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Residents & Fellows Corner | Jan/Feb '14

Transitioning to Fellowship

Starting an ophthalmology fellowship is a unique experience. I remember when I was finishing my residency, I finally felt comfortable—with my knowledge base, my surgical skills, and the inner workings of my institution. I knew how the system worked and what needed to be done to make the day run smoothly for all involved parties (residents, attendings, and patients). Then, fellowship started, and I felt like an intern all over again. Besides often having to learn a whole new system at a different institution, fellows must also take on a whole new set of responsibilities. Considered junior attendings, fellows are expected to function with more autonomy and advanced surgical skill. For this column, I asked several fellows in different subspecialties about their experiences in their new roles.

1. What was the most difficult part of transitioning from residency to fellowship?

Response 1

“The transition from resident to fellow was not that difficult, although there were some challenging aspects. The aspects of my fellowship that I found most difficult were more secondary to changing institutions and practice patterns as opposed to changing into a more senior role in clinic. I felt very frustrated early on in my fellowship when learning a new EMR system. In residency, I could whiz through patients, but, in fellowship, I struggled with simply entering patient data. Also, the patient population was vastly different from the demographics of my residency program.”

Response 2

“The most difficult part for me was the newfound autonomy and responsibility. Most fellowship programs appoint fellows as clinical instructors or attendings. So, within a week of completing your residency, you go from having limited or no autonomy to having the responsibility of staffing residents on consults and surgeries. The transition is difficult, but I think the benefit is that it also quickly builds your confidence as a physician and surgeon.”

2. Do you have any advice for senior residents who are choosing or preparing to start a fellowship?

Response 1

“My advice for senior residents would be to see as many patients as you can; watch and do as many procedures and surgeries as possible, even if it means staying an extra hour in clinic or in the operating room. You will be prepared for any fellowship if you first become a good comprehensive ophthalmologist.”

Response 2

“My advice for senior residents would be to know your future fellowship program. Not all fellowships are created equal. Some are strong in one area and weak in others. Identify weak areas in your future program and try to fill any educational gaps in your remaining 6 months at your residency program.”

Response 3

“I was told to look for a fellowship in which your mentors treat you as colleagues. Fellowship is different than residency: Residency is a requirement, whereas fellowship is not. Fellowship is a personal choice. So, you should look for a fellowship in which your mentors are enthusiastic about teaching and respect your interest and motivation to continue 1 or 2 more years of training. In return, you should also genuinely work hard and learn as much as possible during your fellowship. In addition to academics, fellowship is also about cultivating a long-lasting relationship with your mentors. They will be the ones you will turn to for advice as you start to build your career after fellowship.”

Response 4

“If there are things you are interested in that are not already incorporated into your fellowship program, discuss them with your attending beforehand. You will likely find a way to work them into your schedule.”

3. Did you feel prepared for the greater autonomy, increased teaching responsibilities, and surgical independence?

Response 1

“I felt pretty well prepared from residency for the increased autonomy, and it has gotten easier as the year goes on. It is more stressful in the operating room when you are on your own, but overall I felt prepared and comfortable.”

Response 2

“My residency program had a good balance of autonomy and supervision, so I felt prepared. During the last month of my residency, my mentors gave me more autonomy in the operating room, specifically to give me the confidence to feel as if I were operating on my own.”

The transition between residency and fellowship can be difficult. Fortunately, most fellows feel prepared and ready for the increased autonomy and teaching responsibilities. Take advantage of all of the learning opportunities available to you in residency and remember that you can always ask for help.

Jessica Ciralsky, MD

Jessica Ciralsky, MD, is an Assistant Professor of Ophthalmology at Weill Cornell Medical College in New York, specializing in cornea/cataract/external disease. Dr. Ciralsky may be reached at (646) 962-2020;jbc9004@med.cornell.edu.