Preceptorship (Extern) Program

An optometry student enrolled in a school or college of optometry that is accredited by the Accreditation Council on Optometric Education and which has contracted with a North Carolina optometry practice as an external training site is eligible for this status. The student applicant when approved will be referred to as a preceptee or extern. The optometrist providing the training to the extern is considered the preceptor or supervising optometrist and the program is considered a preceptorship or externship. 

An optometrist seeking licensure who holds a doctor of optometry degree from an accredited school or college of optometry and who has never been licensed previously by the Board  should refer to the Board’s Policy on Intern Permits

An optometrist who has been previously licensed by the  Board but whose license is no longer active, has been relinquished, was not renewed, or has been revoked should refer to the Board’s Policy on Reinstatement or Restoration of License

The following criteria must be met before an extern can begin an externship:

1. The student is actively enrolled in an accredited school or college of optometry as defined above.

2. The school has developed a formal relationship with the supervising optometrist for the externship.

3. The supervising optometrist has registered the externship with the Board. 

4. The school has advised the Board of externs performing externships in North Carolina.

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Externship authority:

Pursuant to section 90-115.1(3) of the General Statutes of North Carolina, the Board may allow the extern to render services and perform procedures that a duly licensed North Carolina optometrist may perform, provided that such are performed “at the direction and under the direct supervision” of a North Carolina licensed optometrist. Ordinarily, such approval will be given by the Board only to persons who have an opportunity to work under the supervision of a North Carolina licensed optometrist in order to gain additional clinical experience. 

“At the direction and under the supervision of” shall be applied to the facts of each particular situation in which an extern performs optometric procedures which otherwise may be performed only by a regularly licensed optometrist. The supervising optometrist assumes the responsibility for the extern and therefore can and should direct what services and procedures can be performed by the extern.

Responsibilities of the supervising optometrist, extern, and optometry school:

1. The supervising optometrist must register as a preceptor by completing an externship application available on the Board’s website. The supervising optometrist must have been licensed for a minimum of three years in North Carolina and this license considered in good standing as determined by the Board.

2. The application should list the following:

• Name of the preceptor(s)

• Name of the practice and locations where the extern will provide care

• Identification of the school where extern is enrolled

• Attesting statements regarding supervision 

3. Within 30 days of the beginning of the preceptorship, the school shall furnish to the Board in writing the following information:

   4. • the name of the school sponsoring the preceptorship

      • the name of each preceptee involved in a North Carolina preceptorship program 

      • the name of each preceptor(s)

      • the practice location(s) where the preceptees will receive training

      • the projected start date and end date of each preceptees training

      • Thereafter, the school shall furnish to the Board in writing information relating to any change of status in items 1. through 5. herein within 30 days of such change of status.

4. Direct supervision required: the supervising optometrist must be physically present within the practice location when the extern is examining patients or providing optometric services. The practice location must be registered as a primary or branch office and located in North Carolina. Being absent from the practice location but being “available by phone” or “by computer” does not constitute direct supervision. Both the supervising optometrist and student must attest to this provision.

5. Identification of the extern to the patient:

• • • The supervising optometrist must have a formal written procedure in place by which patients are informed that an extern will be performing their examination. Further, the supervising optometrist will provide the patient with  information regarding the status of the extern and the intern’s background. Additionally, the supervising optometrist will inform the patient that the extern will have a supervising optometrist and will identify that individual to the patient. The supervising optometrist will advise the patient in a face-to-face session that the supervising optometrist will review the extern’s findings at the conclusion of the exam and when necessary will confirm such findings. A written notice to this effect indicating the patient’s consent must be presented to and signed by the patient prior to the examination.  

    • The extern will likewise inform the patient of his status and introduce herself as an “extern from (school or college of optometry) in training to be an optometrist.” An extern shall also wear appropriate identification at all times when involved in patient care that will identify herself to patients by her name followed by the word “EXTERN”. 

6. Prior to the discharge or release from the practice of any patient who has been examined by an intern,  the extern’s supervising optometrist must personally review that patient’s chart and confirm that the examination was thorough and complete under the circumstances, the extern’s findings and diagnosis are accurate, and the treatment plan proposed by the extern is reasonable and appropriate. The supervising optometrist shall make a notation of his agreement or disagreement with the findings of the extern in the patient’s chart and likewise note any change(s) made in the treatment suggested by the extern.  The supervising optometrist will meet with the patient face to face before the patient is discharged to review the extern’s findings and possibly repeat any aspect of the exam as he deems appropriate. 

7. Prescriptions for glasses, contact lenses, or pharmaceuticals: In all cases when a prescription for glasses or contact lenses is needed, such prescription should be reviewed and signed by the supervising optometrist. If the extern recommends a pharmaceutical agent in the treatment of a patient, the supervising optometrist shall physically examine the patient prior to any prescription being written to determine the agent’s appropriateness for the patient’s condition.

8. Limitations of authority: The extern will not participate in any form of telemedicine or injection procedures.

Acknowledging responsibilities of the externship:

Both the supervising optometrist and the student’s school or college of optometry must register with the Board any such externship. 

Term of an externship:

Traditional externship programs are usually the length of a school semester or quarter. If an externship will last longer than six (6) months, the Board should be advised. 

Supervising optometrist subject to discipline:

The licensed supervising optometrist is subject to discipline under the provisions of, inter alia, G.S. 90-121.2 and relevant Board rules should she fail to practice in a manner which complies with this Policy.