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Peer Advice: A Deep Dive into Preparing for Proficiencies


You’re just starting graduate school – congratulations! You’re going to do great!

The first few weeks of the quarter will fly by and you’ll soon be in the full swing of midterms and proficiencies. If you haven’t heard of proficiencies yet, they are an opportunity to show off mastery of clinical skills that you’ve been learning in your clinical classes.

The proficiency is pretty unique to graduate school and most incoming students haven’t experienced a hands-on test quite like it before. You are graded on how well you can perform a skill such as retinoscopy, manifest refraction, slit lamp, BIO, etc. in a given amount of time. You act as the doctor for a patient (a TA or classmate) while you’re being graded by a proctor (the lab professor).

Proficiencies are often a source of great anxiety for many students. There’s nothing like time slowly ticking away while you scramble to remember the next step in a procedure while the all-knowing proctor holds the power to shape your destiny… er… grade.

Performing well on a proficiency comes down to two main things: practice and staying calm. Here are some more tips with a rough timeline of what I have found helpful. Everyone is different, so find what works for you!

A Week Before…Photo of dog

  1. Practice, practice, practice! This one is pretty obvious, but getting in a lot of practice far in advance is step one. You’ll need all that practice when you’re performing under pressure!
  2. Time yourself. When you’re first practicing retinoscopy on your classmates, you might be taking 30+ minutes, but you need to do it in 10 minutes for the proficiency. At least a week before the proficiency, it’s probably time to work on getting faster. If you’re spending 20 minutes, set a timer for 15 minutes and see what happens! Then, start shaving down your time until you’re able to do it fast enough.
  3. Get someone to proctor and time you. Working in groups of 3 during after hours can be really helpful in adding the pressure of someone watching you! If you proctor someone else, it also helps you see other styles of doing things. The TAs can also proctor for you.
  4. Read the rubric! You don’t want to miss a point for something easy like giving patient instructions, skipping a step, or stating your findings.
  5. Hone your “script”. I usually say the same exact sentences with the same wording each time. It helps because I really rely on muscle memory during proficiencies! Suggestions for how to phrase patient instructions will be in your lab manual. 

The Night Before…

Here’s where nerves start kicking in and if you’re like me, you might go into panic mode.

  1. Go to After Hours one last time. Most of your classmates will go to After Hours the night before, and that’s a great chance to get some last-minute practice in. By this point, hopefully you’ll be under or near the time requirement. Try to keep the run-throughs as “real” as possible (make sure to time yourself!) and take this practice seriously.
  2. But… don’t practice too much! At this point, it’s best to just be confident in your abilities. When you’re tired, you might have a bad run later in the night and then worry that you’ve gotten worse at the skill. It won’t help much to stay up late and practice for 6 hours – go home and rest!
  3. Make sure your scrubs are clean. For proficiencies, you must either wear professional clothing or scrubs. Double check that they’re washed and ready for tomorrow!
  4. Get some rest. You’ll function at your best if you get enough sleep and take the rest of the night off. You deserve it for all of your hard work! I’ll usually review the rubric when I get home.

Proficiency Day

  1. Eat something! I’m not a huge breakfast person, especially if I have proficiency-nerves, but I always make sure I eat something small. Your mind and body need fuel!
  2. Caffeinate per usual. This one is contentious – I know some people swear by drinking no caffeine before proficiencies to calm their anxiety, while other people have more caffeine than normal to stay alert. I think it’s best to do your normal routine! You definitely don’t want to be feeling caffeine withdrawals or be super shaky.
  3. Create some type of routine. Similar to above, develop a pre-proficiency routine. I usually drink black tea and blast music through my headphones. My own peer advisor had a routine of drinking multiple cups of chamomile tea and eating bananas for some natural beta blockers. Find something small that you can do the same way each time!
  4. Arrive early! You’re usually supposed to arrive at least 5-10 minutes early, and leave plenty of time to get to school. I don’t like waiting right outside the lab room for too long, so I’ll usually hang out in my car or outside in the quad.
  5. Don’t forget to breathe. Trust yourself and your skills. You’ve been practicing, and this is the opportunity to show it! Just breathe and do your best.

I recommend trying to not take any single proficiency too seriously! I know this is easier said than done, but letting nerves get to you majorly impacts your performance. It’s helpful to remember that mini proficiencies in particular aren’t worth very much of your overall grade. Failing a few along the way is totally normal and doesn’t mean you’re not meant to be here! It just means you had a bad day or didn’t practice quite enough. Many classmates and I have failed a couple and survived!

The quote "if better is possible, good is not enough"A parting thought: there’s an inspirational quote often attributed to Benjamin Franklin located in the stairwell of Building C that reads “If better is possible, good is not enough”. Though meant to inspire greatness, I have a love-hate relationship with its message. After a proficiency as I pass by it on my way out of Building C, it makes me think about the things I likely did wrong even if I ended up acing the proficiency. I dwell on little things that could have gone better or worry that I missed something big. However, oftentimes in optometry school, good is enough and we don’t need to be perfect at everything. Failure and the resulting improvement are part of the process but in reality, “good” is all you need to demonstrate that you’re growing as a clinician. You’re not going to be perfect at retinoscopy in your first few weeks and that’s okay. Good is enough, improvement is enough, and you are enough. Don’t let one proficiency or experience in optometry school define your success!