So, I’ve come to the end of my pre-reg (well, the bit where I’m paid to test peoples’ eyes anyway). Now I’m waiting for my OSCE results and trying to figure out what to do next. I’ve been thinking about the pre-reg experience, from the day I started (15th July 2013) up until now.

Pre-reg is a balancing act. You have to be assertive enough to make sure you are getting the experiences you need while also being the lowest of the low in the staff pecking order.

So, I’ll share some things I’ve learned (if this was Buzzfeed, the title would be “Top Pre-reg Hacks for a Stress-free Year”):

1) Sweets are always a good way to win friends. Our store ran on Haribo for the last year (I popped into makro and bought a few 1.25kg tubs of Starmix every couple of months).

2) There will always be one member of staff (usually an Optical Assistant) who has been there for a hundred years. Try and befriend them because they’ll know all the quirks of the computer system, where everything is kept, etc.

3) You’ll feel like you are taking forever to test in the beginning. Make sure the staff tell pxs when they book in that they will be with the Pre-registration Optom and that you take longer. A good number of pxs like this – they assume you are more thorough, rather than just doing the same things as the other optom does except much, much slower.

4) Ask your supervisor to watch you do a full eye test and then give you feedback.  By having someone sit in with you regularly, you are also preparing yourself for having an assessor watching you during Stages 1 and 2.  Ask if you can sit in on some of their tests (try to sit in on a range of pxs, especially younger children and older pxs).

5) Make sure your co-workers are aware of the competencies you require for Stage 1. Call dibs on that red eye, that 1 year old and the px with double vision. Fingers crossed that someone wanders in with anterior uveitis.

6) Know what’s appropriate. You can slavishly follow the routine you half-developed in uni or you can look at a px and actually judge what you need to do. Eg. you don’t need to binocular balance over 55s, you don’t need to do amplitude of accommodation or the +1.00DS blur test for them either.

7) Know your room. Is it a 3m room with a projector chart? If so, you might have to double check Rx at the end*, adding -0.25DS if it’s a short room. If you aren’t told about room balance at the start, ask!

* We had a 6/6 letter on the wall that the px can see in the mirror.

8) Keep a note of any medicines you haven’t heard of and then look them up later on. You’ll hear the same ones day in, day out so you’ll get to know what they do and you can look up ocular effects. One of the competencies is ocular effects of systemic meds – this can be something as simple as an antidepressant or a beta blocker in a patient with dry eye.

I bought a really cheap BNF (under £3 on Amazon, delivered) that’s a couple of years out of date and kept it in my consulting room so I could quickly look up new drugs when they were fresh in my mind.

You can also ask pxs what a medicine is for, if you haven’t heard of it before. I usually say, “Oh, that’s one I’ve not come across for ages – what’s it for, again?” So I don’t sound like I don’t know (tsk tsk, pride). I should warn you, though, that some patients will just describe the appearance of their medications to you, expecting you to be like: “Oh, yes, the oval shaped little white pill is obviously cetirizine.”

If someone has asthma, they might just tell you the colour of the inhaler. Here’s a handy guide to inhalers:

http://www.ggcprescribing.org.uk/media/uploads/prescribing_resources/inhaler_indentification_guide_-_1310.pdf

9) Don’t be afraid to ask your supervisor (or anyone, for that matter) questions. You are there to learn and your supervisor is there to teach. Some supervisors are much better at taking on the teaching role than others so you have to, again, find a balance. They will have a full clinic as well as supervising so you may have to keep a note of any non-patient related questions until a time when they aren’t busy. I kept a diary handy that I jotted little notes in (an example would be “DRP in +++?!” – which was a reminder to ask which dailies came in high plus).

10) If you are testing a patient and you want something checked, explain that you’re still learning and, now and again, you ask your supervisor to double check things for you so don’t worry. When your supervisor comes in, introduce them. Pxs may immediately think something is wrong if you get someone else in.

11) Open questions are the best questions. You’ve been told this before at uni but it’s true, especially when someone comes in with a problem.

My first question when a patient comes in with a red eye, sore eye or FL & FLT is “So, what’s happened?” This is a great question and it establishes rapport with the patient. Most people love telling stories, even if it’s just about how they woke up with a sticky eye this morning.

12) You won’t be good at everything straight away. This is something I struggled with, I must say. I am still pretty rubbish at ret and I have messed up my share of refractions (usually people with massive cyls – I hate cyls). If you are lucky, you’ll be working in a supportive environment where they understand that you are just learning. If you are unlucky, you’ll get disciplined and have to write an adverse incident report after each one (try not to let this get you down).

13) You’ll have ups and downs. We all have bad days, you just have to put it to one side and not dwell on it.

Sometimes people are hard work. If someone is being difficult, I just think of them as a usually nice person having a really bad day. In these situations, I find being aggressively nice works really well. Apologise, smile, listen and then try to sort it out.

You have to reset yourself between patients – try to let go of the bad stuff straight away.  Your next patient deserves to see you at your best, not under a cloud left behind by the grumpy sod who previously sat in their seat.

You might also have competitive one-upmanship going on between pre-regs (especially if there are several of you in one store or in one company). If someone keeps telling you how amazing they are, take it with a pinch of salt.

14) Keep a reflective journal. Now, I know you probably snorted when you read that but hear me out. If you regularly write down an honest account of how you are doing, it will increase your self-awareness and highlight any areas you need to work on. You can learn from the embarrassing moments instead of just trying to forget them (you know, like the time you called your primary school teacher “Mum” by mistake**).

I kept a reflective journal for the first few months. I just had a quick look at it and it’s really interesting to see how much I’ve developed as an optom since last July.

** there is nothing to learn from that, I really should’ve thought that example through a bit more. See, I reflected on that by writing it down!

15) Remember: it’s just a year (in most cases).

It’s stressful, it’s isolating, it’s exhausting, it’s demoralising, it’s amazing, it’s transformative, it’s difficult, it’s poorly paid, it’s interesting, it’s over too soon and not soon enough.

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