In 2000, nearly 70% of medical schools required their students to take a formal ophthalmology rotation or clerkship. Just five years later, this number was more than halved, with only 30% of schools requiring students to have a formal ophthalmology experience.
Lack of ophthalmology education during medical school and residency training can prevent future physicians from having the basic knowledge to initially evaluate and manage patients with eye complaints. "Although some eye-related symptoms, such as red eye, are fairly common, primary care clinicians might be unsure about when they can manage underlying conditions appropriately and when the patient should be referred to a specialist," writes Dr. Sumit Garg. "Knowing what to look for when confronted with these patients can prevent a diagnostic error."
Medical students seeking a career in ophthalmology have additional goals for the ophthalmology rotation. Surveys of residency program directors in ophthalmology have consistently shown that ophthalmology clerkship performance is an important factor used by programs in the residency selection process.
I am often asked for advice on how to do well in the ophthalmology rotation or clerkship. Below I offer some very specific recommendations to make the most of your learning opportunities in this important rotation, and leave your attending and resident with a favorable impression.
Become Familiar With The Tools Of The Trade
Most medical students approach their ophthalmology clerkship with a sense of excitement or anticipation. Not uncommonly, however, these initial feelings may be tempered by some concerns as the rotation draws near. Chief among these concerns are worries about appearing awkward using unfamiliar ophthlamic equipment, and how this discomfort with the eye examination may be viewed by attendings, residents, and patients.
The good news is that attendings and residents don't expect you to be proficient with the tools of their trade. "We would like you to acquire general familiarity with the equipment used in ophthalmic examination, for example, slit lamp biomicroscope, applanation tonometry, and indirect ophthalmoscopy," writes the Gavin Herbert Eye Institute at the University of California Davis School of Medicine. "We do not expect you to master these techniques.
They recognize that you will have had little to no experience using the slit lamp or indirect lenses. What they are expecting is that you are open and eager to learn how to use these tools. To relieve some of your discomfort, i recommend that you refresh your memory on how to use an ophthalmoscope, and view videos on the slit lamp and other ophthalmology equipment. Some excellent videos are shown below.
Principles of Ophthalmoloscopy / Funduscopy
Using The Tonometer
Slit Lamp Exam
Learn How To Take An Accurate Eye History
Although you'll likely be asked to shadow early in the rotation, the hope is that you'll have opportunities to independently evaluate patients. In some rotations, this is a requirement. If that's not the expectation in your clerkship, politely ask if you may take a more hands-on role.
In particular, seek out opportunities to take the patient's history. This is an important skill to develop, and, with practice, you can quickly become productive in this area. In terms of the eye history and exam, it's far easier to make a favorable impression through history taking; it's much harder to do so through the exam. Below are some videos to help you gain confidence in history taking.
Ophthalmology History and Physical Part 1
Ophthalmology History and Physical Part 2
Know Your Abbreviations
I know you're familiar with LASIK but what about CRAO, POAG, and PPV? Are you familiar with RP and ARMD? If not, you need to be. Make it a point to look over ophthalmologic abbreviations before your rotation. A useful resource is Learning the Lingo: Ophthlamic Abbreviations (see page 7) published by the American Academy of Ophthalmology in the Young Ophthalmologist's Newsletter.
It can be easy to be a passive participant during the ophthalmology rotation. Depending upon the structure of your rotation, you may find yourself simply accompanying your resident or attending from one room to another. Some degree of assertiveness may be necessary for you to achieve your rotation goals. Some recommendations:
If you're interested in pursuing ophthalmology as a career, say so at the beginning of the rotation. Let your team know that you would like to make the most of your learning opportunities.
Ask if you can spend time with the ophthalmic technician or assistant. Technicians assist ophthalmologists by performing eye-related clinical tasks, including, but not limited to, history taking and the performance of vision and diagnostic tests. There's a lot that you can learn from these team members.
Learn how to perform tonometry using the Tonopen.
Administer eye drops.
Ask questions at appropriate times.
Take the patient history (see above).
Look for ways to help with clinic flow and efficiency.
Assist with the case in the OR by transferring and positioning the patient properly.
Students are often told to find ways to help out. In general, that's good advice. However, in taking initiative, it's important not to overdo it. Seek advice from your residents and fellows about attending preferences.
Soft Skills Matter
Ophthalmology residency programs tend to be small. Therefore, it is crucial that programs select residents who are known to be team players. “Residents have to know that they can depend on one another to take up the slack if there are multiple challenges occurring at once,” writes Dr. Carlo DiMarco, program director of the ophthalmology residency program at Millcreek Community Hospital. “We see if they are personable with patients, residents and staff. We specifically ask our staff how the students interact with them because some students have been condescending."
"Reading in advance of the rotation and on a day to day basis, coming early and staying late, asking relevant and insightful questions, demonstrating enthusiasm and passion for the job, and connecting with an interested faculty mentor are key differentiating features of the best applicants," writes Dr. Andrew Lee, Chairman of the Department of Ophthalmology at Houston Methodist Hospital.
Dr. Samir Desai is the author of The Successful Match 2017 and the co-host of the Success in Medicine podcast.