Prof & Pupil: The Ophthalmology Elective During Medical School

"Our eyes are placed in front because it is more important to look ahead than to look back..."

Jay talks with Mike and Louie about their experiences with ophthalmology rotations during medical school. They realize how much of an influence residents and attendings have on a medical student's decision to pursue ophthalmology. 

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Jay: What are the challenges you two have encountered as students on an ophthalmology rotation as opposed to your core clerkships (e.g. internal medicine, general surgery)?

Louie: For me, the biggest challenge was the learning curve needed to perform a good slit lamp and indirect exam. In medical school, we often spend a lot of time honing our history taking and physical exams, but we never get a lot of practical training on the basic eye exam beyond direct ophthalmoscopy. I felt that I was more of an observer and learner on my first ophthalmology rotation whereas on my core clerkships, I was more quickly involved in the entirety of patient care.

Mike: The biggest challenge for me was the inherent difference in the structure of the patient visit, particularly the physical exam. By the time we start clinical rotations we had been practicing the Internal Medicine-style H&P for a few years, but I had only spent a few minutes on the slit-lamp. Instead of seeing patients on my own, I spent more time observing, learning about different conditions, and exploring different parts of the field. Unlike for core clerkships, scrubbing into and physically participating in surgeries just isn’t as feasible in ophthalmology.

Jay: I agree. I remember as a student how difficult it was to feel helpful as a student on an ophthalmology block elective. However, being on the other side now, I've seen that certain students do integrate themselves into the clinic, which is remarkable. Probably the most important thing I notice is how attentive and courteous the best students are to the patients. The next thing I look for is genuine interest (and not in texting!). And finally the best students ask intelligent questions at the appropriate times. 

Jay: How as an attending can I help involve students on an ophthalmology rotation? What have your favorite clinic or surgery attendings done?

Mike: My best experiences were with those attendings who either were very open to questions, asked me questions to bring up teaching points, or discussed cases between patients. If there was a teaching scope in the room, it was very helpful to hear the attending’s thought process during the SLE, and I enjoyed opportunities to give the exam a try on my own once the “real” physical exam was complete. For surgery, my best experience was a case one-on-one with an attending - he had plenty of time to talk about each step and his decision-making. Similarly during cases with residents, I enjoyed when they chimed in once in a while to make sure I knew what was going on. This really helped connect my book-learning with the real-world procedures.

Louie: I agree with Mike. My best experiences were with attending physicians who always appeared open to questions. I also really appreciated when attendings and residents never assumed what I knew and explained from the most basic level. A quick refresher only helps to solidify knowledge. Other than that, simple things like welcoming and acknowledging the presence of a medical student goes a long way. We already feel slightly uncomfortable when we're shadowing, and a simple gesture like that can really put us at ease.

Jay: I think as a last point you both have mentioned how important residents and fellows can be to the student experience. I would not have gone into ophthalmology if my first experiencehad not been with two incredible residents: Will Parke and Ryan Isom. Students are extremely impressionable and seeing someone extremely generous and willing to act as a bridge to attendings can be inspirational.

Louie: Absolutely. I was in between many specialties when I started medical school, and the people I met in ophthalmology strongly motivated me to choose this speciality. There is a tradition of teaching that we have a duty to pass on.

Mike: That's an excellent point. It's important to have great attendings as mentors, but at the end of the day it's from the residents that students will learn what their day-to-day life will be like for the next number of years. Whether it be from attending or resident, one thing that really stood out during my rotation was how passionate everyone was for the field. I can't tell you how many times I heard "Ophthalmology is an excellent field!" or "This was definitely the right choice for me." When your mentors are excited to teach you and excited about their job, that gets me excited about a future in the field!

To be Continued...

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-Adapted from a real conversation between The Professor (Jay Sridhar) and The Pupils (Louie Cai and Mike Venincasa).