I am a PGY-2 feeling overwhelmed that our program / chief resident expects us to know so much already and choses to be hard on the PGY-2s instead of providing a supportive environment. I have spoken to PGY-2s from other programs, and I do believe that other programs are more supportive.

Please remember for the sake of all PGY-2s out there:

1. It's only been 2 months, and we are all still adjusting to moving from far away to a new environment.

2. We are juggling trying to build the foundations for a good eye exam, to be able to see pathology, to provide service in the clinics, to read the Basic Science Series, and to take calls. Therefore, please do not expect us to be perfect now in every way. We are trying our best.

3. Too much after hours lecture = no time to read at home. Please recall when you were PGY-2s whether there were as many lectures... if there was, were you able to absorb things that were taught after hours and then read after you got home so late? :sleep:

4. Please remember that everyone studies differently. Making up a reading schedule is artificial -- we may want to read about things we saw in the clinic and concentrate on a field that is different than that of the reading schedule. Yes, it's nice to have a schedule so we can all try to get through the series, but please don't be mad if we are reading something else along the way. The reading schedule should be a tool to guide and remind us of our progress, and not be taken so absolutely.

5. We have all worked hard to reach this point. Please have more faith in us that we will read on our own.

6. Please ask for feedback as to how YOU and the PROGRAM are treating US. We are an integral part of the program, and we all want to make the training as good as possible. If you show interest in what we think, then maybe it would make us feel that you actually care about working with us, not just to always to lead us. And if you ask, then do take our opinions seriously. Our suggestions are not personal. Do not be offended.

I would love to hear how other chiefs feel and what their expectations of their PGY-2s are. Also, I would love to hear what other program's expectations are in terms of OKAP performance and PGY-2 level of knowledge at this time.

Happy Labor Day.

Yep, early pgy2 year definitely sucks.

My main expectation of the PGY-2s is that they try and learn as much as possible, as quickly as possible. This is, like it or not, a necessity. The emphasis should be on learning to see things (in clinic & on call) and learning about what you're seeing (through lectures & individualized study).

In clinic, our PGY-2s are not expected to move much volume (~3-4 patients per half day). They work up patients from start to finish (upper levels have technician help). As they become more comfortable with the exam, their volume increases. It is expected that this will happen over the first few months. Of course, some come into residency with more practical experience than others, so there is some variability in progression as well as expectation in this regard.

On call, our PGY-2s are always encouraged to call backup whenever they are unsure about what they are seeing or how to manage it. We only provide ~3 weeks of shadow call, so it is not expected that they will be ready for anything that comes down the chute.

As Chief at my program, I am responsible for designing the syllablus and scheduling lectures, among other things (e.g., putting out fires!). We have no after hours or weekend lectures. We do have 5:30-6:30 journal clubs a couple times per month. Our main lecture block is Friday morning. Rather than creating a reading schedule, I have tried to assign readings from the BCSC that correlate with the weekly lectures. The goal is to cover the series over 12-18 months. That way, you are exposed to the entire BCSC at least twice during your residency. The residents seem to like this (or they are just kissing my butt!).

Residents are also encouraged to read up on patients they see in clinic, at least the more interesting ones. This is a great way to solidify a particular topic in your memory. It's always easier to recall a patient you've seen than one you've only read about.

One of the keys to PGY-2, and residency in general, is time management. Many of our residents, myself included, have families and the associated obligations. You have to learn quickly how to juggle the curricular and the extracurricular.

Don't be discouraged. Your upper levels often forget what it was like to be a newby, just as your attendings often forget what it was like to be a resident. Just do your best and hang in there! :thumbup:

Thanks, Visionary.

Your expectations sound fair and encouraging!

I especially like the way your lectures are structured (1/2 day away from clinic) and how the readings are related to the weekly lectures. The lack of after hour lectures and Journal Club meetings that are not too long -- wow.

I do want to learn ophthalmology as much as possible during my training (and beyond). I am just not sure these late lectures and artificial reading schedules can help me achieve that goal.

Thanks again for your post.

Here's my suggestion:

Stop whining and start working as hard as you can and don't worry about what people think. That's what I did and eventually people notice because the hard work pays off. I understand things are overwhelming up front, just realize you can't do it all at once so take it one step at a time. I have three PGY-2s and I notice the 2 who are working hard and not trying to cause problems. I also notice the one who's calling me at 3 AM to ask if he has to see an end-stage glaucoma pt in severe pain after a surgical procedure and suggesting to me it doesn't matter because the pt's already blind in that eye. Some people just don't seem to get it...

I think the chief of the program sets the tone for the educational environment. As chief of my program, I am trying to make it as laid back as possible. I never learned well with people breathing down my neck. I remember what is was like to be a 2nd year. It can be very depressing, but an ophthalmologist who came through our program and is now a "god" of ophthalmology (IMO) said that he felt that way too. So, I guess I say all of this to say, you'll get through it. Try to be patient with your chief, because you don't know how hard it is to be the point man/woman for every problem. Working hard with a smile on your face is the best way to impress your attendings and rise above the rest. Good luck.

On call, our PGY-2s are always encouraged to call backup whenever they are unsure about what they are seeing or how to manage it. We only provide ~3 weeks of shadow call, so it is not expected that they will be ready for anything that comes down the chute.

When I was chief (and still now) we had 2 weeks of shadow call, then 2 weeks when the 1st year has the pager, but the second year back-up is required to see the patients. Then, in August, the 1st years are required to discuss all of the patients with the second year back-up. This way there is no pressure put on the 1st years to avoid being that one resident who calls for everything. This came in because there had been a few PGY-2s before these rules who tried to bite off more than they could chew.

I was pretty laid back as the chief. I did ask for feedback regularly (much more than I actually got any). I don't believe that reading schedules are helpful; I encouraged them to read, told them how much to read to get through everything by OKAPs (15-20 pages/day), and hounded them to do it; but I left it to them to decide what to read.