Classroom Spotlight: Optometry Clinical Skills 4

PCO Clinical Skills Lab
“Wow look at that,” exclaims a student as Dr. Maria Armandi, instructor in the University’s Pennsylvania College of Optometry (PCO), shows the gathering class of Clinical Skills 4 students a photo of glass stuck in her son’s eye. The real-life example helps visually reinforce one of the topics the class is covering that day – foreign body removal.
While this portion of the class is chatting about the challenges and techniques used to remove foreign objects from the eye, another student group is testing their skills by removing shards of glass from a pig’s eyeball. Another segment of the class is only seeing through one eye as their partner has pressure patched the other. These clinical skills are taught as part of the third program year Clinical Skills 4 course and represent skills that they will need in clinical practice.
“More advanced skills are taught in the class or we enhance skills they were taught previously, showing them other ways to do something so they’re able to perform a more comprehensive exam,” said Dr. Jamie Neiman, assistant professor for PCO and lead instructor of Clinical Skills 4.
Dr. Neiman explains that the course enhances and expands upon the skills that students previously learned in Clinical Skills 1-3 and their experiences in the University’s optometry clinic, The Eye Institute. She said many times she will hear a student say, “I saw this in clinic. Now it makes sense.” Skills covered in the class include dilation and irrigation of system that controls tear drainage, reviewing diagnostic testing, dry eye management, and foreign body removal, among others.

Chantelle Sum '19OD said the class truly helped her deepen her knowledge as a clinician.

"There's a sense of growth that you see in yourself as you become a high-caliber optometrist based on the progression of basic skills learned in first year to advanced techniques in third year that can help maintain or improve a patient's vision," she said.
Clinical Skills LabSome of the course material is a review of previous learning, but there is always a focus on providing the students with new ways to approach using a certain skill while examining a patient. The course is especially impactful as students are preparing to embark on clinical externships.
“When we are trying to refine a patient’s prescription, most optometrists will ask, ‘Do you prefer option one or option two?’ but some patients aren’t responsive to that,” Dr. Neiman said. “We’ve taught them to ask the patient to look at a clock face and ask, ‘Which line appears darker?’ You can determine the correcting astigmatism with an alternate method.”
Other more unconventional substitutions include teaching foreign body removal by placing objects in Jell-O for the students to remove. According to Dr. Neiman, the consistency can be more similar to a live, human eyeball. The goal is the same in each Clinical Skills class, but especially Clinical Skills 4 – ensuring students are well-rounded clinicians and able to treat the individual needs of each patient.  
“We are filling their bags with tricks,” she said. “We’re going to teach multiple ways to do things because not every skill works on every patient. If one way to determine something is not working, you can go into your bag and pull out another approach.”

For some of the techniques, students practice on each other, according to Ms. Sum, which further enhances their patient care skills. 

“We are able to challenge ourselves as students by applying what were taught in class and practicing on each other based on the different conditions, anatomical structures and ethical attributes that we all had,” she said. “These experiences allowed us to master clinical skills as we transition into clinic and externships with ease as we deal with a diversity of patients.”