Ophthalmology residency has officially started. Well, technically it started at the beginning of July, though the first two weeks were spent becoming (dis)oriented on how to use the electronic medical record, how to be compliant with hospital policies, and other mundane HR aspects of starting a new job.
This past week, however, was the first week of seeing patients full-time in the general ophthalmology clinic! All in all I saw probably a half dozen post-op patients, a dozen annual checkups for diabetic retinopathy, numerous patients with blepharitis, several with floaters, three with conjunctivitis, a few very interesting neuro-ophthalmology patients with ocular tumors, cranial neuropathies, and autoimmune disease, and a few with syndromes I had never heard of and did my best with the patients in clinic and then really learned about their conditions by reading at home.
Let me share with you a few of my struggles and one success from my first week in ophthalmology residency.
The slit lamp – This instrument, invented in 1851 by Hermann von Helmholtz is essentially a fancy microscope with several dials and knobs that can be carefully adjusted to allow thorough examination of the eyes and surrounding structures. (A picture of the slit lamp biomicroscope can be seen above.) Here’s the problem. The clinic in which I am working has at least a half dozen types of slit lamps, and each has its own unique quirks. Some slide out on their own and can easily be adjusted, others swing down onto the patient’s lap, and another still is portable and allows for bedside examinations for hospitalized patients that cannot be seen in the eye clinic. This week alone I think I spent at least five minutes trying to figure out how to turn the slit lamp on with one patient, bonked two patients in the head awkwardly as I accidentally moved it toward them, and another still smacked her jaw uncomfortably when I pulled the instrument away and she was still resting her chin in the instrument. Needless to say, I need to figure out how to gracefully use this instrument, and I better figure it out soon! First item on my to-do list for this week is to practice using all the variations of slit lamps in the examination rooms BEFORE the patients arrive.
The clinic lights – Have you ever noticed the different colored lights, rows of flags, or signs that hang outside each examination room? These lights are for clinic staff to maintain an efficient workflow and have some idea of who has been seen by a nurse/tech, who is dilating, who is getting photos, OCT, or visual fields taken, and who still needs to be seen by the doctor. Yes, I have an undergraduate degree and a doctorate degree, but I still cannot seem to figure out this flag/lights system! At least ten times this past week the physician with whom I am working had to pop his head into the exam room and turn off the yellow light and on the green and white light because I had forgotten to do so. Not to mention the fact that every doctor in every clinic has their own system, which only further complicates my struggle. Second goal of the week – master the clinic workflow lights/flag system.
Normal variant or pathologic? Imagine when you were a toddler learning the different colors of fruits. Over time you learned that apples come in shades of green and assumed this to be the standard until someone showed you a red apple. Your understanding for what was an apple suddenly changed. You then came to recognize a green or red apple as delicious, and also learned that a brown apple would not be delicious. In much the same way, ophthalmology as a specialty is all about pattern recognition. Until you have seen hundreds of variations of normal cornea/lens/retinal tissues, you have little understanding for what is normal and what is abnormal. As a new resident I am still learning about green apples and feel far away from picking up on the subtleties of brown, diseased apples and their corresponding ophthalmic pathologies. Fortunately, I never feel left alone to make a diagnosis of normal/diseased on my own and always have the supervision of an experienced attending physician. In these upcoming weeks I will continue to go through an ophthalmology images atlas both in print and online to continue to differentiate normal variation from disease.
Drinking from a firehose! From time to time you may hear someone say they are learning as if “drinking from a firehose.” Even more so than during my internship, residency is already beginning to feel like such a beverage. I expected this to be the case, but what I did not expect would be that it wouldn’t be just one firehose spraying knowledge at a sometimes-painful rate of speed and volume but that I would be getting hosed down from multiple firehoses all at once! Between morning rounds, daily clinic, subspecialty rounds, research rounds, basic science lectures, and personal study, and opportunities to present at each of these events, the educational opportunities are not only ample, they are at times overwhelming! I am realizing that to be a successful resident I am going to need to be disciplined in my personal study, wise in my lecture attendance, and efficient in time management.
The text page that made it all worth it – On Wednesday morning, in the midst of struggling with my nemesis the slit lamp, my failure with the clinic workflow lights, my search for bad apples in the clinic orchard, and feeling water-logged from learning I received a much-needed encouraging message, which came in the unexpected form of a text message on the emergency pager I carry with me all the time. The text page was from an employee of our eye clinic whose sister was a patient of mine the prior day. The page simply read, “My sister was very happy with the care you provided yesterday.” In those eleven words, this employee (whom I have yet to meet) made my first-week of residency struggles all worth it. I may struggle with systems and I may still be learning the kindergarten basics of ophthalmology, but as long as my patients know I care, all the struggles will be worth it, both right now and hopefully for many years to come.
What memorable struggles did you have when you first started residency or when you started a new job?
What advice do you have for handling the firehose of information that faces new residents?