New M.D.

This Resident Came Prepared

By Lauren Eckstein, M.D.

There is nothing more gratifying to a teacher than seeing a student with a great eagerness to learn.

Walking into the operating room to begin a complex canalicular repair, I was pleased to see that the resident was present in the theatre and that the patient had already been appropriately positioned, the operating lights adjusted and the necessary surgical equipment arrayed on a spare Mayo Stand.

But perhaps most important, the resident working with me that afternoon was wearing his operating loupes. Even though he was planning to pursue a fellowship in glaucoma, he had nonetheless purchased a set of loupes early in his first year of residency. By this seemingly simple step — bringing the appropriate and perhaps necessary personal operating equipment — I knew that he had come prepared to work that afternoon. Moreover, I knew from this display that he was committed to learning as much as he could absorb during his time as a resident at the eye institute. He was not merely present as a passive observer. He was there to be an active participant.

A Learning Environment

Residency (and indeed fellowship) provides the novice student of ophthalmology the singular opportunity to learn the craft of ophthalmic surgery and practice. This opportunity is unique in that the resident functions in a protective environment with attentive advisors and patient instructors.

These teachers are invaluable. They bring with them years of experience and the judgment and insight gained from hundreds or thousands of surgeries. Most importantly, they bring with them the desire to share this knowledge with others in the field. They do so not by writing papers, or by presenting at symposia, but rather by forming an intimate, personal mentorship with the residents.

The creation and maturation of these relationships establishes an environment in which residents may freely pose questions, seek advice or ask for help. Unfortunately, this opportunity lasts a few fleeting years. Following graduation, the available cadre of people one may approach for assistance diminishes greatly. Indeed, for many starting in private practice, this cohort of advisors may number just one or two.

You're On Your Own Now

This is most profoundly observed in the operating theater. For most young practitioners, their first solo procedure is — not coincidentally — the first time they operate on a patient following completion of their residency. Undeniably, this transition often provokes significant anxiety. Not because the novice surgeon is unsure how to proceed or lacks confidence in his or her abilities, but rather because of the realization that for the first time, there is no one available to ask for help.

Unfortunately, this insight often occurs too late. Many trainees must first be thrust into the realities of post-residency practice before realizing the value of the opportunities presented during their years in training. The chance to work side-by-side with experienced (often masterful) surgeons is priceless, and the opportunity may never arise again following residency. Therefore, from an early stage, the dutiful trainee must maximize his or her opportunities to learn. It is imperative that he or she seeks as many surgical and clinical experiences as possible. Further, there must exist a deep commitment to exploiting these opportunities to gain as much insight as possible, to acquiring as much knowledge as the attending physician is willing or able to communicate.

Preparation Precedes Success

In my specialty of oculofacial plastic surgery, the ability to adequately visualize the operative field by the acquisition and employment of surgical loupes elevates the resident from a mere passive observer in the operating theatre to an active participant. By enhancing the resident's ability to fully comprehend the surgical approach and execution, he or she is able to expand their ophthalmic knowledge. Such behavior highlights the commitment of the resident to learning, enriches their surgical armamentarium, and contributes to a sense of ownership in the care of the patient. Maximum learning demands maximum participation, and each demands maximum commitment. OM