VA hospital draft. You would think they would all just say “VA” on it, or have a spreadsheet with only VA sites. No. Refer to the “read all your memos section.” The Las Vegas VA does not count as a one of ICO’s official VA sites, so if you choose this site for one of your rotations, you’ll still have to choose another VA site. If you hit control F and put “VA” in your search box, you will definitely miss the “William Chappel Jr. Veterans” site, which is a VA site. Most of them say “VA” or “VAMC,” but not all of them do. The point is, do your research and read careful so that you don’t miss out on valuable opportunities.

  2. Since people in the top tier got first pick last round, people from the bottom tier get first pick this round, top tier moves to middle, the the middle tier moves to bottom pick.

  3. Your placement within your tier also changes. So, if you were number 101 in the bottom tier, you may not get number 1 now that you’re in top tier. The numbers are regenerated at random within each tier.

  4. Following VA selection, you are again given one week to plan your other sites according to what hours you have left to complete.

       Rounds 3 and 4: Specialty Sites

  1. These sites are selected one after another on the same day. This is probably the most exciting out of them all, because you are choosing what hours you want to spend more time on and who you want to learn from without as much restriction.

  2. So again, we rotate the tiers, middle tear is now top tier, top is now at the bottom, and the bottom is in the middle, and numbers are again regenerated at random within tiers.

  3. On the last round, all the numbers are randomly generated, and tiers are dispensed with.

Just when you thought you understood everything, here are some extra rules:


  1. For all our sites, we were allowed to link up with a buddy each quarter, and whomever had the higher number is the number we can go by when we choose our sites. This is so that we can go to the sites that accept two or more students together. We choose who we want to link with before we find out our lottery numbers to keep it fair. So if I were number 44, and my partner were 30, we get to choose the site when they call out number 30.

  2. IF the linked site we originally planned for is already full, we have the option of de-linking (going back to our original numbers).


  1. Just like baseball, steals are possible. If the last few people can’t choose proper hours at the IEI, they can steal from others.

This is the most I can water down my description of the process. At the end of selection night, you’ll feel a heavy weight lifted from your shoulders. You’ll be tempted to think, this is it, I’m set for fourth year… but there’s more! We have to wait up to two months to see if the sites we selected are able to accept us as an extern. So far, one of my sites changed from my original selection, but it’s still worked out quite well.

So, here’s my final list (for now):

Summer: IEI Fall: Council Bluffs, Iowa Winter: Daytona Beach, Fla. Spring: Detroit


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