Toto, we are not at the IEI anymore. Fourth year may have started only 5(?!) weeks ago, but it seems like forever since I’ve been at school. Here are just a few things that are different from working at The Illinois Eye Institute compared to at a private practice externship site.
1. Time.
At the IEI, third years are expected to get to dilation by 45 minutes by fourth quarter (spring). At my first externship at Pinecone Vision Center (Sartell, MN and owned by two ICO alums: Dr. Colatrella and Dr. Hinkemeyer), we are expected to do a complete exam in 45 minutes. This complete exam consists of entrance testing (in and out of the exam room), photos, refraction, and an ocular health portion of the eye. No longer are the exams 3 hours long; real-world practice is happening here.
2. Specialty equipment.
While we try to be quick, our exams do not lack any testing. In reality, I am taking more photos and measurements at Pinecone. I have learned how to use a Pentacam, a spec microscopy, and an MPOD, while also honing my skills on fundus photos and auto-keratometry. I also have attempted macular and retinal OCTs and diopsys, specifically ERG and VEG. ICO and the IEI have shown us these machines. However, we really don’t get much experience with them until 4th year. I have also run a few visual field tests, but I also was one of the visual field techs for work study at the IEI (side note: this one has a liquid lens, which is pretty cool!)
3. Red eyes, Fuchs dystrophy, AMD, and so much more.
The majority of time spent at the IEI during first, second, and third year are in the primary care suites, which usually see comprehensive exams and follow ups for glaucoma and dry eye. The IEI does see red eyes and emergency cases; those go to the different suites where fourth years and residents work. However, since I have been at Pinecone, I have seen corneal abrasions, ulcers, chemical burns, and a flash burn from a welder. I even had to remove and insert a prosthetic eye! I also have had my first experiences with post-cataract follow ups.
Urgent care and unique cases aren’t the only things that are different at Pinecone. Since Sartell and Chicago have different demographics, I am seeing macular degeneration and other diseases that were uncommon in the population at the IEI. I feel like I have gone from one end of the disease spectrum to the other while seeing everything in between.
4. Doctor time.
I have made the transition from calling myself a student clinician to a student doctor. Third year at IEI helped us start the transition. So far, with guidance, we are becoming confident in what prescriptions we give, what treatments are needed, and when to see the patients back. The doctors want us to be prepared with a diagnosis and a plan, and even if we are wrong, at least we are thinking like doctors.
So far, externships life is going well. Sometimes, it may feel like all we do is clinic, sleep, repeat, but it is fun to finally be in the real world as student doctors. I sometimes surprise myself with things that I remember from class. Now, I can actually apply it all!