The onboard formula for new techs

A formal onboarding program can help practices retain ophthalmic professionals who reach their highest potential.

The BPEI onboarding program includes hands-on training with ophthalmic devices, such as a hand-held autorefractor. From left to right: Liliana Perez, COA, OSC; Lil Hernandez, COA; Katherine Leviste, MSc Vision Science & Investigative Ophthalmology, class of 2020; Martha Tello, COMT, OSC, BGS, ophthalmic educator; Gabriela Maytin, COA; and Leisa Gutierrez, COA. Ms. Leviste and Ms. Gutierrez are currently onboarding. Ms. Perez, Ms. Hernandez, and Ms. Maytin have been onboarded and are assisting Ms. Tello with the onboarding program.

At the Bascom Palmer Eye Institute (BPEI) University of Miami Hospital and Clinics in Florida, we recognize that trained ophthalmic health personnel are the cornerstone of efficient and thriving ophthalmology practices. A finely tuned ophthalmic technical team can deliver patient services to the highest standards, ensuring uncompromised quality of care.

In looking for the best ways to recruit, hire, and retain talented ophthalmic professionals, BPEI recognizes the nationwide shortage of qualified ophthalmic technical personnel. To address this shortage, Nicole Perez, executive director of clinical operations at BPEI Miami, supports an individualized approach for professional development.

This approach is reflected in a new comprehensive onboarding program for ophthalmic professionals at BPEI. The program addresses a familiar problem: In some instances, once a new employee is hired, the practice does not offer formalized training. After a short period of observation, new employees may be placed in a position where they either sink or swim. Placing such a burden on the new hire could affect the employee’s confidence, interfere with patient safety, and compromise clinical efficiency. Yet today more than ever, ophthalmic technicians enter the workforce with great motivation to succeed. Given the right opportunities, for example, through a formal onboarding program, practices can develop synergies between employer and employee where win-win scenarios can be explored in a structured environment.

Once new employees are hired, my role as the clinical educator is to set them on the right path for success by developing strategic approaches for onboarding. (See “A comprehensive onboarding overview” below.) The sections that follow discuss the importance of efficient orientation and onboarding strategies for new hires, best approaches for developing technical abilities, how to maintain employee loyalty and engagement, and the top-five errors that push new team members away.

Make a great first impression

So that new employees reach their highest potential, I first perform a baseline competency assessment to review their current skills and set the tone for training. We refine the training through lectures, hands-on education, and an introduction to best clinical practices in our institution, which ensures that our standards align with the guidelines of technical competencies outlined by The International Joint Commission on Allied Health Personnel in Ophthalmology (IJCAHPO).

Our initial goal during orientation is to create a great first impression. In addition to communicating the agenda and establishing expectations, human resources and the ophthalmic educator demonstrate small acts of care: We call to confirm the orientation schedule, provide guidance on what to wear the first day, and reinforce that there will be teaching and mentoring to make the new hire feel at ease. These positive impressions last!

Orientation programs may differ from practice to practice, and those that are short-handed may find it challenging to spend extra time training new hires. Yet, the main objective of orientation is to make the new ophthalmic allied health member feel welcome, appreciated, and excited about joining the practice. It is truly remarkable to have leadership and seasoned technicians recognize the need to provide support, feedback, and expertise in an effort to retain new hires in every practice. BPEI delivers an immersive experience through the “I am the U” new employee orientation coordinated by the University of Miami, which human resources describes as “an opportunity to provide information about who we are, what we do, what we value, and what it means to work at the University.” To add to the experience, a separate hospital orientation day covers HIPAA policy, patient safety goals, OSHA infection control, and patient experience among others.

Once a connection to the new place of employment is established, new hires are ready to start the BPEI orientation and onboarding process with the ophthalmic educator.


Below are some of the main points covered during the BPEI orientation/onboarding overview:

  • Introduce a detailed onboarding checklist (see “Examples of items included in checklists,” p. 14)
  • Confirm learning needs via self-assessment
  • Meet supervisor/manager to cover specific rules and regulations and complete required documentation and tasks required by human resources
  • Tour facilities — share any remarkable highlights of physician’s journey and practice
  • Introduce new hires to ophthalmologists, nurses, leadership, colleagues, and general coworkers
  • Explain the fundamental behavior to offer a great patient experience
  • Use learning activities featuring innovation and dynamism
  • Perform competency skills assessments
  • Focus on new hire skill development
  • Provide sub-specialty specific training
  • Quiz/evaluate covered material on a regular basis
  • Cover physician’s protocols
  • Practice electronic medical records on “playground” environment with non-live records
  • Review chart documentation to learn standard documentation and error prevention
  • Look at quality improvement principles of teamwork
  • Touch on clinic efficiency and ophthalmic technician patient ratio in different subspecialties
  • Provide educational support and mentorship through preceptors
  • Establish performance evaluation period (30, 60, and 90 days)
  • Conduct regular one-on-one meetings to address educational challenges and needs
  • Monitor clinical observation (new hires to follow structured schedule in most subspecialties)
  • Involve new hires in any educational conferences, committees, and task forces

Shift to employee development

At this point in the process, it is time to turn from introductions to employee development and process understanding. Let’s start by clarifying that orientation and onboarding are two separate entities: orientation is the introduction to culture, processes, and clinic delivery teams in the new clinical setting. Onboarding is the continuous introduction and verification of specific clinic processes for each subspecialty, including the physician’s preferences. The idea is to support the new hire’s effort in supporting the physician’s processes in the most accurate and synchronized way.

During the initial clinic orientation, we provide the new hire with self-study modules, physician’s protocols, documentation requirements, skills evaluation, ophthalmic-related lectures and workshops, and observation of more experienced team members in clinic.

Orientation may last days or weeks depending on the individual’s needs. My goal as an educator is to make new employees feel both comfortable and valuable during this time. I also observe new hires early in the process to confirm they are making a successful transition to BPEI employees. The ophthalmic educator, designated ophthalmic preceptor, supervisors, and seasoned technicians all work as mentors to help new hires build confidence and reach their goals as well as emphasize the job’s caring dimension above its technical component.

Leisa Gutierrez (left) discusses details of the onboarding program with Martha Tello.

Have an onboarding plan: Make it personal?

The new hire may feel lost in hiring documentation, new faces, technology log-ins, unfamiliar electronic medical records, cultural differences, and having to adapt to the pace of the practice. (At BPEI, the pace is of a high-patient-volume teaching hospital.) Pay close attention to the new hire to ensure important indications are not lost in translation. Instead of bombarding the new hire with loads of paper and electronic documentation, consider the personal touch of a one-to-one interaction. This is the time to introduce the dynamics of the practice and clarify that the onboarding process will last until goals — focused on the long-term outcomes of their day-to-day tasks — are met. The ophthalmic professional is about to embark on a great journey. Motivating them comes first.


Orientation and onboarding calendar

  • Tips and observations to improve critical thinking while performing refractometry, visual acuity assessment, tonometry, lensometry, ocular motility, confrontation fields
  • Proper hand hygiene, instrument disinfection
  • Patient experience and the importance of caring
  • Physician’s protocols

Ophthalmic technician department-specific orientation

  • History taking and documentation
  • Supplemental testing (perform and record glare, potential acuity test, color vision)
  • Chief complaint based on different subspecialties
  • Ocular pharmacology
  • Dry eye testing
  • Hand off communication

(Note: We review ophthalmic skills to ensure there is a standard of care, and we want to confirm tests are performed properly).

Ophthalmic technician self assessment:

Options given are beginner, advanced beginner, competent, or expert


  • Able to perform retinoscopy
  • Proficient in subjective manual refraction/cross cylinder technique

Visual acuity assessment:

  • Able to identify methods of visual acuity testing
  • Experience with pediatric vision screening
  • Recognize errors that may occur during adult visual acuity testing

At the BPEI Balkan International Pediatric Glaucoma Center, Ta Chen Peter Chang, MD, glaucoma, pediatric glaucoma, pediatric ophthalmology (left), shares insights on intraocular pressure with Martha Tello and Gabriela Maytin.

Build loyalty: Retain your employees

When a well-rounded onboarding program shows ophthalmic professionals the enormous role they play in achieving optimal results in patients’ care and provides them with a sense of appreciation and belonging, new hires are more likely to stay. In addition, all new hires feel invested in via the time and resources spent on their professional development, allowing them to achieve their highest potential. Let ophthalmic professionals know that the practice’s leadership, coworkers, and educators will support their growth in education, which never ends, and certification.

The onboarding process should demonstrate the values and professionalism upheld by the organization, delivered in a way that is tailored to the new hire. In addition to facilitating loyalty, this education enhances the ophthalmic technician’s ability to prioritize an efficient clinic flow, improve employee satisfaction, and support patient safety.

Understandably, not all practices have time to devote to an extensive program. However, resources, such as preceptorship guides and materials, preceptor tool kits, or preceptor training handbook, are available. Also, practices can consider developing specific physician’s protocols as well as a staff training program that provides IJCAHPO credits.

Top five errors for new hires

In the past few months, I have welcomed more than 12 new hires and have found that common errors revolve around the larger problem of unmet expectations. The top five errors are:

  1. Placing new hires in different clinics with no clear structure or planned assignments. New hires often fear working in a confusing environment.
  2. Assigning new hires to seasoned technicians without prior communication or planning. This often results in an interruption to clinic flow and unwanted peer interactions.
  3. Not stating expectations effectively. “You should have clear expectations from the beginning to avoid confusion and despair,” says new hire Katherine Leviste. According to Forbes, the onboarding process could be stressful for anyone, with the “quitting economy [being] a serious issue facing businesses across the United States, showing no signs of stopping.” If found to be disorganized or misleading, the employee’s trust is broken, which sets the new hire to a stressful start.
  4. The absence of an orientation and onboarding process. Among the ophthalmology technical team, the lack of a formal program contributes to rapid turnover, decreased productivity, and employee disengagement. A successful program captures the enthusiasm of new hires during this critical period of adjustment, encouraging them to grow with and embrace their new place of employment.
  5. Not adapting the program to the new employee’s and the organization’s needs. Every new employee is a learning experience for the educator and a wonderful opportunity to improve the process. For example, BPEI is currently developing a preceptorship program for the ophthalmic technicians, modeled after the nurse’s educational program, which is designed to maximize the potential of the new hire and offer opportunities to current employees to demonstrate leadership.

Promote retention, respect, and success

Indeed, a successful orientation and onboarding program will encompass a caring patient experience throughout the journey. It will also promote employee retention, peer respect, and job success. The career of an ophthalmic technician integrates innovation, knowledge, empowerment, insight, and compassion both in clinic and beyond. The workplace is the ideal environment to foster and mentor dedicated, passionate, and curious minds and help them reach their full potential. OP