Tailoring Your Internship to Your Future as an Ophthalmologist

By Paul A. Sanchez, MD, MS
University of Texas- Southwestern Medical Center, Dallas, Texas

On my first day of residency, I realized how little medical school and internship had prepared me for ophthalmology. Can you say OVERWHELMED? Sure, I knew how to run a code and manage chest pain but despite being a doctor for over a year, I had done little to advance my skills as a future ophthalmologist. Now, as a third year resident, I have seen three classes of bright folks struggle with the same issues I faced. I wish someone would have told me what I know now!

Choosing your Internship

The match should not be entered into lightly. Your ophthalmology match is clearly the most important decision , therefore, do not underestimate the value of a good internship. Choose an internship that will make you a better doctor. This is your chance to use the skills you learned during medical school while taking care of the entire body. Do not be fooled into thinking that you will never need them once you begin ophthalmology training. Find a balance between a program that will stimulate you and one that will eat you (and your family) alive!

If possible, choose an internship that will allow you at least one elective. Of course, this is an ideal time to learn more about your future craft. A handful of skills are absolute necessities to your daily life as an ophthalmologist. Becoming familiar with these will save you time and stress during PGY-2. First, review eye anatomy. Develop a three-dimensional understanding of the eye. Second, familiarize yourself with the slit lamp, such as learn how to turn it on and off, adjust the brightness, change the height and width of the beam, and how to change colors of light. Learn how to properly situate your patient into the slit lamp. Learn to check intraocular pressure by applanation, pneumotonometry and tonopen techniques. If you have time, start to learn the basics of refraction. Early on, this is the most time consuming and frustrating part of the eye exam but it will be rewarding when you master it.

Take Advantage of Ward Learning

You will spend many hours in the hospital during internship and you want to make this time away from family and fun as worthwhile as possible. Treat every patient as a learning opportunity. Almost every patient with congestive heart failure has eyes! Every history and physical has an “HEENT” exam – what a great opportunity to begin your mastery of the ocular exam! Use your direct ophthalmoscope and near vision card. Learn how to perform a good pupil exam, especially for ICU patients. If you have questions, then ask an ophthalmology resident.

One of the best ways to reinforce learning is to teach others. Show your co-interns and residents how to use the direct ophthalmoscope. Teach them what to look for. This will impress your attending physicians! Teach them how to intelligently order ophthalmology consults. Your future colleagues will thank you.