Becoming confident clinicians in a recovering labour market

Students graduating and rising through universities in recent years may be entering the profession knowing only the form of optometry that emerged through the pandemic – one of personal protective equipment, communicating behind a mask, and with a stronger emphasis on history, symptoms and triaging than ever.

Placement availability

The availability of pre-reg placements has varied throughout the pandemic, and though there is a recovery, some students are still feeling the effects.

Providing a view into how students are finding the application process, Dr Leanne Smewing, clinical lead optometrist for the School of Health professions at the University of Plymouth, told OT: “Students have certainly found applying for pre-reg a little more difficult this academic year. There seems to be fewer places available than in a ‘normal’ year.”

The university has been supporting second and third year students with CV writing, and Smewing added: “It has been important to emphasise what year they are studying, as we know employers are receiving applications for students aiming to start pre-reg in both 2022 and 2023.”

Anil Kirit Rach, student representative for Optometry Scotland and fourth year optometry student, told OT: “Some of my fellow students have had concerns about securing their pre-reg placement due to changes in the number of pre-reg places available.”

Some practices have had to reduce the number of pre-regs they take on, while in some cases, students have encountered delays caused by an overlap with the previous pre-reg, although Rach said, “most students are still able to join the practice and gain experience front-of-house until there is testing room space for them.”

The majority of students feel there has been a lot of support in securing a placement, Rach found.

Third-year optometry student in Wales, Martha Glain, has also seen a level of anxiety from fellow third-year students about selecting a pre-reg placement.

Part of the reason for this, she suggested, has been that some practices have not been able to offer work experience placements due to capacity issues resulting from COVID-19 restrictions. “Some students have not been able to visit their chosen store to meet staff, or even get a feel for the area where the practice is located, before signing their contracts,” she said.

“In addition, some locations aren’t sure if their current pre-reg will finish their placement in time to take another in the summer,” she added.

Highlighting the importance of forming these connections, Glain said: “This is where we’ll be spending more than a year of our lives, and we know that it can often be a very challenging journey, so it’s crucial that the environment we find ourselves in is supportive, and that we can feel at home there.”

Increasing opportunities

Employers have been seeking to support pre-reg optometrists and students in the transition from studies to placement, or to provide new opportunities.

Among those expanding availability, Specsavers told OT that it intends to increase the number of pre-reg places offered this year.

Places have risen from 450 in 2019, to over 500 in 2020, and for the 2021–2022 period Specsavers has made more than 550 offers and continues to support students “who have been unable to secure a position elsewhere.”

“There is an enormous amount of competition for places, particularly in the popular city centre and more central locations,” Victoria Taylor, head of graduate recruitment at Specsavers, said. “Many of our vacancies in those areas will typically receive more than 100 applicants per role.”

The company has adopted a more flexible approach to its pre-reg programme to “withstand the challenges” of recent years. For example, the onboarding process has evolved from a focus on the autumn months to extend beyond this, Taylor said, finding that this is “more accommodating for both students and practices.”

“I believe we have learnt a lot from doing things differently during the pandemic, and there have been some real positives,” Taylor reflected. Some processes have worked well virtually, but she added, “there is no replacement for getting out and meeting the students in person, which we love to do. I see us working in an agile way in the future, adjusting what we need to do in order to fit with the ever-changing landscape we operate in.”

I believe we have learnt a lot from doing things differently during the pandemic, and there have been some real positives

David Clulow also intends to broaden placement availability in its practices, offering 10 places for the 2022–2023 cohort.

This follows on from the positive experiences of three pre-reg optometrists within the company, explained Natasha Luthra, resident optometrist at David Clulow’s Wigmore Street flagship site, as well as “the growth in interest from our optometrists to supervise, and the capacity to add additional testing rooms to several practices.”

“We’ve already had a mammoth surge in CVs to head office through word-of-mouth, as London placements are so highly sought after,” she continued. With advertising of its pre-reg programme due to be rolled out in the future, the company expects to see even greater demand.

Timelines are still in place to aim for qualifying within 11 to 14 months of embarking on the Scheme at David Clulow, though the company aims to take a personal approach to each pre-reg, appreciating that “everyone needs support in different ways,” Luthra shared.

Boots Opticians currently has 11 pre-regs on its programme, with the intention of welcoming around 85 new members to its team in the summer.

Jayne Johnson, learning and development manager at Boots Opticians, told OT that the team had already planned to integrate virtual elements into its programme, but these were accelerated by the pandemic.

As a result of the pandemic, elements of the application process have moved online with virtual interviews and sessions with optometry schools. Johnson added: “We know it has been a difficult time for students over the last few years and we try to ensure the support and care that we offer comes across when we present.”

Accelerating the roll-out of a virtual programme “allowed us to review the benefits of online learning and its accessibility for bitesize sessions,” Johnson shared.

Running the programme on the platform for a year has helped Boots Opticians to “scope our programme even further for the current year,” she added, “giving us the benefits of online lectures mixed with face-to-face smaller workshops which our colleagues benefit from and really enjoy.”

The business provides a range of support to help pre-regs through their placement, with monthly workshops – some of which are held in-person in triplet groups, peer groups, or full year groups. Activities focus on a range of topics from clinical skills, to the skills needed to support them through the Scheme for Registration, and business knowledge.

“This is all supported by three pre-reg specialists who not only look after our pre-regs but also facilitate supervisor drop-in sessions to support knowledge and understanding of the milestones throughout the Scheme for Registration as well as peer networking,” Johnson said. The specialists work with practice managers and area teams “to create a truly integrated programme.”

We’ve got so much to offer in independent practices

In independent practice, Claire Slade, head of professional advancement and governance at the Hakim Group, told OT: “We have crafted our pre-reg experience to ensure it’s not based around volume, but really creating well rounded optometrists of the future who could work anywhere, and achieve all their aspirations with multiple pathways for career progression.’’

“Previously there hasn’t been one port of call for pre-regs interested in working in independent practice,” she shared, and “there’s not a massive number of pre-regs being trained in independent practice.”

The business has created a central resourcing team to act as a key point of contact for students interested in pursuing a pre-reg in independent practice. Slade suggested this offers a new experience for pre-regs, “and another career opportunity that might not always be obvious to them.”

Students can apply with their CV and information about where they would like to be based or might be willing to move to, and the team then works to try and pair successful applicants with practices.

This work is beginning with engaging universities and talking to second years about independent practice. Slade noted: “We bring in some independent joint venture partners to share that concept with them early on, that part of your career might involve being your own practice owner. That might be an aspirational seed that we can plant early on.”

Meanwhile, the team is keen to support the current cohort of graduates and pre-regs, to try and place more people.

Outlining the business’ desire to support future optometrists, Slade said: “We’ve got so much to offer in independent practices, and I think it can really be the best place to train.”

Challenges to confidence

Discussing the challenges students have faced over recent years, Hathaf told OT: “One of the concerns students face following the pandemic is transitioning from a student to a confident clinician.”

For some, a difficulty in developing that clinical confidence has come about as a result of struggles to secure work experience placements during the pandemic.

Work experience is valuable for supporting the understanding of students. University of Plymouth’s Smewing shared that the department has found: “Particularly in dispensing clinics, those who have worked in optical practice and have dispensed before show real confidence and achieve the necessary episodes and competencies at a faster rate.”

To support students who don’t feel as confident, the university runs additional sign-up sessions to offer the opportunity to gain additional hours of experience in the patient clinic.

Glain reflected that, because of the added pressure of COVID-19: “I feel as though I haven’t had the same level of clinical exposure during my time at university, where a lot of students see their first ‘real’ pathology.”

In addition, she noted that “A lot of pre-reg placements are looking for previous experience working at a clinical practice – an experience many students have not been able to have due to the COVID-19 pandemic. Because of this, options for placements are limited and students are feeling pressured to accept any offers that come their way.”

Third-year optometry student, Amy Cooper, agreed recognising that “understandably, practices aren’t too keen on bringing in additional unnecessary people,” and that often it has not been possible to have a student in the testing room with the optometrist, while maintaining a reasonable distance.

Explaining why this is worrying to students, she shared: “I think that some people are concerned that they should have more to show on an application, or think that it’s absolutely crucial to have lots of work experience.”

Concerns about confidence and ‘having more to show’ on applications have been common issues identified amongst broader populations of young people.

I think that some people are concerned that they should have more to show on an application, or think that it’s absolutely crucial to have lots of work experience

Research by the Institute for Employment Studies (IES), an independent centre for research in employment and human resource management, into employment of young people, found three different common experiences amongst university students.

Cristiana Orlando, health foundation research fellow, explained that IES research found experiences ranged from those who were concerned about higher levels of competition for graduate jobs in the year ahead, to those who felt the direct impact of the pandemic on the practical aspects of their degree, to students who had the added disadvantage of reduced opportunities for work experience.

She said: “All types of experiences are important to develop, and then show, those transferrable skills.”

“Young people are concerned that, increasingly, we are moving into a more competitive labour market, where employers have more stringent requirements for recent graduates,” she explained, adding: “There is a generalised anxiety of ‘I have to show something,’ and that the lack of experience of the practical side would be a deterrent that would play against them when looking for a job.”

Careers consultant, Estanis Bouza, at The Careers Group in City, University of London, also noted this nervousness from students: “I think we will always look back on the last couple of years as a period of time when lots of students missed valuable opportunities. Many have struggled in different ways over this time. I have spoken to many students about the anxiety that missing out on opportunities has caused them.”

While the group recognised that while organisations “made great efforts” to provide virtual experiences during lockdowns, there was an overall reduction in availability, and that, “it is still difficult to replicate some of the benefits of an in-person experience, particularly the more informal social benefits that would arise from just being in a shared environment with other workers.”

Some students have been particularly hard hit by the shrinking of opportunities over the past few years.

Research by The Sutton Trust, an organisation championing social mobility, indicates that 39% of graduates in their twenties have completed an internship, including almost half of young graduates under 24.

However, 2021 research indicated that there had been a drop in students from low-income backgrounds participating in extra-curricular activities.

Dr Rebecca Montacute, senior research and policy manager at the Sutton Trust, explained that, as focus shifted to core learning: “Unfortunately, this means that extra-curricular activities and work experience placements have fallen down the priority list, and this has affected disadvantaged students most keenly.”

This widening of the participation gap could have knock-on impacts to accessing the workplace, she suggested.

“Our previous research, in 2017, highlighted how important ‘essential life skills’ – things like confidence, motivation, and resilience – are for the workplace, with 94% of employers saying these skills are as, or more, important than academic qualities,” Montacute added. “It is vital that all young people have access to extra-curricular opportunities which help to develop these skills.”

The market and perceptions

What does this variation in opportunities, and impact to confidence, mean for students and how they feel about their prospects?

“As a student, navigating your career path and the pressure to make sure your pre-registration application stands out can be overwhelming,” shared Hathaf.

While work experience opportunities have become easier to access than early in the pandemic, some areas – such as hospital experience – have remained limited. “This has been difficult for students as it limits the chance to learn more about the profession of optometry,” she added.

Glain agreed: “I believe that a lot of students are feeling apprehensive about starting their pre-reg placement, a main reason being that, compared to students in previous years, we simply have not had as much experience of working in practice.

“Overall, I think students do feel ready, but perhaps not that they have the confidence to tackle complicated cases.”

The fluctuating levels of confidence seen amongst students have also been reflected in the labour market.

As a student, navigating your career path and making sure your pre-registration application stands out can be overwhelming

 
As job and work experience places started appearing again, IES noted a discrepancy between this recovery and young people’s perceptions of the market.

“That speaks about the lasting impact on confidence and motivation,” Orlando identified. “Young people who have had to transition from one stage of education to the next, or into the labour market, during the height of COVID-19, have had to face something humongous. It is stressful to bounce back from that.”

Looking forwards, the careers market seems positive. She told OT: “Across the country we are seeing the highest number of vacancies there has been for over 20 years, and they are not being filled.”

Bouza agreed: “The great news is that, according to the Institute of Student Employers’ Graduate Vacancy Survey, graduate vacancies have surpassed pre-pandemic levels, and are set to increase by 20% compared to pre-pandemic levels in 2019.”

“In other words, the number of vacancies has done more than recuperate, it is now higher than it was before COVID-19,” he said. But employers have noticed a drop in applications.

“Students are not putting themselves forward for opportunities as much as employers would like to see,” he concurred: “It is possible that the pandemic has affected students’ confidence to apply, or that students are not aware about the fact that the market is recuperating.”

Employers want good quality applications, Bouza said, recommending that students work on their levels of confidence, and observe “the positive messages we are getting from the labour market.”


In Scotland, Rach told OT that some students are worried about their experience levels and “meeting the expectations of practices.”

However, he identified: “Practices have been very supportive,” and while some students might not have had the same opportunity to see patients in third year, he added, “hopefully we’ll start to see that change as we move forward, and fourth year students have still been able to see patients.”

Having observed the impact of the pandemic on previous year groups, Indy Ghuman, final year student and chair of the AOP student committee, said: “I had somewhat discounted that those experiences would be viable for us and I was grateful I had an optical job that was providing me with experience nonetheless.”

However, many of his peers have also been able to secure optical jobs alongside studies. He said: “Despite the pandemic coming in between, especially in 2020, towards the middle and end of 2021, it seemed there were opportunities for students.”

These jobs “not only form the foundation of building that relationship with the practice to get a pre-reg place but also provides you with a baseline for experience to get a pre-reg elsewhere as well,” he noted.

Reflecting on his experience, Ghuman shared that while there have been difficulties, particularly in accessing hospital experience, “I had quite a diverse, enriched experience compared to what could be described as a very challenging environment.”

Employer requirements

To address student concerns around the work experience factor of applications, OT reached out to a number of pre-reg employers. Consensus seemed to be that work experience was valuable, but that similar skills could be demonstrated outside of optical placements.

Asked the extent to which having work experience or prior part-time work within a practice is considered in applications, or as a condition for acceptance, Luthra, from David Clulow, said it is “hugely desirable and can help those looking for a placement secure one early if they’re already known candidates to us.”

However, for students who may have found practice experience hard to come by, she noted that “leadership, good organisational skills, and the ability to self-motivate as well as work in a team, are important transferrable skills” that can be demonstrated through extra-curricular interests in a CV or cover letter.

In order to be formally offered a placement in one of their practices, David Clulow does run an experience in practice prior to embarking on the Scheme, “so both parties can ensure the fit is right for them.”

Specsavers’ Taylor also reflected: “It is fair to say that having some exposure to a busy practice environment is an advantage. However experience working in any customer-facing role is also valuable and is of benefit to the individual themselves as well as a prospective employer.”

Taylor added that the business understands that not everyone can take on part-time employment to build their CV, so said: “I’d encourage you to consider bringing to light other examples in areas of your life where you might have been part of a team – sports clubs; charity and volunteer work.”

I do think we are going to see a lovely generation of optometrists come through who have a unique skill set that they have had to take on board

At interview stage, Boots looks for skills such as leadership, teamwork, customer care, and problem solving, Johnson said. She explained: “These examples can come from optical experience, but also any work experience, college or university experience, or from any other life situation.”

Johnson outlined: “Optical experience is not a must-have.”

Acknowledging that “optical experience is fantastic,” the Hakim Group’s Slade said, “I think everybody loves that pre-reg who has had a Saturday job in a practice so they get the sense of what it is all about.”

“But what we’re looking for are individuals who are ambitious and will go the extra mile.” She continued, “Sometimes the people who are best suited, are the ones who have perhaps done something different.

“If that means that they’ve had an experience, like running charity events or being a Guide leader, but they haven’t had that weekend or holiday job in a practice, that’s fine by us,” she said. “We want to know about every experience like that – where you’ve pushed yourself above and beyond. We want people who engage with the environment around us.”

This will mean that applicants need to put a lot of thought into the experiences they might have had in their journey so far.

“People quite often have skills and knowledge that they probably don’t put a lot of value on,” she said. “Sometimes the things that you do for fun, from an employer point of view, demonstrate that you have got a fantastic skill.”

Recognising the impact of the pandemic

As part of its research, IES put together recommendations for employers and stakeholders involved in the employment of young people.

Speaking to OT, Orlando said: “The first element is to listen to what young people are saying.”

“What do they talk about when discussing positive experiences? From being provided with a diverse learning experience, to being given guided opportunities to actively develop new skills, feeling that the employer is involved in their development but also their wellbeing – mental health in the workplace is becoming increasingly important.”

She noted: “One of the things that young people themselves suggested was: ‘give us more opportunities from an earlier stage to start developing skills, don’t wait for us to graduate.’ Whether that be shadowing, short placements, or internships.”

Montacute at the Sutton Trust highlighted: “It’s important for organisations to keep in mind when looking at applications that young people will likely not have been able to gain as much work experience over the last couple of years.

“It’s also crucial to recognise the impact of the pandemic on their education,” she added. “Workplaces should assess candidates based on their future potential, and not necessarily the experiences they have undertaken.”

A new generation

Chair of the AOP student committee, Ghuman, reflected that while experiences have been so different – such as the addition of PPE, which has made communicating more challenging – they have brought their own benefits.

“Developing those communication and interpersonal skills would have been more difficult,” he said. “But doing so would be very beneficial, because you’ve got that extra skillset of being able to build a rapport with a patient while wearing a mask, and being able to show that you are listening, and engaging with them, with these extra obstacles in your way.”

He suggested that students can make the most of experiences to shape them to “what they want it to be.”

Ghuman added: “I think something that employers and other optometrists in the profession will maybe notice about the graduates coming up through the pandemic, is that they are a lot more adaptable to change.”

Similarly, Bouza shared that students have showcased flexibility, “perseverance and stamina to keep going.”

“They all count,” he said. “Employers love candidates who can reflect on what they have learned and can explain clearly the value of this.”

I think something that employers and other optometrists in the profession will maybe notice about the graduates coming up through the pandemic, is that they are a lot more adaptable to change

In addition to the transferrable skills students might bring from their work experiences, part-time roles, or extra-curricular activities, employers also recognise that students will have a different set of skills following the pandemic.

Speaking to OT, Slade observed: “When I look at the students who have come up in the last 18 months, I think they must have bravery and tenacity in bucketloads to adapt through COVID-19.”

“I do think we are going to see a lovely generation of optometrists come through who have a unique skill set that they have had to take on board, and it will arm them very well,” she added.