Thursday, November 08, 2007

What Makes a Successful Ophthalmology Resident? Residency Program?

Featuring: Thomas Oetting, MD
Residency Program Director

University of Iowa
Department of Ophthalmology & Visual Sciences

(Interviewed September 2007)

1) What qualities make an outstanding ophthalmology resident?

A great ophthalmology resident is hard to define but when you see it, you know it. A great resident has infectious enthusiasm for our great profession and the science of the eye. He or she enjoys working with patients and wants more clinic opportunities, more surgical opportunities, and more chances to learn. A great resident makes our patients feel cared for and special. A great resident is coach-able (i.e., learns from his or her mistakes and moves on). A great resident is a great teacher and creates a sea of medical students interested in ophthalmology. A great resident gets things done when they said they would. A great resident does their dictations, notes, work hour requests, faculty evaluations, and the other important administrative jobs on time and with no fanfare. A great resident gives more than he or she takes. And like a good camper, a great resident leaves our program better than when they arrived.

2) What are the biggest challenges for new ophthalmology graduates, and how does Iowa prepare them for these challenges?

These times are good for ophthalmology. Our residents are highly sought after for positions in fellowships and most importantly for comprehensive positions across the U.S. Our goal at Iowa is to produce the best comprehensive ophthalmology graduates in the U.S. We know that the ophthalmologist of 10 years from now will be doing different procedures and using different medicines than today. We hope to develop flexible and creative physicians centered with a solid background in eye disease and surgical skills that will carry them toward whatever future comes their way.

3) For current residents and prospective residents, what advice do you have for them during residency?

Get involved, have fun, and make yourself useful. In the old days, the trade off was that the residents did all the work, the faculty billed for the work, and the residents got paid with teaching. Now with rule changes in Medicare, work hour rules, and changes in VA resident supervision, the faculty are working harder in clinic and as such, residents have a hard time adding the same kind of value as they did in the past. As such you must find other ways to add value. Write up a case report and do it on time. Start a web site or create a patient advocacy group for a disorder. Teach the technicians or medical students without being asked. Create a video or handout to help orient other residents when you finish a rotation. “Be a useful engine” to quote the conductor from Thomas the Tank engine.

Most of all -- As soon as possible, realize that residency is not a hurdle. Residency is part of a long path of growth that has no real end. Be the captain of your ship on this path.

4) How long have you been a program director and what is your history with Iowa?
I have only been the residency director at Iowa for about 18 months. Dr. Keith Carter was the first real residency director at Iowa for 15 years (all of the other predecessors were chairman/residency director combos). He became quite famous in this regard and developed many programs and was viewed as the Dean of Program Directors among his peers until he “retired” to become our current chairman. I have big shoes to fill and intend primarily to not change the great course of our program.

5) What challenges have you made to the residency as the program director and why?

I have made very few changes to the program that Dr. Carter and others made so great. We continue to make small changes to grow along with our amazing profession and to comply with requirements of the Accreditation Council for Graduate Medical Education (ACGME). Lately, our emphasis has been on the competencies. These six areas of emphasis: clinical care, medical knowledge, systems based care, professionalism, communication, and practice based learning now form the structure of our program. We have developed many new assessment tools, programs, and lectures centered on this new structure. We are fortunate to have Dr. Andrew Lee who is the national expert in this area on our faculty guiding these issues. We have been very active academically along these lines and consider ourselves leaders in curriculum development for residency programs.

All this being said, the challenges today at Iowa are the same as in the past. We want to develop the best comprehensive ophthalmologists in the nation. Our history at Iowa is about great residents because of our faculty’s commitment to excellence.


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