New M.D.

Be Kind to First-Year Residents

By Allen Hu, M.D.

As July approaches, each ophthalmology residency across the country will soon be welcoming a batch of new residents, hopefully eager to learn. Ophthalmology is a special field that requires a combination of fine motor skills, visual recognition ability and a solid fund of knowledge to arrive at the correct diagnosis and treatment plan. For example, how do you "teach" someone to recognize mild macular edema, a finding that can often be very subtle, yet may be the exact cause of the patient’s chief complaint?

As a new student in the field of ophthalmology myself, I have a unique perspective because I personally had to face and overcome the common hurdles to learning to become proficient in a field previously completely foreign to me. In most situations, it is easy to overlook the teaching and learning process and tell the junior resident or medical student, "Either you see it or you don’t. If you didn’t get it this time, hopefully you’ll recognize it next time. Clinic is really busy today. Let’s go work up the next patient."

As I finish my first year of residency, I hope my experiences can provide practicing and teaching ophthalmologists some insights on how to best help first-year ophthalmology residents progress with their education.

Tips on Teaching (From the Student)

Having a great clinical atlas handy is invaluable. Spending a few extra minutes looking up a lesion with which they aren’t familiar will allow new residents to deposit the information into their memory banks. I was surprised how much basic science and clinical knowledge I obtained after spending just 1 hour a week with one attending at my residency program going over individual fundus photographs and fluorescein angiograms on patients we saw in clinic. Showing a visual example of the lesion is much more concrete than saying: "Well, the lesion looks a little more elevated and a little darker" and so on. Another retina attending had a teaching mirror on his indirect scope so that I could confirm I was seeing what I was supposed to be seeing.

Another tip that I found to be particularly useful to pass on to firstyear residents is to slow down and take time to examine patients while on call as a way to really solidify physical exam skills. Without the pressures of a hectic clinic schedule, a resident can do a very thorough examination while honing his or her exam skills.

Encourage Residents’ Questions

Another approach, however, should be taken in a busy clinic. At most residencies, the resident usually performs the initial workup before the patient is examined by the attending or fellow. I found it useful to tape small post-it stickers with very specific, focused questions about a particular patient’s physical exam findings or management onto the patient’s chart so that after the attending or fellow saw the patient, they could quickly and efficiently address my questions in real-time rather than at the end of the clinic day when it is often difficult to remember the details of every patient. In this manner, I was able to pick up a at least one teaching point on each patient I saw during the day and the attendings didn’t seem to mind because this format allowed them to teach without substantial delays during the clinic day.

Third, people usually respond well when given the opportunity to succeed. Attendings and senior residents should set high expectations, but make your junior residents feel comfortable asking questions. Remember what it was like to be a first-year resident in July. Subtle retinal tears at the vitreous base in a patient with moderately dense cataract can be hard to see even for experienced physicians, let alone someone who is just learning how to turn on a slit lamp. Some residents may fear that they are showing lack of knowledge by asking questions, but reassure your junior residents that it is better that they ask because it will provide an opportunity for both of you to learn.

One of the best things about residency is being in an environment in which you get to learn from people at all levels of experience. I hope these suggestions will improve your interactions with your junior residents and improve the overall learning experience. OM