This post is about the Scheme for Registration. 

Now, before I started the Scheme for Registration, I didn’t actually know much about the pre-reg year.  Yes, I knew vaguely that we had to collect a certain number of patient episodes, that there were visits and OSCEs but I didn’t really know much about the content of the visits or the type of competencies.  All I really heard about it was “it’s difficult”, which isn’t really that helpful.

When I was in my final year of uni, two representatives from the College came to speak to us one evening.  I attended but found it far from enlightening and, in fact, I can remember more about the accompanying sandwich platters than the presentation.  I think the College assumed that we would get more information about pre-reg from the uni or from colleagues who were currently in pre-reg or who had recently qualified.

If you are a final year student, you can look at the College’s pre-reg documents on-line, just to get an idea of what’s expected.  The first visit happens about a month after you start your pre-reg.  Mine was scheduled for the middle of August but I had a change of assessor so it became the start of September.  Having an extra two weeks before my “four week” visit helped quite a bit.  I had settled a little more into practice and I had seen a decent number of patients so I was quite confident in the practical side of things for that visit.

I was very nervous before my first visit.  I had heard that my assessor was fair but that she liked you to have quite in-depth knowledge.  Apparently, my assessor had asked a previous pre-reg what squash goggles were made out of so this was one of the many little facts I looked up on the off chance.

Anyway, visit one assesses ten competencies.  You have to verify a pair of multifocal specs (I made life difficult for myself by choosing to use our battered manual focimeter instead of the nice, shiny, working, automatic one).  You have to assess a pretend patient’s tear film (just to be clear, it is a real person just not a real patient), their pupil reactions and take K readings.  You have to produce a record saying you’ve done an I&R for a soft contact lens patient (my assessor asked me to roleplay this with my pretend patient) and a record of a patient you’ve seen who is at risk for any common ocular condition.

Visit one breaks the ice between you and your assessor.  Hopefully your assessor is (or will be) as nice as mine.  We chatted for ages.  She had also been a mature student and asked how I found university.  Although I got my ten competencies signed off that day, it was touch and go for a while with the varifocal verification.  I would say to any future pre-regs to keep it simple.  Do what you usually do and try not to overthink it.  A couple of people I know failed the tear film assessment for the silly reason that they forgot to turn the lights back on to instill fluorescein, something they always do in practice.

Anyway, visit two happens a couple of months after the first visit.  Mine was in early November and I was actually quite laid back about the whole thing.  That is, until the morning of the assessment, when I started freaking out a little.  I developed a bit of clinic management OCD, where I would go the computer, stare at the clinic, make sure the correct time was blocked out for the visit, make sure the patients were all in calendar for the correct time and then I would repeat the process again a few minutes later.

In the end, the OCD didn’t matter as my assessor ran late from her previous assessment (where she was also being assessed).  So yes, my assessor was assessing while being assessed that morning and she had to stay a little late to get feedback from her assessor.  Then my presbyopic patient was late as well.  The word stressed doesn’t come close to describing how I felt that evening.

I won’t go through all the competencies that were assessed from patient records, instead I’ll write about one in detail.

For a patient with anxiety, I had several eligible records but the patient that stood out most in my mind, though, was D.  D had called our practice one evening and told one of my colleagues (H) that he had been seeing flashing lights.  H then asked D if he had noticed any floaters.  He had.  H asked me what we should do as the clinic was fully booked (both mine and my supervisor’s) but I said that we really needed to see D.  I should mention that we are open quite late so we get emergency appointments like this on a regular basis.  H and I rearranged the clinic and worked out that when D came in, H would knock on my door, I would instill drops and then go back to my patient while D sat in the waiting room dilating for a while.  Then I would take him through and have a look.

Anyway, when D arrived, he was shaking.  His family were in the waiting room with him, all of them looking pale.  I was very aware that D had probably jumped on the internet after hanging up the phone so he was likely to be imagining the worst case scenario. When D sat down in the testing chair, he was still shaking.  I told him that I was going to have a good look in his eyes (especially the left one) and then I would then ask my supervisor to have a look.  He nodded, silently.  Now, I asked, tell me about these flashing lights.  

He had noticed the lights the previous evening, in his peripheral vision. They were zig zags, a greeny-yellowy colour.  The lights seemed to move a little, oscillating inwards.  In all, the whole thing must’ve lasted twenty minutes.  He also felt a little “weird” when he saw the lights and had to sit down.  At that point, I relaxed a little.  And what about the floaters? When did you noticed them? When he was on holiday a few months ago.  He noticed little dots and threads in his vision when he was out in the sunshine.  There were only a few of them and there had been no recent increases.

I know you are worried, I said. But what you’ve described sounds like a silent migraine.  I’m going to have a look in your eyes now, just to make sure they are nice and healthy and I’ll get my supervisor to check as well.

I then spent so long using my Volk lens that my hands cramped up.  I then got my supervisor in and he also checked every last visible millimeter of D’s eyes.  We didn’t see anything out of the ordinary, thank God.  When I came out of the test room, his wife and son ran up to him.  I explained about the silent migraine and they looked relieved.  When they left, H rushed over and asked if everything was okay.  I told her that it wasn’t a retinal detachment.  The atmosphere in the practice suddenly lightened.  We had all been so worried about D that there had been an air of tension all night.  I think sometimes our patients don’t realise that the things they are worried about having are the things we are worried about finding, if that makes any sense.

On a lighter note, my adult patient with heterotropia was a lovely man in his 70s who had a 40D LSOT.  At the beginning of the eye test, he told me that one of his eyes was a lazy eye.  “Would that be the left one?” I asked.  “How did you know?!” He exclaimed.

My next visit is next week.  I’ve been struggling to find RGP wearers and, when I wasn’t testing on Saturday, we had three come in for aftercares.  This is pretty indicative of my luck with some of the competencies.  Anyway, the day before my visit I have a multifocal RGP aftercare, which should be interesting in a terrifying sort of way.  I’ve also got a wonderful friend who is coming over this week so I can do an RGP aftercare on her, even though she lives at the other side of the country.