4th Year Rotations – Choosing Your Sites

So you’ve just started your 3rd year of optometry school, finally got a grasp of seeing patients on your own, and now you’re about to take on the daunting task of choosing from over a hundred externship sites for your 4th-year rotations.  

On top of the vast number of sites to consider, the process can become stressful given most school’s “lottery” protocol, especially as the list of available favorable sites dwindle.

However, determining what you deem most fundamental in the last year of clinic and doing thorough research to ascertain the pros and cons of each site will make externship selection the easiest feat of your 3rd year.

Research the Externships Available

Doing your due diligence before selection day and categorizing sites will save time and headache amidst the chaos. Where do you start?

  • Ask classes above you!

Inquire about site patient volume, specialty, learning environment, and the student clinician’s role at the externship. Past students may also have housing and travel suggestions that can’t be found from other resources.

Take into consideration information from those that recently rotated through these sites, but do so with a grain of salt, especially when it comes to discussion about practice culture or clinical preceptor-student interactions.

Variation in personalities can lead to differing experiences between two equally competent students.

  • Meditrek, if available—Meditrek is a great resource for clinical site evaluations.

Recurring remarks from numerous past classes helped me confirm levels of complexity and expected involvement, which greatly factored into the chronology of my rotations (i.e. greater patient volume or disease complexity closer to graduation).

You can also find a breakdown of specialty encounters that provides an idea of skills that will be utilized at the site (see Table 1).

No formal externship site evaluations? Be the class that starts an ongoing list, such as a Google doc or excel sheet!

  • Ask you school’s externship director.

If it’s a new site, ask your school’s externship director about the type of practice, expectations, and mission statement.

They often must make site visits and are in frequent contact with clinical preceptors

  Table 1 

Questions to Consider

The motivation for selecting one’s externships are unique to each individual. In a survey of current 3rd years, 4th years, and graduated optometry students, we found that the desire for expanding clinical experience through variation was the greatest deciding factor (see Figure 1).

4th year is the most learning intensive portion of optometry school due to the hands-on, clinical nature of the curriculum, and with the right selection, can provide a well-rounded experience.

However, priorities can shift due to personal or professional reasons.  Here are a few questions to consider when ranking your sites:

  • How many mandatory rotations through your optometry school are there?

Rotation periods can vary between schools with different “in-house requirements”.

If your curriculum requires at least one school-based location, consider what type of care you’ll be providing at this site and create variety with the remaining externships.

  • What is my plan after graduation? VA, private practice, or residency?

4th year is an ideal time to look into your post-graduation pursuits.  Although each location has specific procedures for 4th-year externs, every practice will treat the students like a member of their team.  

As student clinicians are immersed into the programs, it is a great opportunity to learn more about practicing in the real world. For example, private practice offices can give invaluable insight about billing and coding, human resource, overhead, and meeting with industry representatives that translate to future endeavors.

Similarly, rotating through a VA or Kaiser can provide the novice clinician an idea about the structure and flow of these multi-disciplinary organizations.

  • Are there “priority/primary” sites?

Priority” or “Primary Sites” are those that the school specifies must be filled. All other sites are deemed to be “alternative” or non-priority.

Some schools may have approximately the same number of externship sites as students within a class, in which case every site is selected. Depending on how your selection standing is determined (i.e. GPA, lottery, local-need, etc.), you may need to anticipate that these sites will likely be the only sites that you can choose from.

Despite what you may hear regarding sites from upperclassman, approach the site as an instrumental learning experience. Each experience is directly related to what you put into it.

  • Do I have enough experience in certain specialties?

Following graduation, many become primary care doctors or highly specialized in their field. Although you might be apt to refer out patients outside one’s own specialty, being able to confidently diagnose and initiate treatment prior to further consultation or referrals smooths the transition of care between providers.

For this reason, it is critical to determine how each specialty may be weighted at each site prior to selection.

  • How important is the site’s location?

Life happens. Whether it be due to family obligations, professional networking or other pursuits, the location may be the primary reason that one chooses particular sites. The following should be considered: demographics, cost of living, access to public transportation, family, proximity to Charlotte, NC for NBEO Part III boards. However, these factors should not hold precedent over one’s clinical education.

The following should be considered: demographics, cost of living, access to public transportation, family, proximity to Charlotte, NC for NBEO Part III boards. However, these factors should not hold precedent over one’s clinical education.


Organizing Your List & Making Final Selections

Regardless of how your externships are chosen it would be beneficial to make a list of most desired sites and “absolutely never” sites.  Ranking your sites for each period of rotation also eases the process on selection day.  During the selection day, you may need to rearrange your list as externships are eliminated, or shifted as you select certain practices. For example, you have selected two VA sites for your first rotation, so you would want to consider removing VAs from additional rotations, moving other practices higher. 

During the selection day, you may need to rearrange your list as externships are eliminated, or shifted as you select certain practices. For example, you have selected two VA sites for your first rotation, so you would want to consider removing VAs from additional rotations, moving other practices higher. 

If you have your eyes set on a site or even one of your top 5, don’t dwell! Accept that each rotation will help you become a better optometrist, helping you to provide the best care to your future patients.

Overall, Get Excited!

Despite the initial uncertainty and stress, don’t forget about the fact that you’ve already completed half of your optometric career.

The externship selection process is a milestone and a stepping stone towards an incredible adventure with memories and clinical pearls that will stay with you for a lifetime!