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  • Writer's pictureLFaits

Comprehensive vs. Follow-up Exams

In third year at ICO, you see a variety of exam types. Some people prefer one type over the other, but why? What are the benefits and disadvantages of both? Do you learn more from one or the other?

First, I’ll explain the two main types of exams. Comprehensive exams are the typical exams you think of when you go to an eye doctor. It is usually an annual eye exam that includes basic screening tests, figuring out a prescription, and dilating the eyes to make sure everything is healthy.

A follow-up exam is an umbrella term for all other types of exams, such as monitoring a disease, evaluating how medication is working, and running other tests to figure out what is wrong. Follow-up exams can also happen after a patient has worn their new glasses or contacts for two weeks and “something is just not right.” So, again, which one is better? Which one teaches us the most?

Comprehensive Exams: 1. Starting fresh- One benefit of comprehensive exams (especially for new students) is that you get to start from the beginning with a patient and make your own conclusions. Since we students only work on certain days, follow-up patients might have seen someone else before. In a comprehensive exam, you don’t have to look at why a patient is coming back or who took care of them previously.

2. Repetition– Going into a comprehensive exam, you get into a routine with all the tests you have to run. There may be an exception to pin-hole, gonio, etc., but for the most part, you get into your routine and it is smooth running.

3. Practicing your skills – As I stated in #2, the more you repeat the basic skills you need to know, the better you get. My difficulty lies with BIO and 78/90. When I get a follow-up, I usually don’t end up dilating and I don’t get to practice those skills.

Follow-Ups: 1. Shorter exams– To be honest, most students like follow-ups because they take less time, allowing you to see more patients.

2. Critical thinking– When we have follow-ups, we need to figure out what we’re seeing, how we will further manage the patient, and what else needs to be done. If you haven’t seen this patient before, it is critical to figure out what the first doctor was thinking. That challenge can be fun.

3. Practice– Follow-ups often contain tests that we don’t perform during a regular, comprehensive exam (i.e. gonioscopy, visual field, pachymetry.) Some students haven’t done visual fields or 4-mirror gonioscopy since practicals, and therefore need the practice during follow-ups.

4. Relationships– Usually, if you have a comprehensive exam, you won’t see the patient again. Third years tend to be be on rotations when the patient needs their next annual, so we miss out on developing relationships with these patients. I think the best situation is when you get a follow-up patient who you’ve seen before. I have had a few patients who I have seen multiple times and I find these exams to be some of the more meaningful ones. Even though I am a student, I have already started building relationships with my patients. These exams are when I really start to feel like a doctor.

So, which exam type do students prefer? Follow-ups or comprehensive exams? I think that both are very beneficial because you get to learn something different in each type of exam. Having a mix of both really helps prepare students for what it will be like when we are seeing our own patients.


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