ESCRS - The balancing act ;
ESCRS - The balancing act ;

The balancing act

The balancing act

What does it mean to be a good ophthalmology resident?

What does it mean to be a good ophthalmology resident? What does it take? Hard work, dedication and enthusiasm for the field are the big three essentials, but these are just the starting points.

Our dedication is evident in our four-to-five-year commitment to residency. Further, enthusiasm is more or less assured, since we were all free to choose ophthalmology out of many possibilities. Many of us chose to specialise in ophthalmology for similar reasons: the fascinating microsurgery, the nearly endless range of pathology, the chance to sub-specialise, and the fact that ophthalmology patients find their own vision so important. Not to mention the generally benign workload, the relatively painless call duties and the high job satisfaction. But more is needed than the big three.

Dr G Venkataswamy, founder of the Aravind Eye Hospital in Madurai, India realised this early on. In the Aravind hospital hangs a plaque with his inspiring quote: 'Intelligence and capability are not enough. There must be the joy of doing something beautiful.'

But can we translate this notion into something more concrete? 'Dr V,' as he is known in Aravind, did so by founding an eye care centre that treats more than 2.4 million patients per year, many of them impoverished patients who could otherwise never have afforded to be cured of their blindness. Short of this earthly miracle, which includes 300,000 surgeries per year, what should a resident be striving for? That depends on whom you ask.

For example, a staff ophthalmologist who supervises residents in the emergency room might focus on a resident's basic clinical knowledge, diligence of examination and patience with patients and colleagues. What's the differential diagnosis for this high IOP? Did you prescribe the correct medications for this corneal ulcer? Did you remember to check the angle for microhyphemae in the unlucky tennis player's left eye?

A sub-specialist might demand more in-depth and detail-oriented knowledge. Which patients are not eligible for refractive surgery? What are the potential complications of this corneal transplant?

A research professor will look for academically oriented residents who are involved in setting up studies, seeing them through, and getting them published. Any professor would be thrilled with a resident who could help set up a confocal microscopy study of endothelial involvement in HSV keratitis.

A resident's peers expect their colleagues to help out, pick up the slack and generally be a decent person to work with. How annoying would it be to work with someone who always selected the easy patients to treat, leaving his or her colleagues with the complicated multi-pathology late on a Friday afternoon? And it doesn't end there – further afield, those in charge of fellowship programme admissions will likely look for good letters of recommendation and a strong résumé. Has this applicant published serious work? Has he or she presented at international conferences? Will he or she contribute to my department?

But a resident can't be the best in everything. If the resident spends a lot of time working on cutting-edge research, basic clinical knowledge will suffer. On the other hand, a single-minded obsession with detailed learning might threaten to overshadow patient care, research opportunities and collegiality.

So where do we begin? How do we know that we're making the most of our short time in training? Niels Hoevenaars, a first-year resident in Rotterdam, finds that 'a good resident must be very critical regarding his or her knowledge and clinical work. On the other hand, young residents have to be able to put their abilities into perspective, to realise that older, more experienced residents and attendings will simply know more, and that this should be a source of learning and inspiration, rather than frustration.'

The senior staff isn't looking for a resident to be an instant expert in every field – it takes years of experience to be able to interpret fluorescein angiography – but rather for a resident who is eager to learn.

Ideally, a residency programme will provide all that is needed to become a good resident and, by extension, a good ophthalmologist: a large and varied clinical case load, knowledgeable and enthusiastic mentors, surgical experience, research opportunities, useful and focused teaching moments, the opportunity to spend time working abroad in a less fortunate region, time for self-study and also a little time to let it all sink in.

But maybe the most important person to decide what makes a good resident is the resident him – or herself. He or she is the one who will have to function as an ophthalmologist until retirement, and will have to launch a practice with the knowledge, competencies and experiences gained during what was hopefully a fruitful and satisfying residency.

Dr Marijke Wefers-Bettink, a neuro-ophthalmologist who supervises first-year residents in the emergency room in my hospital, agrees. 'Simply becoming a good ophthalmologist is not enough. Non-ophthalmic education is crucial, including training to become a good team player and a good practice manager.'

Dr Wefers-Bettink offered this optimistic advice: 'You will learn quickly, and if you keep your eyes and ears open, you will succeed in becoming a good ophthalmologist.'

We should see our residency as a period of freedom to learn as much as we can, because the more we learn, the better we will be able to treat our patients later on and that is ultimately what will give us the joy of doing something beautiful.

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