"All of the above being said, you should enjoy the interviews as well and be yourself. You are being fed well, shown the sights, and you are meeting applicants from all over the country with vastly different medical school experiences."

          -Jay Sridhar

Whether you're applying for residency, fellowship, or even medical school, interviews can be a busy time full of preparation and excitement, stress and uncertainty. Today, Jay shares a few tips on how to excel on an ophthalmology interview. However, his pearls of wisdom are also applicable outside of ophthalmology to any field of interest! Thanks for joining us today!

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We are entering the heart of surgical retina fellowship interview season. Nipping on its heels is the ophthalmology residency interview circuit. In a prior blog post about residency applications in general we briefly touched on interviewing, but here are some specific pearls to remember before you take that fancy suit and new dress shoes on the road:

1)    Mock, mock mock: Practice makes perfect. Practice interviewing with your medical school classmates, mentors, significant other, whoever. Everyone has different comfort levels with interviewing. Just like you would not expect to pick up a tennis racquet for the first time in your twenties and play like Roger Federer, you should not expect to walk in cold and nail every interview.

2)    Common is common for a reason: While it may come across as mechanical to memorize responses, you should be prepared for the most common questions you may be asked. Here is a list to practice:

     -Do you have any questions about the program? (the most common question)

     -Why did you go into ophthalmology? Who were your biggest influences?

     -Tell me about yourself

     -Tell me about X activity/interest/hobby (from your application)

     -I have to sell you as an applicant to the rest of the residency committee. What should I tell them? Give me a 2 minute synopsis.

     -Why are you interested in our program?

     -Have you visited here before? If not, how do you find this city? Why would you be happy here?

     -Why are you a good fit for our program?

     -What are your three biggest strengths? Your three biggest weaknesses?

     -How can I convince you to come here? (not a promise)

     -I saw that you did a presentation on XYZ topic during your ophtho rotation. Tell me more about this. What do you know about current research on this topic?

     -Where do you see yourself in ten years? Why (academics/private practice)? Do you want to do fellowship?

     -Tell me about your research. How do you think this will be applied in the future?

     -What problems did you face in your research? What were your results? What would the follow-up project try to achieve?

     -If you were not a doctor what would you be? Why?

     -What are your hobbies (or questions about hobbies listed on your application)?

     -What is your favorite book? Why?

     -What is your proudest achievement? What was your biggest failure and how did you learn from it?

     -What is the future of this field? How will healthcare reform affect us?

3)    Be enthusiastic: No matter how high or low a program is in your mind, remember always that if you are visiting a place that means on some level you are seriously considering working there. So “turn it on”! Be excited, smile, be interested in the program because THIS MAY BE WHERE YOU TRAIN! You put in all the work to get to this point and now you get to see your future as a resident first-hand. You may be tired from a long day’s travel, you may be sick of seeing another examination room with slit-lamps, you may be sick of answering ‘Do you have any questions for me?’, but always remember to be enthusiastic and polite. This is the beautiful place you may be privileged enough to call your home program in the future.

4)    Be prepared: Given that this is YOUR program of the future, you should be well-prepared in advance about the program. At the bare minimum know how many residency slots there are, who the program chair and residency director are, who the coordinator is, and any other information available on a program’s website. Asking any of the above indicates to faculty/residents that you have not done your homework. In addition, talk to residents at your home program who may have interviewed there in the past. Read all feedback about the program posted online at Student Doctor Network or match applicants. All of this will help you come up with specific questions about the program that show how interested you are. And you should be interested, because this may very well be the place where you train. Better yet, these questions will actually be legitimately thought-provoking to you and your interviewer as opposed to the standard ‘What are the biggest strengths of this program?’-type questions asked by everyone.

5)    Carry on, carry on: Always carry extra photos, copies of your CV, and any of your publications (if you have them) on interview day. I stopped doing so about half-way through (since they were never used). Then I wound up interviewing with a faculty member who was pinch-hitting for a colleague and had never seen my application. That CV would have really come in useful.

6)    Do not sweat the small stuff: There are debates how “even” applicants are when they arrive for an interview. The best philosophy is to consider it dead-even and treat it as such.

7)    Have fun: All of the above being said, you should enjoy the interviews as well and be yourself. You are being fed well, shown the sights, and you are meeting applicants from all over the country with vastly different medical school experiences. Talk to them and learn about them! You will meet some very cool people who will be your colleagues for the rest of your life. You will see the same people at national conferences as a resident and then perhaps in fellowship and beyond. Some of them will be your co-residents! I made some very good friends on the trail and we wound up helping each other out throughout the season.

Note: much of this article I previously wrote up in a now defunct “Updated Unofficial Guide to the Ophthalmology Match.” Stay tuned for more excerpts in the future!

-Jay Sridhar

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"In medicine, however, you cannot afford to be poor at any aspect of your work because in most instances it directly influences someone's health."    -Jay Sridhar

Jay continues the convesation with Mike and Louie about clinic vs. OR, and how preferences can shape your career.

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LC: Do you find it's common that people tend to shape their careers around their forte or do most ophthalmologists have relatively balanced practices? Also a related question: If during my training I discover that I'm better in clinic than in the OR, would it be more effective to hone that strength or spend more time improving my weaknesses?

JS: Tough questions that I will not pretend to be smart or wise enough to answer well. The most I could say is that when you read about or talk to successful people in general life they talk about maxing out strengths. The more you do something, the better you get (see Malcolm Gladwell's 10,000 hour theory) and if you are good at something already the ceiling should be higher.

In medicine, however, you cannot afford to be poor at any aspect of your work because in most instances it directly influences someone's health. What you can do is tailor a career to strengths; maybe stop operating and focus on research if that's your love and strength, or refer complex ocular oncology patients to another doctor who is a specialist. Maybe the most important talent you can have as a physician is to know your limitations, work hard to improve what you can, and ask for help when you need it.

However, as a resident your goal should be to be as good as possible at everything. It's too early in your training to punt on operating, for example, and the ACGME has basic requirements in terms of knowledge base and skills that are necessary to graduate an ophthalmology residency. So if you realize you are deficient seek help from mentors and work to improve.

LC: Those are wise words and very applicable to our medical training now as well. Even if we know we're going into ophthalmology, we have a duty now to excel as medical students for we never know when our knowledge may be useful and aid in the care of a patient. Who knows how the future of medicine may be like, and we have all the possible tools to be prepared to handle anything.

MV: I agree with Louie and really like that analogy! It's nice to hear about the variety of exposures we will receive, and also about the ability to customize our career to our interests.

When you were going through medical school and deciding on ophthalmology, did you know/assume that you'd prefer the OR over clinic, or was that a preference that came out during residency or fellowship?

JS: I had no idea because I loved both the clinic and the OR for ophthalmology. As a resident I actually preferred clinic in some ways; the OR lends itself to simultaneous excitement and anxiety when you are starting since the only way to avoid complications completely is to not operate at all. But as a fellow as I gained in confidence operating full-time as a retinal surgeon the OR slipped ahead in my personal rankings.

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

"...everyone has a forte. It's like saying Michael Jordan's greatest strength as a basketball player was scoring. It doesn't mean he was not a great passer or ball-handler, but his peak was scoring."     -Jay Sridhar

Jay talks with Mike and Louie about preferences of clinic vs. OR and how to stay interested throughout your career. They realize that while we strive for excellence in all areas, everyone has a forte.

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LC: Things I commonly hear from medical students when I tell them I'm going into ophthalmology include "Eyes gross me out." or "Doesn't it get boring only working on one organ?" How do you usually respond to those sentiments? 

JS: I think all of us in medicine have components of our field which give us more of the “ick” factor than others. For example, I discovered during my trauma rotation that broken digits bother me a bit. Having seen good friends of mine vasovagal seeing eye surgery videos, I can honestly state that being grossed out by eyes may be a legit reason to not pursue the field. Still, unless you have a visceral response, it is worth exploring and seeing if your initial hesitancy is really all in your head.

As far as boredom goes, a wise doctor (an internist) once told me in medical school: everything becomes rote after some time. That is to say, every field has its bread and butter that you will see over and over again, and then its zebras that pop up occasionally and stir that old flame in your soul. The real question is whether or not the rote stuff is still interesting to you after the umpteenth time of looking at a retina. And yeah, being able to directly see part of the central nervous system is still exciting!

MV: That's a really great point. As students, and really throughout the entire career, it seems like that is a goal - to get to the point where you know your field well enough that you're really only "stumped" by the zebras. At that point, there's that risk of boredom. But then again I suppose that's where research comes in - with treatments constantly progressing, those things that were once mundane could become quite exciting again!

LC: I never thought of it that way. In that case the rote things in ophthalmology are pretty interesting. Even a simple slit lamp exam can be performed more efficiently, more accurately. I think the procedural aspects of the field will always be enjoyable as long as we're striving to improve our technique. 

MV: With regards to your comment, Dr. Sridhar, I'm curious if you feel a difference between clinic and surgery. I've heard a number of residents from various fields say something like, "I can't wait to get through this clinic day and get to the OR tomorrow." For you, do "easy" surgical cases remain exciting because of how much attention to detail is required regardless, or are they subject to this "bread and butter" idea too?

JS: Excellent question, Mike. So the fellows used to discuss this amongst ourselves in fellowship. We concluded that each amazing surgeon we trained with had one arena where they were in their absolute element, be it the OR, clinic, the podium giving a talk, or writing a paper. Now, this is not to say they were inadequate or uncomfortable in the other arenas. Retinal surgeons are generally exceptional people who excel across various facets of their work. But everyone has a forte. It's like saying Michael Jordan's greatest strength as a basketball player was scoring. It doesn't mean he was not a great passer or ball-handler, but his peak was scoring.

That being said I think I am not unusual in preferring OR to clinic. I enjoy talking to and seeing patients tremendously, but there is something uniquely meditative and special about the privilege of performing surgery. We talked about retinal surgery at length before (link), so I will summarize by saying that retinal surgery stimulates because every case is its own challenge. 

LC: Thats a really interesting analogy. That's a point I never considered but makes a lot of sense. There are multiple definitions and aspects of what it means to be a good doctor, and it's natural to have a particular strength - whether with clinic, teaching, or research.

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). 

"The only thing worse than being blind is having sight but no vision."  -Helen Keller

Jay talks with Mike and Louie about which skills best carried over between medical school and ophthalmology residency. They realize how important it is to stay connected to other specialties. 

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LC: Dr Sridhar, for someone going into ophthalmology, which skills from other clerkships helped you out a lot during residency? 

JS: Thats a phenomenal question Louie. The cop out answer is all of them contribute because the most important skills to develop are a strong work ethic and a dedication to approach patients compassionately, intelligently, and efficiently. You gain that skill over time via repetition regardless of subspecialty rotation. I will say that the major principles I learned in general surgery about hemostasis, minimizing surgery duration, and tying good square surgical knots all were extremely applicable during ophthalmology residency. Understanding internal medicine is critical given how many systemic conditions manifest in the eye. You would be surprised how often you are the first doctor to tell a patient they have hypertension or diabetes. Even malignancies such as leukemia may be first noted on funduscopic examination. 

MV: I just started Internal Medicine today and have my Surgery block next, so I’ll definitely keep those points in mind throughout these rotations! I often hear others claim that ophthalmology is this isolated niche where you “put away your stethoscope” and forget about the rest of the body, but it’s great to hear how that is far from the truth. Thanks for the great perspective, Dr. Sridhar.

JS: When I interviewed Dr. Craig Greven he referenced how ophthalmologists sometimes isolate themselves from other parts of medicine and how we cannot forget the importance of communicating with our non-ophtho colleagues. Never forget how frustrating it could be as a student on a primary care rotation to either not know what happened at a patients subspecialist appointment or to not be able to reach the subspecialist with questions. This will reinforce your feeling of responsibility to send accurate and useful letters to your referring primary care physicians as an ophthalmologist. 

LC: I completely agree. It's so easy to forget how specialized the knowledge is. Our acronyms make documentation more efficient but often make it less interpretable for general practitioners. I'm starting to realize how important it is to effectively communicate the implications of the diagnoses and management plans we create .

JS: And acronyms vary from institution to instruction! I did not realize this until I started fellowship, but even similar programs can have very different ways of saying the same thing. Similar to how a sub sandwich in Miami is a hoagie in Philadelphia. 

LC: One thing I noticed on my clerkships was that whenever a patient has anything eye related, ophthalmology is consulted. What criteria would you say warrants a consult? For example dry eye or viral conjunctivitis could potentially be managed by the general team. Or is it better to be safe than sorry? 

JS: A great question and one we should save for a bigger piece next week. Come by for next weeks post and we will discuss inpatient consults.

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). 

"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).