As an attending physician at an academic institution, I always view July 1st with excitement and apprehension. First-year residents are so eager and refreshingly enthusiastic, but very inexperienced. Medical schools rarely emphasize ophthalmology in the curriculum, and only the rare resident has the opportunity to rotate through an ophthalmology department for more than a month or two. The learning curve, therefore, is very steep. The majority of residents entering their first year of an ophthalmology residency have very little ophthalmic knowledge or hands-on experience.
Most programs ease “first years” into residency with introductory orientation sessions, dedicated basic ophthalmology lectures and courses, and “buddy” call, where a first year is paired with a more experienced resident. After a few short weeks, though, many first years are expected to function independently with very high-level skill sets. Having experienced this directly as a first-year resident and indirectly as an attending physician supervising first-year residents, I always wonder how we can make this transition smoother for everyone involved. I asked several first-year residents these two questions:
What were the biggest challenges you faced in your first few weeks of residency?
• learning to use the ophthalmic equipment, especially slit-lamp fundus biomicroscopy and indirect ophthalmoscopy
• learning the vocabulary to describe ophthalmic pathology
• finding the time to develop a habit of reading, even though very little of what I read “clicks”
• failing to correctly answer many questions
What were the most difficult adjustments from internship and medical school?
• During internship, I often found myself learning what I “needed” to know about a given disease process to safely and competently provide patient care. Often, what I needed to know was just a small slice of the available information. Now, I want AND need to know virtually everything about each ocular condition I see in the clinic or emergency department, and I find adjusting to both the intellectual stimulation and the sheer volume of information to be a huge adjustment.
• I think the most difficult adjustment is starting over again. By the end of my internship year, I really knew how to get things done and take care of patients, and then all of a sudden, I’m back at square one again. The incredibly steep learning curve was unexpected.
• One week before residency on my third surgery rotation, at 2:00 am in the emergency department, I admitted a 45-year-old woman with acute pancreatitis. I was able to complete the exam, make the diagnosis, place the orders (imaging, IV fluids, and pain medications), and transfer the unstable patient to the ICU. Seven days later, as an ophthalmology resident—my future career— I did not even know how to turn on the slit lamp. Losing my ability to derive a differential diagnosis and complete a thorough exam is humbling.
Because ophthalmology is one of the most competitive specialties, residents are often among the best and brightest in the medical school class. Most of these students are used to performing at a very high level and excelling at even the earliest stages of training. Unfortunately, unlike other medical specialties, most of what one learns in medical school and internship is not applicable to an ophthalmology residency. Therefore, residents are essentially starting over.
Residency programs need to provide first-year residents with the necessary resources, proper guidance, dedicated study time, and adequate hands-on experience to ensure a smooth transition. Learning a new field, particularly ophthalmology with its specific vocabulary and instrumentation, is always difficult. Luckily, we have a superb class of residents each year who are up to the challenge!