Preparing for the next stage: reflections from a year of pre-reg practice

Do you have any specific reflections from your past few months in practice?

Nora Amoakohene (NA): One of the biggest changes over the past few months has been recognising how much confidence grows through repetition. Procedures and decisions that once felt daunting have started to feel more natural.

I have particularly noticed growth in managing uncertainty. Early on, I sometimes felt pressure to have an immediate answer to every clinical question. With experience, I have learnt that good practice is often about recognising uncertainty, gathering the right information, and making safe, reasoned decisions.

I have also become more aware that communication can be as important as the clinical finding itself. Explaining a management plan clearly, reassuring anxious patients, and adapting communication to different people can transform an interaction.

If I could go back to the beginning of pre-reg, I would tell myself that confidence does not come straight away, and not to be too hard on myself.

I underestimated how much learning happens through mistakes, questions, and difficult cases. At the start, it can be easy to compare yourself to more experienced clinicians and feel behind as a result.

I also wish I had appreciated earlier how important it is to reflect little and often, rather than only when something goes wrong. Recognising this has made pre-reg feel much less like an uphill battle.

Eliza Jane McCall (EJM): The past few months in practice have been enjoyable and I feel much more settled in my role. Looking back, I am often reminded of how challenging I would have found some of the cases earlier in the year, which has highlighted the progress I have made.

During this time, I have fitted a high myope with a piggyback contact lens system and spectacles, carried out testing for patients involved in clinical drug trials, and encountered a number of interesting pathologies, including severe visual field defects in asymptomatic patients.

My most important reflection is that learning never stops. Completing a degree or passing an exam does not mean you have finished learning. Standards of practice, treatments, and clinical information are constantly changing, so it is important to continue developing your knowledge throughout your career. Staying up to date and discussing new evidence and treatments with colleagues helps ensure we provide the best possible care for patients.

ZS: Over the past few months, I have realised how important communication is in clinical practice. Being able to explain findings clearly and reassure patients is just as important as developing technical skills.

My most important reflection is that qualification isn’t the end of the learning journey. I have learned that professional growth comes from continually challenging yourself, seeking out new experiences, and being willing to step outside your comfort zone. Exposure to a variety of clinical scenarios, learning from colleagues, and reflecting on feedback have all contributed significantly to my development.

I have learnt that good practice is often about recognising uncertainty, gathering the right information, and making safe, reasoned decisions

Where are you in the Scheme for Registration, and how are you preparing for the next stage?

NA: At the time of writing, I am waiting for my final visit of Stage 1 of the Scheme for Registration. As I begin preparing for the next stage, I have started looking over the overarching cases for Stage 2 and becoming more familiar with what will be expected.

I feel that everyday patient encounters are already preparation in themselves, but I have become more intentional in my approach. More recently, I have focused on applying knowledge consistently, strengthening my clinical decision-making and reflecting on patient encounters to identify areas where I can continue to improve. I have found that everyday practice remains one of the best ways to prepare, as it allows me to continue building confidence and experience in managing different patients and presentations.

Which OSCE sitting are you aiming for, and have you started considering your preparations?

NA: Yes, I have started considering objective structured clinical examinations (OSCEs) preparation and currently plan to sit the October OSCE. Although my main focus remains completing Stage 1, I have begun looking at different providers that offer mock OSCE stations to help with preparation when the time comes.

I have also started revisiting techniques that I do not use as often in practice, such as confrontation perimetry, to make sure I remain confident across all areas of assessment. At the moment, preparation is less about intensive revision and more about continuing to build confidence through everyday clinical practice while keeping key skills fresh.

EJM: At the time of writing, I am preparing to sit the July OSCEs. I am consolidating my clinical knowledge through textbook study while also focusing on developing my communication skills and practical techniques. My supervisor has been a valuable source of support and feedback throughout this process, helping me build confidence and refine my approach ahead of the assessment.

I feel that the OSCE is the final hurdle after a demanding year. Although I know it will be challenging, I feel much more confident than I did earlier in the year and it now feels within reach. I am continuing to practise both my clinical skills and communication, and I am attending the Johnson & Johnson mock OSCE sessions to help prepare for the assessment.

ZS: I am aiming to sit the October OSCEs and have already started preparing. I am taking the "little and often” approach, by building revision into my routine and gradually increasing the intensity nearer the OSCE dates.

The OSCE is the final hurdle after a demanding year. Although I know it will be challenging, I feel much more confident than I did earlier

Do you have any highlights from the past two months?

NA: A highlight has been seeing how much more independently I can approach patient care compared with a few months ago. There have been moments where I have recognised findings, made management decisions I would once have second-guessed, and felt genuine professional growth.

Another highlight has been the variety of patients and presentations encountered. Challenging cases, although sometimes uncomfortable at the time, have often become the most valuable learning experiences.

I have also appreciated the support of supervisors and colleagues. Pre-reg can sometimes feel very individual, but some of the best learning has come from discussing cases, asking questions, and learning from others’ experience.

EJM: One of the highlights of the past two months has been working with my colleagues, who I have built strong relationships with over the course of the year. We have celebrated each other's achievements and worked well as a team. I have also enjoyed seeing regular patients, building rapport with them, and catching up with them at their appointments.

ZS: A highlight has been continuing to gain exposure to a wide range of pathology within the hospital. I have been lucky enough to have people around me who can pass on their expertise, all in different sub-specialties.

How have you managed your work-life balance during your pre-registration placement?

NA: Work-life balance has had its obstacles. At times, pre-reg can feel like it is taking over all aspects of life, especially when balancing clinic, competencies and exam preparation. Small, regular preparation tends to be more productive than trying to cram everything in at once.

I have been trying hard to keep at least one day a week optometry-free, which has helped balance things out for me.

EJM: At the start, it was a significant adjustment, but over time I have developed a more consistent routine. I now feel more organised, which has helped me manage the demands of the placement alongside my OSCE preparation. The structure I have built has made it easier to balance work and study, and I feel the effort I have put in so far is reflected in the progress I am making towards my goal.

ZS: Managing my work-life balance has largely come down to being organised and realistic with my time. While there have been busy periods where assessments and revision have required extra focus, I have tried to maintain a routine that allows time for both hobbies and work.

How much do you feel like you have progressed as an optometrist, and how have you built your confidence?

NA: I have learnt that confidence is not about never asking for help, often it is the opposite. I feel I am moving from focusing only on ‘doing the test correctly’ towards thinking more broadly about managing the patient in front of me, and that shift feels like an important step in developing as an optometrist.

EJM: Having a supportive team and supervisor has meant I have always felt able to ask questions when needed. I now feel more confident, particularly with conditions I have seen repeatedly, and I have noticed an improvement in my problem-solving skills. When I encounter something new, I am better able to consider possible causes and appropriate next steps.

I also feel I have developed more of a clinical approach. Earlier in the year, I often relied on following a set structure, whereas I now feel more comfortable working through cases in a more flexible and considered way. This increased confidence and supportive environment have helped me develop my own clinical style.

ZS: I feel I have made good progress since the start of my pre-reg. My confidence has grown through exposure to a wide variety of patients and clinical scenarios, as well as through learning from both positive and challenging experiences.

As you move towards the end of your pre-registration placement, what is your most important takeaway?

NA: Starting pre-reg, I expected the challenge to be mostly transitional; from textbook to refining clinical knowledge, improving speed, and preparing for assessments. What I have learnt is that becoming a better optometrist has been just as much about judgement, communication and confidence as it has been about technical skills.

What are your plans for after qualification?

NA: Following qualification, my immediate goal is to continue developing my clinical skills and confidence as an optometrist while gaining further experience across a broad range of patient presentations.

Ideally, I would like to secure a resident optometrist position close to home. I am particularly interested in continuing professional development and exploring opportunities for enhanced clinical practice in the future. More broadly, I hope to continue building on the foundations established during pre-reg and learning from the experience of those around me.

EJM: I am planning to continue my education and remain working at my current practice, as I really enjoy the role and the team. I also intend to keep progressing with further learning, as I work best when I have clear goals to work towards.

ZS: Following qualification, I hope to continue working within the hospital, where I can continue developing my knowledge and gain further experience in a more specialist role – in time, of course.

Any final thoughts, or advice to pass on to future optometry trainees?

NA: Pre-reg has challenged me in ways I expected and in ways I did not. It has stretched clinical knowledge, but it has also taught resilience and confidence, and I look forward to the next stage on my journey.

EJM: No question is a silly question. It is important to make use of the experience of more senior colleagues and to keep asking questions when unsure. Ongoing learning and research are essential throughout training.

It is also useful to observe how different clinicians approach the same situation and to reflect on why they may choose different methods, as this can help develop your own clinical thinking.

ZS: My advice would be to ask questions, seek feedback, and make the most of every learning opportunity. Everyone progresses at their own pace, so focus on your own development.