Pearls for Starting Ophthalmology Residency

By Don Sauberan, MD

You have finally made it through undergraduate education, 4 years of medical school, and 1 year of internship (which often seems longer than the 4 years of medical school!). Your ophthalmology residency is just about to begin. I will provide several pearls for your first few months as a new ophthalmology resident to have a gratifying experience?

1. Be eager to learn. Beginning an ophthalmology residency is like drinking through the proverbial fire hose. Most medical schools have very little training in ophthalmology, and even fewer require clinical experience prior to graduation. You have just spent the past year dealing with MIs, abdominal trauma, and end-stage renal disease. What ophthalmology knowledge you may have gleaned from medical school could be long-gone. The terminology and examination techniques are often completely foreign. Accept this initial ignorance, and dive in with eagerness. Ask lots of questions. Have techniques shown to you. Retinoscopy and scleral depression are two techniques which take time to master. Try to practice on as many patients as possible. No question is too small. If you don’t ask questions early, it becomes harder to ask later on when you “should know better”.

2. Read, read, read. The volume of information present on such a relatively small portion of the body can be overwhelming. As a new ophthalmology resident, you will receive the Basic and Clinical Science Course (BCSC) from the American Academy of Ophthalmology. This is a 13-volume series discussing all aspects of ophthalmology. Because it is the Academy’s own publication, it can be considered to be what the Academy wants you to know about the specialty that you are now a part of (this becomes important at OKAP time!!). It is much easier to read small amounts consistently than large amounts less frequently. Dedicate 1 hour (at least) per night to read. At the beginning of your residency, do not worry about other sources such as peer-reviewed journals, or more detailed textbooks. You will probably have some type of lecture series/OKAP review session. This can be subject-driven (e.g., all of oculoplastics lectures are in September), or, more frequently, are randomly arranged. If you have a more random lecture series, you may want to start with the Glaucoma book (Volume 10), as it is the smallest book. Finishing it often gives you a much-needed boost to continue your reading schedule.

3. Lean on your senior residents. They have “been there, done that.” They can help with clinical acumen, logistical questions, and deciphering your various staffs’ personalities. Initially, they see patients with you on-call, so right from the beginning they are helping to craft how you react to patients. Pick their brains on knowledge, technique, and survival strategies. Learn from their mistakes.

4. Be a team player. Residents spend more time with each other than with their own families. Thus, a quality relationship with your fellow residents (both senior and otherwise) can be the difference between enjoying residency and simply surviving it. The best way to foster a good relationship with other residents is to have a good work ethic. Don’t disappear when the last consults are waiting to be seen. Keep your senior residents informed about what is going on. Do not have an “attitude” with other services. If there is an ophthalmology consult, you as a first year are not the one who should be talking to the staff internist about why it isn’t warranted. You want to avoid getting a bad reputation. No reputation is better than a bad reputation.

5. Don’t forget about your family. For those with a family, they have probably sacrificed greatly for you to get to this point. However, residency is a stressful time, and families can often feel the brunt of it. Do not forget about them, and lose yourself in ophthalmology. Make sure you plan for “non-ophthalmology” time, whether it is simply a trip to the park, or a real vacation during one of your weeks off.

6. See as much as you can. Ophthalmology is a very visual specialty. Much of what we diagnose, we diagnose by visualization. There is an old adage, “you only see what you look for, and you only look for what you know”. If someone has an interesting case, make sure you go take a look at it. Examine all the patients at grand rounds. Many things in ophthalmology will only come around a few times, even in a teaching hospital with a residency program. A good ophthalmology atlas (such as Spalton’s Atlas of Clinical Ophthalmology) can supplement your clinical experience with pictures of many ocular diseases.

7. Learn to love the Wills Eye Manual. The Wills Eye Manual is the Washington Manual of ophthalmology. It has all of the vital information on nearly everything that you would see walking in to clinic, including differential diagnosis and treatment. It also has a good section on presenting signs and symptoms in ophthalmology. As a new ophthalmology resident, you will only know what symptom brings your patient in for a visit. The Wills Eye Manual lets you begin to learn how to craft a differential diagnosis based on symptoms.

8. Remember to have fun. This is what you have waited to do for some time. Despite the lack of sleep and the seemingly endless reading, remember how enjoyable the field of ophthalmology is. Remember how lucky you are to be training in a specialty that can help your patients so much. And remember that when you are finished in 3 years, you will have had a wonderful experience, both personally and professionally.