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Advice helps surgeons in training improve skills, knowledge, patient care
Getting the most out of ophthalmology residency and fellowship training makes for a better physician and surgeon.
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July marks the beginning of the academic year for residency and fellowship ophthalmology training in the U.S., and it’s a time when young physicians start the next chapter in their careers. The purpose of residency or fellowship training is not merely to receive a diploma or certificate to hang on the wall or to have another stamp on the resume. Rather, the goal of ophthalmology training is to squeeze every drop of technical surgical skill, medical knowledge, and patient care experience out of the residency and fellowship. Like a sponge, you should aim to soak up every aspect of your training program so that you become a better physician and surgeon.
Surgical skill
The time spent in an ophthalmology residency is limited, typically to just 3 years in U.S. programs. And during residency the actual number of hours spent in the operating room doing surgery is even more limited, amounting to just a fraction of the total training. This makes it difficult to learn and master surgery without focus, guidance and self-practice.
Make it a point to operate with a variety of different attending surgeons and faculty members so that you can learn multiple techniques of the same surgery. Then think to yourself, “What could I do better, more efficiently or more safely?” As you develop your own surgical style, you may even pioneer new techniques and develop new instruments. Ocular surgery will continue to evolve in the future, and a decade from now you’ll be using new techniques that have yet to be invented. Think at every step of the surgery, starting with the preoperative evaluation. As experienced surgeons know, sometimes the best surgery is no surgery at all. Surgical judgment is developed slowly, over the course of years or decades, and is one of the hardest aspects of surgery to master.
 Residents at UCLA’s Jules Stein Eye Institute spend many hours in the operating room at Olive View UCLA Medical Center, where they learn surgical techniques from all subspecialties of ophthalmology. The author gives hands-on teaching to first-, second- and third-year residents in techniques of cataract and anterior segment surgery. Image: Devgan U |
No one is born knowing how to operate on eyes, and every surgeon can benefit from spending time in the microsurgical wet lab. To this day, more than a decade after my own training ended, I regularly spend time in the wet lab exploring new ideas and honing my skills. Start with the basics, such as suturing with 10-0 nylon and handling delicate tissues to enhance your dexterity. If you come to the operating room with insufficient wet lab time under your belt, then the attending surgeon will end up focusing on basic suturing techniques instead of teaching you other, more critical maneuvers that you cannot easily learn on your own. Remember that you need to maximize your learning while in the operating room under the watchful guidance of an experienced surgeon. After your training, you will be on your own and you will long for the days when you had a senior surgeon by your side to teach and guide you. Make sure that you learn the full spectrum of ocular surgeries, including newer procedures, such as femtosecond laser-assisted refractive surgery and the use of premium lens implants.
Spend time at home watching surgical videos, such as those on the Internet. There are literally thousands of excellent surgical teaching videos that can be watched and studied on your computer or even on your mobile phone. In addition, you should record your own surgical cases onto digital media such as DVDs so that you can watch, relive and re-think your own cases. Professional athletes watch videos of their performance in order to learn from their mistakes and their successes. You should do the same, with careful attention paid to your technique, which should look fluid and effortless. Most beginning surgeons notice that they have some difficulty with their nondominant hand. To further enhance your manual coordination, practice eating, brushing your teeth and shaving with your nondominant hand. Remember that skilled surgeons need to be able to operate well with both hands.
Medical knowledge
Ophthalmologists will spend their lives constantly learning more about the eye, and this requires self-study. While your training program may provide you with formal lectures and grand rounds presentations, you will need to find time for self-study from books, journals and online resources. An excellent way to cement medical knowledge in your mind is to read about a specific subject after seeing a patient with that disease process in the clinic. For example, examining a patient with Vogt-Koyanagi-Harada syndrome and then reading about the disease will allow you to permanently remember the details of diagnosis, treatment and prognosis.
Be sure to involve your attending physicians and faculty members in the evaluation and treatment of your patients. Ask questions and take note of the way in which your professor examines and interacts with the patient. Choose a faculty member to be your mentor, and then emulate his style and technique until you develop your own. Also be sure to learn from your senior residents and fellows, who will have additional pearls to offer. During residency, make sure that you study the entire spectrum of ophthalmology even if you plan to subspecialize later. If you become a vitreoretinal specialist in the future, it is helpful to have knowledge of strabismus because your implanted scleral buckles can cause diplopia. Absorb as much as you can during your training and then continue learning for life.
Patient care experiences
My goal for every patient is to deliver the same high level of care that I would want for my own family members and for my own eyes. Use this golden rule when treating patients, take pride in your work, and come to the operating room with an open, enthusiastic attitude. Your clinic notes, operating reports and other paperwork should always be complete and legible, with your name clearly printed underneath your signature. Learn to make a to-do list on your notes to remind yourself or the next resident what needs to be done for the patient’s next visit to the eye clinic. For example, for a diabetic patient who has received focal macular laser treatment, writing “To do next visit: check refraction, dilate, examine for macular edema and perform OCT” on your exam form will help the patient receive the appropriate care at his next visit.
Some of the most valuable patient care experiences come in the middle of the night and on weekends. Being readily available for emergency patients when you are on call will give you experience treating complex issues such as traumatic ruptured globes, corneal ulcers and retinal detachments. These after-hours cases are often performed with other residents and fellows, so you’ll have an opportunity to work together as a team. Learn to work well with the nurses and ancillary staff in order to facilitate optimal patient care. These staff members can make your life easier and your workday more pleasurable.
Finally, enjoy your training. You’ll look back on these years as one of the best times of your life. You will work hard, learn a lot, make new friends, take great care of patients and blossom into the surgeon you’ve always wanted to be.
- Uday Devgan, MD, FACS, FRCS (Glasg), is in private practice at Devgan Eye Surgery in Los Angeles, Beverly Hills and Newport Beach, Calif. He is also chief of ophthalmology at Olive View UCLA Medical Center and associate clinical professor at the UCLA School of Medicine. He can be reached at 11600 Wilshire Blvd., Suite 200, Los Angeles, CA 90025; 800-337-1969; fax 310-388-3028; e-mail: devgan@gmail.com; website: www.devganeye.com.