PAP and the Holy Grail
A major deciding factor for me in choosing ICO is that clinical experience begins in the very first quarter. In the first year, this experience–all of it in ICO’s clinic, the Illinois Eye Institute–is called the Patient Advocate Program. During first quarter, our PAP experience includes familiarizing ourselves with the layout of the IEI, getting an eye exam and writing a report based on our own experience as a patient.
The eye exams at the IEI probably aren’t like others you’ve had. Before coming to ICO, I’d arrive at the clinic and a technician would perform most of the entrance tests like lensometry, OCT, fundus pictures, keratometry, autorefraction and tonometry. All of these tests would be performed with automated machinery, and they’d be completed in about 20 minutes. I’d then be directed to a waiting area, where I’d sit for 10 minutes or so. Then the doctor would see me for another 20 minutes. I’d be in and out within an hour, and I was never dilated.
An exam at the IEI is much more thorough process. A student clinician–usually a third or fourth year–performs all the entrance tests manually, and will commonly dilate the patient. A typical appointment runs two to three hours. Yes, it’s a long time. On the upside, when you’re finally finished, you know that you’ve had a thorough exam, and you’ll even get a discount coupon for eyewear along with your prescription.
During PAP in the second and third quarters, we shadow a third year student as they perform an entire exam sequence, occasionally jumping in and practicing some of our newly acquired skills. We spend three hours a week at the IEI observing and fulfilling the requirements of the PAP check lists, which include the following procedures: visual acuities, pupil testing, cover test (pictured above), confrontation visual field, Humphrey visual field, lensometry (both automatic and manual), color vision, stereopsis, automated refraction and non-contact tonometry. We then present to our attending student the patient’s case history and chief complaint. Humphrey visual field testing is known as the holy grail: It’s the one test everyone needs, but it’s harder to perform than some of the others.