One Hour to Dilation
Once classes resumed last month, my fellow second years and I began working in the IEI as student clinicians. Whereas last year we were flies on a wall, observing and admiring the skills of the upperclassmen, we’re now endeavoring to provide care in the PCP program ourselves.
At the end of first year, we learned how to complete a gamut of entrance and problem-based tests, evaluate the posterior pole with direct ophthalmoscopy, and determine a patient’s distance prescription. Half of my classmates and I are putting these skills to use in the first half of the quarter, while the rest of my colleagues will be clinicians later on. While practicing, we work with an assigned partner under the guide and eye of an attending doctor.
My partner, Ashley, and I are in clinic each Monday afternoon. The morning starts off with Binocular Vision at 9, is followed by Optics at 11, and then Pharmacology until 12:50. For us lucky few in the afternoon shift on Monday, that means that we have about 10 minutes–depending if we get out of class on time–to get from the lecture hall on the first floor, to our lockers on three, to our office in suite 1.
Our first day in clinic together, Ashley and I brought our cases of equipment along to our designated office, took out the necessary tools and attempted to organize our gear and arrange things neatly. But between the two of us and our trial lens sets, our briefcases and our BIO cases, there was only so much order to our chaos. We nibbled on granola bars between setting up, logging in and opening EHR, and then raced to meet our attending doctor and receive our patient.
When I called our patient’s name, we looked around eagerly for the owner of “Yes. Here.” Facing our patient, my partner said, “We’ll be your student clinicians today. I’m Ashley and this is Fatima.” In that moment, standing in my white coat, I felt important and somewhat proud. I was a student clinician. And this was my first charge.
Back in our office, we proceeded with the exam. We decided to split up the exam so that I would begin with case history and finish the entrance tests. Afterward, my partner performed keratometry and completed the refraction sequence. While one of us worked, the other scribed. We discussed the case with our attending during intervals, and finished with distance refraction. It was now our attending doctor’s turn to determine a near vision prescription, examine the anterior pole, analyze the retina, and then inform the patient about the new Rx and address health concerns. Throughout the exam, I jotted down details in my little red notebook and took note of the care and skill of our attending.
When the exam came to an end, we were happy to be done and pleased with our performance. Though there’s plenty of room for improvement, we know our skills will progress with practice each week. From start to finish, the exam took a good two hours–over an hour of which was before dilation. The next time we work together, we’ll bring a single set of equipment. Per our attending’s advice, one of us will complete the entire exam while the other scribes, and then we’ll switch the next week.
Now that we’re in our fifth week of school–how time flies!–we’ve learned new skills in Optometric Procedures 2.1 and in Ocular Physiology. Last week we learned how to determine phoria inside and outside of the phoropter using the Von Graffe method and the Modified Thortington card, respectively. In Ocular Physiology lab, we all learned how to take blood pressure with our new cuffs. As we continue to learn new tricks of our trade, we’re expected to perform these in clinic with proficiency.
Soon we’ll learn how to refract at near, use the slit lamp and our new lenses to examine the anterior and posterior poles, analyze the retina using our fresh BIO and lenses, and then make informed decisions on prescribing lenses and educating our patients on their health concerns. We have an exciting journey ahead of us.