struggling with clinical ophthalmology

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Ophtho222

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Hi all,

I was hoping someone could offer me some advice. I am starting my second year of ophthalmology residency this upcoming July and I still feel like I am confused and struggling with diagnosis and management of cases in clinic. My program strongly emphasizes the BCSC series so I've read the books multiple times but it doesn't seem to be translating into clinical knowledge.
For instance, the BCSC glaucoma book may give a list of risk factors for POAG but doesn't go into sufficient depth regarding day to day clinical management (i.e. determining a target IOP, glaucoma progression, visual field severity criteria or myopic discs vs GON), or for example in retina, when should I try avastin over steroids or focal laser for DME or CRVO/BRVO related macular edema? I know I need to start reading other sources, but I'm not sure where to start. Ideally, I would like a source geared toward a resident/general ophthalmologist that focuses on the day to day practical management of various bread and butter topics. Does anyone have any suggestions?

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You're right, BCSC does not always provide the most practical info. Your attendings and fellows are usually very good resources for this kind of stuff.
 
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Hi all,

I was hoping someone could offer me some advice. I am starting my second year of ophthalmology residency this upcoming July and I still feel like I am confused and struggling with diagnosis and management of cases in clinic. My program strongly emphasizes the BCSC series so I've read the books multiple times but it doesn't seem to be translating into clinical knowledge.
For instance, the BCSC glaucoma book may give a list of risk factors for POAG but doesn't go into sufficient depth regarding day to day clinical management (i.e. determining a target IOP, glaucoma progression, visual field severity criteria or myopic discs vs GON), or for example in retina, when should I try avastin over steroids or focal laser for DME or CRVO/BRVO related macular edema? I know I need to start reading other sources, but I'm not sure where to start. Ideally, I would like a source geared toward a resident/general ophthalmologist that focuses on the day to day practical management of various bread and butter topics. Does anyone have any suggestions?

I think you've figured it out. Reading for okaps is very different than reading for clinic. Currently I'm reading up on dry eye. My primary source is kanski and AAO website. My thoughts are that Your ability to know practice patterns that are nationally accepted this early is mostly program dependent. If you're in a program where some attendings do whatever they want or they don't teach you it's hard to learn. I find when I'm with attendings that are willing to teach, I ask questions. I say "will you go over this with me" and obviously I try not to be clueless about any single topic. Sometimes I'll try and have a specific question. It stimulates my learning and sounds better than "I'm clueless, please help me" :). I bet you know more than you think...

The other thing is remember you are in a residency and you're not supposed to have mastered everything by 2nd year. You have two more years to get management down and recognize patterns. I do think in most programs there is a lot of need to be self motivated and read on your own. It's a reality for many of us, so don't worry too much.
 
Thanks for all your suggestions. Unfortunately, I'm part of a program that uses the line "we don't spoon feed residents" as an excuse not to teach us. I will read the diabetes book. If anyone knows of any other good resources, please let me know
 
Thanks for all your suggestions. Unfortunately, I'm part of a program that uses the line "we don't spoon feed residents" as an excuse not to teach us. I will read the diabetes book. If anyone knows of any other good resources, please let me know

Kanski and the AAO website are huge. They have preferred practice patterns on AAO website. Can't really go wrong with that if your faculty wanna come down on you.
 
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Thanks for all your suggestions. Unfortunately, I'm part of a program that uses the line "we don't spoon feed residents" as an excuse not to teach us. I will read the diabetes book. If anyone knows of any other good resources, please let me know

Honestly a lot of common issues are managed very differently by different ophthalmologists. I rotate through more than 1 department, and more than once I've tried to manage a patient by how 1 attending does it only to be told "that is garbage" by another at a different hospital.

If you have any questions you should post the clinical scenario and we could all discuss it! I think it would be interesting to see differing perspectives from differences in training that people get across the country.
 
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