Pre-Reg | The Brink of Qualifying

22:16

The Gift of (Hind) Sight...

How am I already writing this post. It seems crazy to me than less than a year ago, I was in full-blown panic mode about how unprepared and incompetent I was to even think about starting testing patients, let alone actually do it. But here I am. Partial optometrist. Tested 1000+ patients.  Just about one step away from calling myself a qualified optom. Almost at the final final final finish line (there have been many finish lines I've had to cross in the last few years but this, this has to be the most momentous).

You remember my frequent meltdowns? You remember me calling my journey a personal hell? You remember how optometry had me feeling so down, I was borderline clinically depressed for most, if not all, of it. The thought of pre-reg made my insides curl with dread. I couldn't fathom how I was going to cope. I am sure that you, like me, are standing at the bottom of the mountain looking up, thinking you won't survive the climb. Then you get to the (semi) top, and the view is pretty damn great. The feeling, even better.

It is an insurmountable challenge that tests and pushes you, that will make you question your abilities almost daily, your life choices even more. And the doubts, the difficult patients, the feeling of being lost, it will drain you. But the victories...the patients who compliment you without you asking for it, the knowledge that you have played a hand in making a patient feel better - whether you've given them the gift of sight, or just been a friendly face and lent a compassionate ear - it will lift you up and make the journey worth it.

Take it from me. A girl who had no idea why she was here or how she was going to get through it. A girl who was determined that this life path wasn't for her. She now believes there is nowhere else she was meant to be.





There will come a time, a day, a specific patient, where everything just clicks and you suddenly realise that you can do this. Come the days where your clinic is only patients 80+ yrs of age, come the school holidays where you seemingly only test under-8s who test your patience and make you grind your teeth, you realise that you have what you need in your arsenal to face it. And I can't tell you how, or why. I most definitely can't tell you when. But come it does. And it's the most empowering you will feel.

I finally feel like I am in my element. I am, after six long years of discovering and struggling and accepting, my own person, in the place where I am meant to be at this given moment in time, in control of a life I was convinced was not for me, no longer feeling as lost or misplaced in the optom world as I once was. The feeling of "lost-ness" will always be there...sometimes you'll be straddling the moral high ground, drifting into moral grey areas, questioning your call of clinical judgement. But it fades. It will never feel as profound as it does on your first day of pre-reg, in the first sight test you ever do on your first patient, the first big mistake you possibly make. Pre-reg makes or breaks you. But I can almost promise that it will make you.



P R E - R E G | 

The Brink of Qualifying...



I went into pre-reg blind. I had zero knowledge of what it entailed and I was wholly unprepared on my first day of work. It can be overwhelming in the first few days when information is thrown at you left, right and centre. More so when you are told that your first assessment is within 4-6 weeks from your start date. Yes, you read right. No rest for the wicked! Here's a heads up of what to expect:

STAGE 1

Stage 1 is made up of, generally, four visits. There are 75 competencies of optometry, all of which you have to prove you're competent or safe in, to qualify. These are split between three visits; at each visit, some competencies you will have to prove physically in front of your assessor, others you will have to present patient records that prove they have been completed. You will also be asked theory questions relating to each competency.


ADVICE

  • You'll be given a pre-reg folder that holds all the info regarding each stage and visit. Read up on which competencies are being assessed at each visit so you're prepared

  • Note-taking can be overwhelming - where do you even start? I found that the best way to make notes was taking it each visit at a time; I would work my way through the competency list (which tells you exactly what is being assessed and what they need you to prove) and make relevant notes pertaining to each one. I also had my supervisor quiz me competency by competency - that's the best way to know how much knowledge you need to have around the subject. It's not as heavy or as detailed as lecture notes - use them as a reference to make condensed snapshots of each topic

  • If you've read the competency list in your first week, you'll know which patients you have to see in order to present their record. Keep an eye out for them. Tell the rest of the optoms and put up a list which they all have access to - that way they can pass on the relevant patients to you as and when they come

  • You may not see all the patients you need to see before each visit. That's okay. Visit 4 is the visit where you present/prove any competency not yet achieved. (You have up to 7 visits to get them but any visit past the fourth, you have to pay for). You can also switch out competencies; if you get any from future visits earlier, you can present them earlier, and you can present those you don't yet have in a later visit

  • Keep a notebook to store copies of the prescription stickers/record number/customer number for every test you do and record any pathology, symptoms and relevant history they presented with e.g. cataract/glaucoma/diabetes. When the time comes to filter out patients to present, it'll make life so much easier. (I kept a sectioned journal that allowed me to keep my sight test patients and contact lens patients all in one place. Also a little folder to store all your dispensing slips in will come in so handy)

  • Tight record-keeping. THIS WILL BE YOUR LIFE-SAVER. Most people fail at the visits because their records just aren't good enough. Start with good habits and I swear you'll be ten times the better optom. Get your supervisor to check every record you choose to present. And then get it checked by the previous pre-reg's and other senior optoms. Everyone will pick up on something different and the more eyes that check it over, the more likely it is to be fool-proof

  • You have to have performed a certain number of sight tests, contact lens patients, and dispenses at each visit. Keep on top of it. Push for dispenses if your store aren't making it a priority. And get the dispenses in your first few months because the quicker you get through them, the quicker you can spend more time in the testing room. Again, make a list of specific dispenses you need for your competencies and make a list for the shop floor staff - if they're as great as mine are, they'll be more than happy to keep an eye out for you

  • Find a routine that suits you. Your sight test and CL routine will, naturally, differ slightly, but each hold a similar backbone. Create that backbone. We all do our tests differently; every optom has their signature test style. You will find it and it will flow - a little better with each test you do - and before you know it, you'll be able to do an eye test in your sleep. 

It gets easier. Trust me. I started off shadowing my supervisors tests - this was useful because I picked up on clinical tips and also tips on how to let a test run smoother. My supervisor would let me view any pathology, even just getting me to differentiate between different types of cataract and grading it was so useful. She would get me to grade every C:D ratio. And anything I would struggle to see, she would help me see it. It was invaluable. Then I started testing staff members - this was like a trial run of sorts. My supervisor would watch and make notes on what to improve and check my clinical competence. I only did five though because of how busy our store is - so then we went on to real patients.

It was a mess. I'm not going to lie. My first few eye tests maybe not so much; it was just a bit rusty and when giving advice and/or clinical management, it needed a bit of work, but that's what my supervisor was there to observe and advise on. My first contact lens patient though - wow it was a hot, hot mess. I think I was about to cry. It took me over forty minutes. I had no routine, my slit lamp technique was all over the place, my supervisor had four full A4 sides of feedback. Now my routines are in tip top shape you could almost forget I'm a trainee and my contact lens patients are in and out of my room with the smoothest aftercare routine I can forge. Like I said, it gets easier. And practice makes perfect.

  • Your real patients won't be yours for a while. Your supervisors will watch the first few and then when you're finally let loose on the public, they'll come in and check the health of the eye and, if necessary, the final prescription. And when they feel confident enough for you to do your own thing, they'll let you go. But you can obviously shout them in if/when you're not sure of anything or if you ever want anything double-checking. They're not that cruel. I hope.

Don't sweat it. So much of pre-reg is being thrown into the deep end and you either sink or swim. But you also have lifeguards. Shout SOS if you need to!



STAGE 2

Stage 2 is THE BIG ONE. The biggest hurdle, the one where most of us fall. Four hours in which any of the 75 competencies can and will be assessed. Four hours to perform a full sight test, a CL fit, and a CL aftercare - all of which will be assessing relevant competencies - and you'll also have to present 45 records, again assessing competencies that your theory knowledge will be tested on.


ADVICE

  • The eye test is hand-written. Practise hand-written eye tests on the template you'll have in your folder. And do it multiple times

  • Your patient will be a presbyope your assessor brings in. You will have to perform ret as well as either direct ophthalmoscopy or volk. Practise all of them. We are all awful at ret - mine was so bad I can't even explain how much work it needed. But now I'm pretty much bang on a good 7 out of 10 times. I only got there with constant practise. Get your supervisor to watch a full test under exam conditions - they'll pick up on so many things, it's life-saving

  • Time yourself. You have 40 mins for the eye test, 40 mins for all the CL work. Time your H&S, eye health, refraction, advice. Refine as necessary. This is a really good tip because your assessor will ask you whether you want time warnings so if you know where to be at a certain time mark, it'll ensure you don't only half-finish the test

  • REVISE. Re-revise everything you learnt for stage 1 because if you know all of that, you'll breeze through the record section

  • PRACTISE. EVERYTHING. Get watched on everything. Get quizzed on everything. Stage 2 is all about prep and if you nail that, your job is 50% done.


OSCEs

And this, ladies and gentlemen, is you standing at the pearl gates, waiting to be entered into the heaven they call the land of the qualified. 14 stations. 5 minutes at each station. 75 competencies - any of which can be assessed. May include practical clinical work, role-play, discussion of theory. Practise focimetry (inc. bifocals). Know your BV theory and common motility abnormalities/cover test anomalies. Learn common pathology. e.g. hypertensive/diabetic retinopathy, macular degeneration because you'll be presented with fundus images and asked to give a diagnosis. Brush up on those communication skills - do you know how to handle breaking bad news, or how to explain pathology in lay-man's terms?


ADVICE
  • None. Awaiting OSCEs. But from what I've been told, above advice is sufficient. The rest is luck and practising what you know best. 


Best of luck folks - see you all on the other side.



GENERAL ADVICE

THE PRE-REG MOTTO:   F A K E  I T  T I L L  Y O U  M A K E  I T
If you have good social skills, you're halfway there...the rest is wingin' it all the way...

  • The team make the job. If you're already working at the store you're doing your pre-reg at, you have the advantage I do - your team become your second family, the store your second home. They'll be cheering you on from the sidelines and picking you up when you're feeling down. Build that relationship with the people you're surrounded with. And build a solid relationship with your supervisor. They are your mentor in every possible way. I am so very lucky...my supervisors are friends more than anything. It means I got honest constructive criticism, I get their advice (pre-reg and beyond!), and I get the support, love and laughs that make the stresses of pre-reg that much more bearable. It is so important to have that. You should be able to turn to them come rain or shine

  • Everyone is there to help you. The dispensers will help you with the many system errors and inputting difficulties you'll come across with your many dispenses. The DOs will help you with the dispensing theory that optoms are not quite so savvy with. The optoms will help you every single time you are stuck. You're not alone. Please don't ever think you are. Ask, ask, ask. My peers are probably tired to death of me pestering them but hey ho here I am all the better for it so really, is anything lost?

  • Don't panic when you feel out of your depth. Especially in certain areas that you're not well acquainted with (contact lenses in particular). Ask your CLO whenever you're stuck - mine was/is a lifesaver. (Those pesky multifocal CLs will forever be the bane of my existence...)

  • There is no stupid question. Can't focus on the cornea? Don't know what a cataract looks like? Not sure if you should prescribe? ASK. You'd rather look like a floundering pre-reg than a stupid optom. 

  • Practise makes perfect. Broken record? Don't care. PRACTISE YOUR HEART OUT. I couldn't even touch my volk lens when I first started because I couldn't see anything. I now reach for my volk for every single patient. I had to get my supervisors to double-check my ret for the young 'uns because I had no faith in it. Now I trust my gut instinct (and put them on a 6 month recall.) I kid. No, but seriously. See what happens when you practise?

  • Pre-reg is the time to learn. Everything I know now as an optom, I picked up throughout pre-reg. I was equipped with sub-par, below basic knowledge/clinical skills when I started. But every patient is a guinea pig, every test a learning curve. And know that you will never know everything - there are things I still don't know - but you are a work in progress. You always will be. Whether you're a second year optom student, or a soon-to-be pre-reg, or 30 years qualified, you are always learning 

  • It will start to come naturally. You will see so many patients that the routine, the pathology, the theory and knowledge, the advice and management...it will, quite literally, just fall into place that you won't even have to think about it. It can only get easier and you can only go up from rock bottom. If nothing else is a comfort, that should be

  • If you have a pre-reg buddy, you're in a win-lose situation. Ditto that if you don't have one. It's great for you to have someone to bounce ideas off, to seek one another's pre-reg advice, helping each other prep before visits/assessments. It's useful to teach one another because each of you will have strengths and weaknesses and together, you can learn from that. You have someone who understands the emotional and clinical stress better than anyone can at that stage. But it does mean that you will find yourself comparing you to them. DON'T DO IT. Please, don't do it. I know it's hard - I've been there. It can be a shitty place when you compare where you are, with where they are, and you'll tell yourself that everyone else is doing the same. NO ONE ELSE IS. No one - not your supervisors, not the optoms, not the shop floor staff - is comparing the two of you. It's in your head. Let it go. Pre-reg is not a race...you're going at your own speed in your own time. You are your own person; everyone's pre-reg journey is different, embrace yours and think of only yours. You'll be in a much happier place when you do

|   Take it one day at a time, one patient at a time, one assessment at a time

  • Everything in its own time, always. In the grand scheme of things, an extra visit (or two, or three), a few stage 2 resits, a delayed OSCE...none of it matters. It doesn't make you any less of an optom. If anything, it will make you a much more refined, clinically adept version of one. The pitfalls only serve to make you stronger. If it's your day, it's your day, and if it's not your day, it'll be another day. It is what it is - have patience when it's not your time, and have faith that your time is coming.

  • Find a good work-life balance. It will preserve your sanity. Be smart with allocating revision time. It's so tough having to revise while also working full time - plan ahead and do your revision in chunks to minimise the work load. Take days off prior to visits if you need the study leave. But also take time off regularly to recharge and de-stress. Take a few days out of pre-reg/optom life. You need it.

Lastly, believe in yourself. You are here because you deserve to be. Have a little bit of faith in the optometrist in you. And always remember - today and tomorrow and on the first day of pre-reg and the days when things don't always go to plan - you are exactly where you are meant to be at this given moment in time. You were made for this. Go out there and prove it.

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