Even before entering optometry school, students wonder about their options for clerkship or externship sites. It is brought up during the frequently asked questions portion of the interview process or even highlighted in a school’s presentation to promote their program. It can even be the basis on which some students decide to finalize their offer from a school. It is an exciting decision, requiring carefully narrowing down the various options and weighing the pros and cons of the sites on the list. Of course, having the freedom to select where one can practice for a few months is a blessing and a curse. When the time for making these selections finally comes, many questions arise, including the important decision of whether to select a site located in a major city or in a rural town. During my selection process, I opted for a mix: one site in each of the two settings. Here are the highlights of my experiences.
Rural site: Grande Prairie, Alberta
This was my very first clerkship site, and I chose a great multi-doctor clinic in “northern” Alberta. In my mental map of Alberta, Grande Prairie was as north as you could go, hence the quotations. Having grown up in Vancouver, I was shocked to find out later that you could travel even more north, to what I can only assume is polar bear territory. It was interesting driving four and a half hours out of Edmonton, the closest major city, surrounded by the unfamiliar sight of expansive crops.
One of the most interesting aspects of this site was the lack of ophthalmologists in the area. There was only one surgical OMD in the area who was no longer accepting new patients due to being far too busy. It was strange to be in a situation where we needed to educate the patient that they must drive all the way to Edmonton for a simple procedure. It was always a big decision to send a patient into the city to see an ophthalmologist, so making sure to educate the patient well on the importance and time-sensitivity of the situation was key. In the city, it can become a habit to refer as it is easy to do and not too much of a hassle for the patient, but at a rural site, you are challenged to debate if a referral is truly needed.
As one of the only eye care providers in the surrounding area, most of the ocular disease cases will come to you. I often got the feeling that we were the emergency room for eyes and it was exciting going to work every day. For example, I would practice my fine motor skills by removing metal foreign bodies at least once a week. It also was educational to follow more advanced glaucoma patients who would normally be followed through an ophthalmologist in the city. Severe cases would need a referral, but moderate cases would be monitored via our office as it was easier to maintain compliance for follow-up appointments.
In addition, the patient may have traveled far to get to our office. We were sought out by concerned patients, elevating our importance in their health care that much more. Valuing the patient’s time and factoring in their convenience was important as it was tough for them to return multiple times for different scans and follow-ups.
Urban site: Calgary, Alberta
My second clerkship site was a single-doctor, private practice in Calgary, Alberta. In fact, my business-savvy supervisor owned three different clinics across town, and we would travel to each clinic multiple times a week. This was a great learning experience for a variety of other reasons and provided a whole new set of skills to learn.
Some of the most important lessons to be learned in the city are how to run a successful business and handle the competitive nature of working in an urban and well-populated area. Although this is not what many students search for in a clerkship site, it is a very important aspect of optometry. Most optometry programs only offer one or two business courses. For this reason, a good hands-on experience is priceless. You will get the opportunity to see your supervising doctor manage staff and sales as well as interact with sales representatives. This is incredibly beneficial if you are hoping to own a business of your own, especially in a busy city.
In contrast with the rural sites, there are a variety of specialists to whom you can refer. This makes working in the city a great opportunity to practice interprofessional care and each office has its own areas of focus and wait times. In addition, there also are many other referrals that can be made in the city to providers such as social workers, physiotherapists, and psychologists. Of course, we can refer to specialty optometrists, too! Whether it is for the purpose of vision therapy or specialty contact lenses, there are often more options for specialized care.
Along those lines, if you would like to learn beyond the limits of the clinic you have selected, there also are opportunities to shadow ophthalmologists and other optometrists in the area. Of course, this may be during your off-days or after hours but if you are keen and want to observe what it is like in an OMD’s office, this is an option for you. For example, I have an interest in specialty contact lenses, so I reached out to a local office that services many difficult-to-fit patients and shadowed one of their fitting days.
Of course, we cannot forget the exciting activities that are offered in the city. Unfortunately, with COVID-19, there were limited activities available, but the food and entertainment scenes were still more diverse. Even takeout is more interesting than just the chain restaurants. On your days off, you have the chance to explore and enjoy the city. Unfortunately, the cost of living is higher in the city so that must be factored in as well.
Author Bio: Cindy Shan is a student at the University of Waterloo School of Optometry and Vision Science. She is the class president for the Class of 2021 and was the director of internal affairs for the UW chapter of the AOSA. She has a special interest in practice management, specialty contact lens and myopia control. Cindy also loves to travel and explore other parts of the world, test her skills at DIY projects and hike the beautiful mountains in British Columbia.