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Residents & Fellows Corner | Sept/Oct '16

Reflections on Fellowship Year: Five Lessons Learned

The transition from ophthalmology residency to fellowship is a unique one. It’s the first time in most of our lives when we can make a decision to either pursue additional training or begin practicing on our own. This year also coincides with the time when most graduates take the American Board of Ophthalmology Written Qualifying Examination and find their first post-training position. Both of these events can be added stressors to an already challenging year. I personally made the decision to pursue a fellowship after I found myself drawn to anterior segment surgery during my second year of residency. I wanted to attend a busy fellowship with the goal of sharpening my surgical and clinical skills while also forming lasting relationships with my mentors. After my 12 months as a Baylor cornea fellow whisked by, I reflected on how this past year surpassed all of my expectations. I discovered there were five key lessons that I learned.


During my residency at Emory, one of the retina fellows had a little notebook in which she drew pictures after each surgery she performed. She told me that this was the best way for her to remember how she tackled different techniques. I thought this was an ingenious idea and attempted to create my own artistic journal during my first few weeks of fellowship. I quickly learned there was a reason I chose to become a physician and not an artist. My drawings did not do the surgeries any justice. I needed to find a new way to ensure that I could reference a specific surgical technique at a later date.

Call me a millennial, but I thought, why not use technology to help me reach this goal? With this in mind, I borrowed a few of my attendings’ videos at the beginning of the year. These were mainly examples of straightforward procedures that I could refer to the night before surgery. Finding this useful, I began to record all of the procedures I did throughout the year and used them as benchmarks for future surgeries. It was helpful to see how I had improved since the beginning of the year and to quickly learn from my mistakes. At the end of fellowship, I had a total of approximately 100 videos in a library that I now keep on a separate hard drive. Every time I need to prepare for a surgery, I can just find and watch the associated video. If you learn better from writing things down or drawing, then definitely do that. Start early in the year so that you can get into a routine.


I was fortunate to train with some of the top leaders in the field of ophthalmology. Although working with them was extremely intimidating at first, I quickly learned that all of my attendings shared the same goals of training me well and getting me connected with the ophthalmic community. Everyone was extremely supportive in all of my endeavors and were valuable resources when I asked questions about topics I was uncertain of. Fellowship is an excellent time to make new connections and get involved with local and national committees. This will not be the last opportunity to do this; however, being immersed in the academic arena is a great starting point.


Call is always one of those things we dread about training. My fellowship call consisted of anterior segment globe and cornea call every other week. I knew it was going to be rough, but I made the decision early on to make the most of it. Yes, it was difficult, and, yes, I was exhausted at times. However, I realized that if I dreaded it the whole year, it was going to be a long 12 months with little reward from the potential experience gained while on call. I turned every open globe injury into a jigsaw puzzle, and the senior resident and I had to figure out a strategy to solve it. Each case also became an opportunity to teach the senior resident how to suture (a daunting task). Toward the end of the year, call became second nature, and open globes actually became exciting (I know—hard to believe!).


My biggest struggle at the beginning of my fellowship was crossing that line from being a cautiously supervised resident to a bright-eyed fellow operating on my own. I did not have many opportunities to operate on my own during residency, so that first day in the operating room by myself as a fellow was extremely intimidating. What I didn’t realize was that fellowship was a form of training wheels for the rest of my life. If I made an error, I tried hard to correct it, but when I continued to struggle, my attending was downstairs in clinic and happy to come up to help. This didn’t happen often, but when it did, I was appreciative that I was still a fellow and not out on my own. It helped to build confidence if I was able to get myself out of those sticky situations but was also humbling if I couldn’t. Make the decision to operate as much as possible on your own as a fellow because this unique experience will only be available for a limited time. Don’t be afraid to make mistakes! This is your final year of training and the last time someone will be looking over your shoulder to help you.


Everyone has different goals for their fellowship year. You learn this quickly on the interview trail. Do you want to publish 20 papers, learn every type of endothelial transplant, or brush up on your teaching skills while staffing residents? Unless you do a research-heavy fellowship, you will likely have to pave your own way and make the experience what you want it to be. It is important to be true to yourself at the beginning of the year and concentrate on what you really want to accomplish.

For example, my goals for fellowship were to become a better cataract surgeon and learn new techniques that would make me a marketable corneal surgeon. At the beginning of the year, I told one of my attendings that I really wanted to learn DMEK, so I made every effort to practice and study on my own to learn the technique. This proved to my attending that I was motivated and ready to tackle the procedure. By the end of the year, I assisted three of my other attendings on their first DMEKs. This was something I never imagined doing, but, by pushing myself, I surpassed even my own goals. It is easy to fall into the trap of doing what is expected. By this point in your life, you are good at checklists and completing your to-do lists on time. However, if you push yourself beyond expectation, you will have a much more gratifying experience.


Fellowship is an exciting, albeit challenging, year and one of the most unique opportunities of your career. The year flies by, so spend your time wisely. Give it your all, and you will reap the benefits. Write down or record everything you see and do. Embrace the call, and learn from your mistakes. Move outside your comfort zone, and make new connections. It is an exciting time to be an ophthalmologist, and fellowship year is a perfect jumping-off point to begin a fulfilling lifelong career.

Heather Weissman, MD
Heather Weissman, MD