New M.D.

Making the Most of a Residency

By Allen Hu, M.D.

Clinic 8:00 am to 6:00 pm every day. Emergency call at night 3 nights per week. Learning to become an expert in an unfamiliar and complex field. Acclimating to a new hospital system and staff. These are just some of the challenges that face most new ophthalmology residents.

Similarly, I faced a very steep learning curve during the first few months of ophthalmology residency. A completely different knowledge base and skill set not really emphasized in medical school was required daily to effectively see patients.

I would like to share three principles that have helped me make the most of my time thus far.

Build and Expand Your Knowledge

Perhaps the single most important aspect of the first 2 years of residency is to build a solid knowledge base. Trying to learn and retain an overwhelming amount of new material can be daunting even for the most motivated resident — especially while operating on 2 hours of sleep and 5 gallons of coffee.

I found that the best way to stay motivated is to create a reading schedule at the onset, with the goal of completing one book in the American Academy of Ophthalmology’s Basic and Clinic Science Series each month. Second, each night I would read about one of the diseases I encountered in clinic that day. Third, I made sure that I performed at least one complete scleral depression, one gonioscopy exam or one special procedure in clinic each day. I saw my first year as my chance to build the foundation for the rest of my endeavors in ophthalmology. I was exploring uncharted territory and wanted a detailed and robust map.

Be Available and Enthusiastic

One of the main reasons I went into ophthalmology was for the perfect mix between the medical and surgical care of patients. However, most first-year residents spend their time in the clinic learning medical ophthalmology.

I have found some ways to supplement my experiences in the clinic. It is routine practice in our resident clinic that patients with conditions that require minor procedures (e.g., chalazion, epidermal inclusion cyst) are given a future clinic appointment day specifically for the procedure. In my mind, this equated to a lost learning opportunity. Instead of giving up these opportunities, I chose to perform those procedures the same day, even if it meant finishing clinic a little later that day.

Second, when given the opportunity to go to the operating room or perform a procedure, the answer should always be an enthusiastic, "YES." These are chances to learn how seasoned veterans assess, avoid and manage complications during surgery. When I am out in practice on my own, these are the experiences that I will draw upon to solve my own surgical dilemmas. Moreover, having a more complete picture of these surgical procedures has helped me to manage these patients when they return to clinic for post-operative follow-up exams.

Practice: Again and Again

No one is born with surgical skill – rather surgical dexterity and competence are learned through practice, practice and more practice. When I started my residency in July, even the most mundane skills, such as loading the needle holder, positioning the needle at the proper angle and tying a square knot required a lot of deliberate effort. By watching surgical videos, assisting in the operating room and practicing in the wet lab, my skills improved, allowing me to focus on learning other important aspects of the case like making a clear corneal incision or scleral tunnel.

Lastly, listen to the advice of your mentors. My mentor, Uday Devgan, M.D., advised me to improve my ambidexterity by completing daily tasks like brushing teeth, eating and shaving with my non-dominant hand. It actually helped.

Having a clear plan and focus during the first part of a residency makes you feel more in control and helps to maximize your efficiency. In future issues, my fellow resident, Allen Chiang, M.D., and I will discuss other matters that new ophthalmologists often face, including finding a fellowship program, managing finances, maintaining a balanced life during residency, as well as clinical topics regarding topics such as learning intravitreal injections and retro-bulbar blocks. OM