The College of Optometrists

what kind of experience do you need to get into the HES, i did my pre reg in a multiple and am working in a multiple now, i really want to work in the HES full time but dont know how i should go about it...can somenone please help me in the reight direction...also in HES do you have more control in the management and clinical decision making of your patient??

ps...i also have one years experience in a hospital laboratory (not optometry related) but would that help my chances?

With the patients charter - you will find you will have to be careful. You work in a team - it can be a curates egg however. I resigned from my hes post ten years ago, went part time and finally gave up. Happily high street now. :-)

The honest answer is it depends, on both the post you are applying for and the Hospital department. I prefer to appoint candidates with previous HES experience, especially pre-registration experience as they have a much clearer idea of what HES work entails, more RGP experience and usually better refraction skills in complex cases and better management strategies. However I have appointed candidates who have had no previous HES experience and they are now valued memebers of the team. The main difference is they require more support initially and this may not be available at all departments.

Your role should be as part of a team but certainly here in Leeds we manage our own contact lens and low vision patients and interpret the refractive results for Ophthalmologists and Orthoptists and suggest management options where appropriate. It is not without its problems in terms of complexity of cases and intensity of workload and is not for everyone.

Depends on your area, and whether you're prepared to move, but often it's easier to get some sessional work in HES initially. This gets you experience, and also gets you known in your local area, so if any extra sessions, temporary contracts etc come up, people might think of you!! If there are any co-management schemes in your area, could you get involved with this initially?

Also, you don't state this, but it's kind of implied in your post that you don't enjoy working for your multiple because you don't have enough control of clinical decision making etc. Have you considered other multiples/indepentdent practices?

Good luck

Lisa

I don't agree with Tims statement regarding OOs that have not done a HES re-reg, I know of plenty OO that are more capable than me at fitting contact lenses. Also, in my experience a significant number of HES pre-reg OOs fail the refraction PQE probably because they spent their year as a perimetry technician?

If you’re concerned about control in management and clinical decisions then maybe you should also consider working for a good independent as well as doing a few HES sessions. I think this will make you a more rounded professional.

Where do you live chocoholic?

If you're near/in a big city there are usually many opportunities if you look hard enough.

I agree with jonesal2 I fitted all sorts of wonderful c/l during my HES pre-reg, I'm sure I could make it look good on an application but at present it is not my bag...therefore I'm distinctly average at c/l

I think HES departments follow the personality of there principals. Therefore there are some that are forward thinking vibrant and exciting. Some that are not (i'm being polite)

In addition the NHS is full of financial constraints and beaurocracy: just see the Agenda for Change thread I'm about to join in above:

To me (a biased opinion) good independent + a specialist HES or Uni day is the way

I didn't really answer your question.

Write to local HES heads, asking what experience they look for

Ask to sit in the occaisional clinic

Demonstrate an interest in c/l or low vision or Glaucoma management by focussing you CET in that area.

As for your last question when I locummed I didn't feel pressurised by any multiple in my management or clinical decision making obviously within the constraints of routine refraction sight tests. I most certainly am given strong guidelines within my role in the HES. Still enjoy it though

All Tim said was that hospital pre-reg tend to have more RGP experience. While there will always be exceptions I'm sure that overall, HES pre-regs have seen and used a wider variety of CLs than most non hospital pre-reg. It stands to reason that these people will be (at least initially) better equipped to deal with hospital contact lens clinics than those who (like me) did a pre-reg with a multiple, fitted dailly and monthly soft lenses, and virtually nothing else.

I hope the perimetry technician is at least partly tongue in cheek! I think the main reason that hospital pre-regs perform less well in refraction is simply that they can never do the number of full routines that a non HES pre reg will do. Given the performance of hospital pre-reg in other areas of the exams, this is perhaps a small price to pay?

thank you for all the replies, you all have given me a lot to think about, Xavier i live in birmingham, i have given my details to a hospital just on the outskirts of b'ham who said that they will contact me if thhey ever need to, i have also expressed that i dont mind doing voluntary sessions just to gain the experience..may be i should also apply to other HES depts and sit in on a few sessions.......

thanks !!

I am also aware of plenty of OOs who are better CL practitioners than me, but that says more about me and the amount of continuing education I am prepared to do than it does about being a HES optometrist.

I would still say that generally HES pre-regs are better at managing the type of contact lens patients we see in the HES as they should have had lots of experience, I accept that there may be exceptions to that.

I am also aware of HES pre-regs who have failed Routine, however the pass rate is usually better in the HES for routine than for community practice. The pass rate in Routine first time is about 70% and it is the lowest pass rate of all the PQEs for all candidates regardless of their background. Last year the HES pass rate was 76% in Routine and the overall pass rate was 47% compared with about 33% overall.

It sounds as though you didn't have a fantastic year as a HES pre-reg and that is a shame as it should be a really firm base to build your optometric career.

Defiantly do some sessions before committing to any regular work. You may find at certain hospitals, you have even less capacity to make ANY decisions. If this is your only reason, then really would advise you try changing the practice you work in first. Hospitals can be excellent places to learn, but others can make you feel even less in control. I agree with Tim. If you have not worked in HES before then there is a lot to learn about the way HES work, and it can take time to understand what is actually expected of you. It can feel very alien at first. My advice is be clear that it will take time to adjust to working in the HES and be committed to making that transition. It can be tough and it’s not always about your intentions alone, if you join a team which isn’t used to working with optom’s you might feel there is no way up. Each department is very different. Make sure you join a team which is clearly pro-optometry and has experience at taking on optom’s without HES experience. Good luck with everything. Private practice can be very rewarding, if you find the right place. This is true for HES. Likewise both can become undesirable environments if they are not right for you. Give both a go. Good luck. Hope whatever you decide it works out for you. I believe your local hospitals include good hope, heartland, Birmingham city eye hospital, Wolverhampton eye hospital and West Bromwich. May be worth writing to the optometrists directly. Letters might not make it all the way otherwise.

I didn't do a HES pre-reg and still managed to fit more RGPs than my peers in the HES because I made a point of doing so. I am a firm believer of your pre-reg is what you make it!

I got in to HES optometry by virtue of my research background. When I started I could already interpret topography plots, had a fairly in-depth understanding of corneal physiology and management of anterior segment problems mainly from my time in the LASIK industry.

Personally, I'm not sure a HES pre-reg is all it's cracked up to be, but may be I'm biased?!

I apologise I had assumed you had done a HES pre-reg and therefore were talking with some personal experience.

I do agree however that not all HES pre-reg years are fantastic and that they are not for everyone (which is just as well as there are only about 40 places available a year anyway). I also agree that your pre-reg year is what YOU make it.

I accept as an ex HES pre-reg and full time HES optometrist I may be biased also!