The final year in optometry school is an exciting time for students, as they transition into becoming independent Doctors of Optometry. It is also a time for students to contemplate career paths and consider residency training as means of achieving their professional goals.
In this article series, we are interviewing residency directors from across the spectrum of optometric practice modalities. We will shed additional insight for students contemplating whether or not residency training is right for them.
Today we are interviewing three residency directors from community health center programs, two in Massachusetts and one in California: Drs. Daniel A. Bastian, OD, FAAO, Nicole D. Pogue, OD, FAAO and Frank Giardina, OD, FAAO.
Dr. Bastian is an Associate Professor of Clinical Optometry at the New England College of Optometry. He is also the Director of Eye and Vision Services & Residency program at Lynn Community Health Center in Lynn, Massachusetts.
Dr. Pogue is an Assistant Professor of Clinical Optometry at the New England College of Optometry. She is also Clinical Director of Optometry Services and Residency program at The Dimock Center in Roxbury, Massachusetts.
Dr. Giardina is the Residency Director for the Community Health Centers of the Central Coast program, located in Nipomo, California. This program is affiliated with the Southern College of Optometry, Memphis, Tennessee.
For students interested in applying to residency at your respective community health center, what are some characteristics that make a high quality candidate?
Dr. Bastian: Characteristics of high quality candidates include but are not limited to the following. Strong work ethic. Passion to serve a patient population that is underserved. A passion to serve the poor, immigrants and refugees. An ability to provide high quality eye care regardless of the patient’s ability to pay for it. A comfort in being able to deliver eye care to patients who do not typically speak english or who speak english as a second language. A comfort and respect for different cultures. A passion for ocular disease and a desire to manage advanced ocular disease cases. A passion for lifelong learning and academics.
Dr. Pogue: We look for candidates who are passionate about community health. All the optometrists at Dimock love serving in this community and we want someone who has the same passion as us to help us do the work. We value kindness, compassion, and enthusiasm. We also look for candidates who are willing to learn but can also contribute to our team with their ocular knowledge.
Dr. Giardina: In regards to the characteristics that make a high quality candidate for residency, two in particular come to mind: 1) a desire to practice full-scope, primary care optometry on a very diverse group of patients, we see a wide variety of ocular and systemic conditions, the resident is expected to learn how to diagnose various ocular conditions, order lab tests and imaging as appropriate and interact with fellow health professionals. 2) the resident should be willing to treat non-English speaking patients, especially Spanish in our clinic and as well as deaf patients.
What specific advantages will residents take away from their training? What clinical/professional expertise will they be able to carry forward into their careers?
Dr. Bastian: The biggest advantage residents take away from their training at the LCHC residency is the ability to handle any clinical case in any type of patient they may see. The residency is in ocular disease with an emphasis in community health. The schedule of patients seen can be from 2 years old to 92 years old and everything between. By the end of the residency, the provider feels confident and capable in all clinical situations. It is not to say that all residents come out knowing everything but they feel comfortable being able to work through advanced cases in all ages which gives them confidence no matter where they end up practicing.
Dr. Pogue: The resident gets to see a wide range of ages. We’ve seen patients as young as 3 months old all the way to 99 years old. We also see a lot of disease here, so our resident gets very comfortable treating a wide range of ocular conditions. We are fortunate to have a pediatric optometrist and a contact lens specialist on staff so our resident has weekly clinical sessions dedicated to these specialties. We also partner with the NECO Center for Eye Care to give our resident a three-month rotation in their low-vision clinic. This allows our resident to gain valuable low vision skills in addition to the other optometric skills they are developing and refining at Dimock. Our hope is that when the resident leaves our program they have the skills needed to give a wide range of eye exams.
Dr. Giardina: One of the specific advantages of completing a residency in a community health clinic is the wide variety of patients and conditions seen. In addition, there are opportunities to "shadow" other health professionals and allow the optometrist to expand their knowledge base.
What is a typical “day in the life” for residents at a community health center?
This could include details on patient demographics, clinical hours, or after hours call, etc. Also, are there additional opportunities to give CE lectures or participate in other extracurriculars such as journal clubs?
Dr. Bastian: A day in the life of an LCHC resident involves direct patient care, precepting if desired, addressing and triaging eye cases sent from an urgent care department. Interacting with a visiting OMD to the health center, visiting Boston Medical Center to work with Ophthalmology in many different disciplines, observing surgery at Boston Medical Center. There are also didactic responsibilities during the year delivering 2 one hour CE lectures, and participating in a journal club with OD4 NECO interns.
Dr. Pogue: Our resident typically sees between 8-10 patients per day, Monday through Friday. Depending on the session these patients may be primary care (adults or pedi) or they may be contact lens exams. Our resident participates in on call services but does not have to go into the clinic; it is strictly phone triage. The on call service is minimal and the resident typically gets paged less than five times in a month.
Our resident leads weekly journal clubs for our fourth year students. They will also give “pop up” workshops for our students during the week if time allows. The resident also presents once at our monthly Dimock wide grand rounds. The Dimock wide grand rounds include all the departments within the health center.
Dr. Giardina: There is no "typical day". One day it may be routine eye exams, another ocular injuries and emergencies, often referrals from other professionals. We have x-ray, blood-draw, laboratory testing and pharmacy all on-site.
What is one of the biggest challenges residents may face during their time at a community health center?
Dr. Bastian: The biggest challenge is being able to handle advanced ocular disease in a busy clinical setting. The resident gets a lot of personal attention from 4 other residency trained attendings. The resident gets on call experience by handling same day triage cases from urgent care without having to be on call outside of clinic hours. There is a lot of flexibility with the residency program depending on the likes of the resident.
Dr. Pogue: One of the biggest challenges we see is the language barrier. We have a large Spanish speaking population and our residents generally do not speak Spanish, so they need to learn how to effectively use the interpreters while still maintaining an efficient exam. Another challenge our residents typically encounter is the transition from student to doctor. It usually takes them about two months to really make the transition and start trusting themselves to make decisions regarding their patient care without feeling like they have to rely on the attending optometrists for all decisions.
Dr. Giardina: The biggest challenge (there are many) for the optometry resident is developing a wide medical base of knowledge in order to correctly identify the diagnostic tests necessary for a definitive diagnosis.
Is there a specific practice setting or modality that residents commonly pursue after training?
Dr. Bastian: Community health practice or OD/MD hospital based.
Dr. Pogue: We have seen most of our residents complete our program and go on to work in a community health care setting which is our goal. We want to train optometrists who can take the skills they have learned during their year with us and then go serve other communities in need.
Dr. Giardina: Many of my prior students have continued to practice optometry in public health settings.
Conclusion
While residency training may not be necessary for achieving every new grad’s optometry career goals, it can certainly help facilitate personal and professional growth. Community health based residency programs provide students with an opportunity to gain experience practicing in a multi-disciplinary setting while also seeing a vast array of patient cases. While heavily based on ocular disease management, community health residency programs also expose residents to other areas of optometry including contact lens, low vision and pediatrics.
New grads opting for community health residency may also qualify for various loan repayment programs including Public Service Loan Forgiveness.
Students interested in a career path practicing in a multi-disciplinary, multicultural, diverse patient setting may find residency in community health to be the perfect starting point into a successful and fulfilling career in optometry.
