Expert tips on finding a pre-reg placement

Completing a hospital placement is an essential part of your pre-registration period. It’s your opportunity to find out what happens to your patients once you have referred them, and an invaluable way of improving your understanding of eye disease, its investigation and management. Some of the conditions you encounter, you will come across regularly in practice, whilst others you will only have read about in text books or heard about in lectures. If chosen correctly and undertaken with enthusiasm, your hospital placement could be one of the most enjoyable parts of your pre-registration period. So here are some tips to get it right:

Applying for your placement

• Apply early - placements get snapped up, leaving you little choice about where you go and less chance of being in your local eye unit, which has advantages in terms of learning about local referral pathways and clinical decision making. Start making enquires as soon as you confirm your pre- registration position in community practice. Making enquires once you have started your pre-registration period may be too late.
   
• Do your research - find out what each hospital you are interested in offers for their placement. Speak to a newly qualified optometrist who has recently completed their placement, to your supervisors or ask the placement co-ordinator in the hospital (it may not be an optometrist).
   
• Don’t expect a ‘hands on’ placement - placements may be purely observational (more likely) or may involve you seeing patients under supervision (less likely). If it is the latter, please check the supervision arrangements with the College to ensure they meet College requirements. 
   
• Think about what kind of clinic would suit you best - some placements will be the same day each week, which means that you attend a limited variety of clinics but will get a vast amount of exposure to that clinic type. Other placements may be on various days of the week or in ‘blocks’, which means you will have a greater variety of clinics. Think about which would suit you best. It is essential that you are flexible in arranging your placement and while you are on it, as what may suit you best may not be best for the HES (Hospital Eye Service). Also, some placements will be solely in ophthalmology clinics, while others may include any combination of ophthalmology, orthoptics, low vision, contact lenses, eye casualty and optometric paediatrics and so on. Decide what you would prefer and then find out what is on offer.
   
• Ask your supervisor to make contact - many hospitals prefer the supervisor to make the initial contact and introduce themselves and their pre reg. It may be worth enclosing your CV at this stage or a brief description of why you would like to be considered for a placement at that hospital.
  
  NB The hospitals charge for the placement and this is paid from the training grant that your supervisor is given. The charge may depend on how long the placement is and what type of placement it is. 
   
• Complete any paperwork promptly - you may be required to have an observer or honorary contract for your placement and this may require you to complete some pre contract checks and health checks. The quicker you complete these the quicker your contract will be in place for you to commence your placement.
   
• Check your work permit status - if you need a tier 5 visa to undertake your pre-registration period in practice, the hospital may have additional requirements before they can accept you on placement. It would be beneficial to find out about this early so that you can get your paperwork in order.

Completing your placement

• Make the most of your placement! Enjoy it, ask questions and really take the opportunity to learn. If you are in a hospital with hospital optometrists, find out about their work: which clinics they work in, which additional clinical skills they have developed and which higher qualifications they may have taken. There are many different career opportunities available to you once you qualify, so it would benefit you to take the time to find out about these when you can.
   
• Read your contract - be clear about what your contract type allows you to do whilst on placement and what the local arrangements are in the hospital that you need to follow. 
   
• Be professional - remember when you are on placement you are an ambassador for your practice and for your profession. Arrive and leave on time, be polite at all times, be sensitive about what you discuss in front of patients. 
   
• Familiarise yourself with your logbook - the HES logbook has blank and pre- formatted witness testimonies, as well as patient encounter sheets. It also has a daily log that has to be signed each session by your supervising clinician. The person co-ordinating your placement has the opportunity to provide an overall statement on your placement in this logbook. Take time ahead of your placement to familiarise yourself with the logbook and print off spare witness testimonies in case you need them when on placement. Expect that your assessor will look at your HES logbook during at least one of your assessments.
   
• Remember you are expected to obtain all your competencies from community practice – don’t rely on your hospital placement for this. The hospital co-ordinator and supervising clinician can comment on what you have observed and done whilst on placement but not on your level of competence.

And finally, enjoy yourself!  Your hospital placement is a great opportunity within the pre -registration period to develop and enhance your skills and to better understand what happens to your patient once they have been referred.

Try and get as much hospital experience as possible, maybe over the summer holidays, so you know what you’re getting yourself into.

You can apply for most pre-reg hospital places via the NHS website. Hospitals advertise at different times of the year, so keep looking or set an email alert. UHCW is going to advertise its next pre-registration positions on the Colleges’ jobs board, however the application period will only be two weeks. 

Try and get as much hospital experience as possible, maybe over the summer holidays, so you know what you’re getting yourself into. I think a Saturday job or a temporary summer job in private practice is also useful so you can compare the differences. UHCW views previous optical experience in any sector as extremely important. The post for the pre-registration placement at University Hospital in Coventry advertised through my university by email through one of the lecturers. I thought I would apply and try! I was extremely lucky to be invited to interview.

The first part of the interview was a series of different OSCE stations. These were basic clinical tasks that we had learnt at university – so nothing too difficult. The second part was a face-to-face interview and I was asked for examples of working as a team or with difficult patients and so on. I think they wanted to find out if would fit into a large team and be able to cope with the wide array of patients. There were also clinical questions – eg ‘What would you do if you had a patient with a disability?’ or ‘What tests would you carry out if you had a 12 month old baby in your testing room?’ They also asked about my previous optical experience.

I was able to get all the competencies I required, although some were a bit harder to gain. Most of the patients we see in the hospital require RGP’s so it was harder to find patients with soft contact lenses. Patient with flashing lights or floaters would go straight to Eye Casualty, so we would never see them first for refraction before they had scleral indentation.

We had a dispensing shop on site so, during my pre-registration year, I would spend half the day dispensing and the other half in clinics. As the optometry team is very large (19 optometrists), there was always someone to go to in terms of supervision. Some optometrists specialise in particular areas, which was useful when I was studying for different aspects of pre-registration such as low vision or contact lenses. We had numerous ‘teaching sessions’ where we would sit with our supervisors and go through different topics/skills such as slit lamp technique, glaucoma etc. One of my supervisors was also a college assessor, which was really useful for when it came to my case records as she would pick out certain things that could be flagged up.

I would definitely recommend working in a hospital for the clinical experience, as you see all kinds of weird and wonderful patients. You also get to work with other clinicians such as orthoptists, which is very useful when it comes to binocular vision (BV). The best thing about it for me is being able to work with such a large team. You get to interact with all different departments and you are constantly learning. It builds your confidence in seeing so called ‘tricky’ patients, although I guess you do lose your skills of routine sight testing if you solely work at the hospital.

Don’t expect your dream pre-reg to come to you. If you want it, you have to go out and look for it. Sometimes it seems as if students want all the information handed to them on a plate but the best positions are often the ones you have to dig a little to get to. All the big multiples came and gave talks at GCU, but I had to find out a lot about hospital pre-regs myself, but the information was out there when I looked for it. I found independent pre-reg information was delivered more by word of mouth, which makes sense, as this is the way most independents gain patients too. Keep your ears open and tell others (lecturers, students, colleagues) what you are looking for in case they hear of anything or know anyone.  I’d also recommend contacting pre-regs or newly qualifieds from your university to see where they did their placement and if they recommend it. Check the College’s jobs boards or the AOP website. Another option is simply to email independents in the area you want to work and see if they would consider taking on a pre-reg. They might not have thought of it and are likely to be very impressed by your initiative to ask. If you can, meet your supervisor and your team before you accept a placement. Your chemistry together will greatly affect how easy you will find coping with the stresses of pre-reg. If you can get a part-time job there or even a couple days work experience just to see how they run the practice that will help you hit the ground running when you start.

I had a part-time job in an independent whilst at university, but I craved a different experience when it came to my pre-reg. I originally had my heart set on hospital optometry, and received an offer for a pre-reg in England. I had also hedged my bets by completing a summer placement and receiving an offer for a pre-reg in a multiple. I was torn between the two and was struggling to decide, when one of my lecturers brought me in for a chat because he knew of an independent opticians looking for a pre-reg. He was convinced if I went for the interview I’d love it, as he thought it would provide me with the more clinical experience of optometry I was looking for. He had worked as a locum there, knew the staff well, and had a feeling that the job was right for me.

He was spot on, it was exactly the type of practice I was looking for but hadn’t known about. It was my interview that really sealed the deal. I was interviewed by the two optometrists who would be my supervisors, one of whom was the owner of the company. My boss is renowned for trying to give difficult interviews. He tried to catch me out with a question on prismatic difference. But I know now he didn’t care if you got this right or not, he just wanted to see if you’d panic, try to work it out, or just guess. I would suggest you prepare for a lot of questions like that. You won’t be able to answer absolutely everything so don’t panic about it. Just work out what you can and admit when you’re not sure. There was also a role play, with him as a patient with suspected glaucoma who was unwilling to go to the hospital to get it checked. I had to explain the condition in lay terms and convince him to go to his appointment. This is something I’ve had to do many times where I work, so I felt it was a good assessment to be given.

My other supervisor asked me a lot more about my roles outside of university and what I liked to do in my spare time. I relaxed massively at this point because it simply became a conversation about our shared interests. When I said I liked cooking they wanted to know what baked goods I would bring in to work with me for them to try! The focus was clearly on whether I’d fit in as a member of their team rather than how much I knew about optometry.

The questions asked were very similar to those I got asked at my hospital and multiple interviews. They all want to test your optometry knowledge, your extra-curricular activities, what you are like as a team member and what you are like as a person. However, I felt that the atmosphere was different. In the hospital, the interviews were conducted very seriously and this made me nervous. It also led me to be unsure of how I would get on with my possible supervisors as they were conducting the interview. The multiple interviews had a lot less one-on -one time. You were unlikely to be interviewed by your prospective supervisor, and you felt you had to shine during team-building tasks. Although I don’t doubt this gives the companies a better idea of what you are like, it certainly doesn’t give you any idea of how well you will get on with your practice team. After my experience and my final choice, I can’t stress how important I feel it is that you try meet your supervisor before you make a decision. Although you can never be sure, you should be able to tell the difference between an instant rapport, or if they frighten the life out of you.

I got an instant good feeling at the independent  interview, I didn’t get from the other two options. I now can’t see myself working anywhere else, not in the near future anyway, and feel privileged that I ended up with such a good pre-reg. My supervisors would talk to me or come in on their day off if I needed them to. The best support I got was when I failed my Stage 2 assessment. They picked me up after having a big confidence knock, identified the exact areas I went wrong, and helped me practice and revise until I genuinely felt I couldn’t fail.

Real RGP patients were difficult to come by, but we called all the ones we knew who came in as a favour. Staff members and their friends and family, were often kind enough to come in and have RGPs fitted, and the children of staff were often brought in to help me have more time to practice my children’s sight tests.

I think that when you do your pre-reg in an independent practice, your role within your team is much more important and you will feel more valued than you necessarily would working for a multiple. If you find the right practice you will find the exact “type” of optometry you want to be part of. This will make your working life a breeze, and that is more important than I can put into words.  

I think it’s important to be organised, take the advice of those that have recently done pre-reg, and always be over prepared rather than under prepared.

I don’t think that there is anything that makes any particular mode of practice better for pre-reg. It’s about the individual person and where they feel they will be most comfortable, and also about the support that you get from a good supervisor, and the people that you work with.

I was lucky finding my placement. The practice where I did my pre-reg emailed the optometry department at Bradford, and they forwarded it to all students. I would recommend that you go out and meet the people that could be your future employers, use the events that are arranged for you to meet them in a less formal situation before you get to interview. Get some kind of work experience, optics or not, your future employers will like it if you’ve had/got a job and know a bit about the world of work before you begin your pre-reg.  Also, join your OPSOC as they may have some good connections.

In my interview, I was asked about myself, my career path so far, and what I did when I wasn’t working. I was asked about where I would consider working, and travelling distances. I was asked about how I would explain a varifocal lens to a patient that was having them for the first time. I think it’s important to be organised, take the advice of those that have recently done pre-reg, and always be over prepared rather than under prepared. Also, meet the team that you’ll be working with if possible, make sure that you think you’ll fit in and get the support that you will need during your pre-reg there.

While you are on your placement make sure that you start ‘collecting’ patients with conditions that you don’t see every day as soon as you see them. And get your practice team on board to help find the things that you know will be difficult.