The COVID-19 pandemic has created a unique set of stressors and setbacks for medical students applying to ophthalmology residency programs this cycle. Gone are the days of flying cross-country to interviews, rotating at outside programs, and attending local and national meetings. In this article, Tobin Thuma, OMS-IV, a fourth-year medical student, discusses some of the trials and tribulations that may be encountered by the next generation of ophthalmologists preparing to apply for residency.
—Eric Rosenberg, DO, MScEng; and Andrea Tooley, MD
In keeping with years prior, 2020 began with a room full of hopeful medical students looking forward to starting their rotations at nearby hospitals. Then came the outbreak of the COVID-19 pandemic—and the swift construction of several barriers to entry into the clinical ophthalmology setting. In the blink of an eye, the majority of ophthalmology programs had pulled their rotation slots from the Visiting Student Learning Opportunities (VSLO) website, the exclusive online collaborative that matches and provides rotation opportunities for fourth year medical students in the United States. This maneuver was expected and mandated across institutions nationwide in order to protect patients, staff, and faculty.
Unfortunately, this move compounded an already-complex situation for those without home residency programs or ophthalmology departments. Most notably, during away rotations programs get to know the applicant and the applicant becomes acquainted with the program; without rotations this year, ranking lists will certainly be difficult for both sides to make. Sadly, not only will personal connections be lost, but also adequate exposure to a highly specialized field may be lacking. When it comes time to enter residency, will trainees be prepared? Superseding all of these considerations, however, are the immediate requirements of the residency application.
LETTERS OF RECOMMENDATION
The San Francisco (SF) Match ophthalmology program opens on September 15 of this year and requires three letters of recommendation. Requirements dictate that one letter must be from an ophthalmologist; however, mentors have suggested that applications with two letters from ophthalmologists may be preferred. With rotations off the table, obtaining new letters of recommendation has become a near Sisyphean task for many. While applicants are weathering this storm together, many will have difficulties establishing relationships with ophthalmologists and getting quality letters of recommendation, as there is little clinical accessibility at this time.
Luckily, with the assistance of online meetings such as those hosted by various ophthalmologists, including Dr. Tooley, and those led by the American Academy of Ophthalmology (AAO) and the Association for University Professors of Ophthalmology (AUPO), it appears that residency program directors are sensitive to the difficulties that medical students are facing. Further, medical student directors are continuously looking for opportunities to get students involved when and where possible.
USMLE AND MEDICAL BOARDS
Board examinations have become a particularly tricky undertaking. Prometric, the United States Medical Licensing Exam (USMLE) and Comprehensive Osteopathic Medical Licensing Exam (COMLEX) testing center, was required to reduce its testing capacity due to physical distancing guidelines. As a result, many students’ scheduled exams were cancelled. The shortage of seats increased demand, and minimal options for rescheduling are available at this time. Thus, these students now worry about when they will be able to take their board exams, with many deferring their Step 2 exams well into their fourth year.
With the clear importance of competitive board scores for the ophthalmology residency application, some applicants may worry about not being able to complete their boards before the SF Match opens. The National Board of Medical Examiners is aware of the issues with testing availability and has responded by developing a pilot program to administer the USMLE exams at medical schools. This program will create regional testing centers in Arizona, California, Indiana, Rhode Island, and Texas. Hopefully this maneuver will satiate the demand and prevent further delays.
Many medical students, myself (TT) included, contracted COVID-19 early in the start of the fourth year, which prevented us from commencing early rotations. While I sat in quarantine, I could not help but be grateful, for others have it significantly worse, not only from a health perspective but also from a timing standpoint. What if this illness had affected me during a scheduled board exam, midway into a clinical rotation, or worse, during a residency interview?
Although many medical students have been down, we certainly have not been out. During recovery time, virtual platforms have allowed students to attend ophthalmology Zoom webinars, reach out to local residency programs, and try to contact nearby ophthalmologists. Speaking with mentors can help students assess their residency applications and coordinate strategies for the coming months. This year will undoubtedly require students to pursue creative avenues to get involved in ophthalmology at various stages, depending on their individual situations.
With the quality of applicants improving each year, it is no surprise that ophthalmology self-selects top candidates from the medical student pool. Therefore, issues that may not ordinarily seem knotty may make the difference between seeing an accept or a reject on the match paper. While we appreciate that countless attributes cannot be quantitated, we fear that we will see the razor-thin differences on paper be the deciding factor. Therefore, it is now more important than ever for medical students to advocate for themselves and let programs know succinctly that they are interested, personable, and willing to put in the time and work. While this truly demonstrates that nothing in medicine is static, we wish to impart that necessity is the mother of invention, and those of us in the ophthalmic community are cheering on applicants and wishing them nothing but success!
—Eric Rosenberg, DO, MScEng; and Andrea Tooley, MD