Advice for current interviewers/applicants!

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I am currently a PGY-2 at a reasonably well-known program. I just thought I'd offer some unsolicited advice from the insider's perspective, and maybe garner some from the other lurking ophtho residents.

First, things you need to find out on your interview:

--One year of primary call or two? There is a big difference. Generally, programs with 4 or more residents/year will have 1 year, 3 or less will have 2. Call sucks.

--How busy is call? How many times/night are you called in on average? How is weekend call different from the weeknights? How much time do you spend fielding phone calls from attendings' patients? (At my program, it's a LOT!) Be sure to ask more than 1 resident so you get an honest answer.

--How are consults handled? Can you leave clinic to do them or do they have to wait until the end of the day? This policy can often make the difference between getting home at 5:30 vs. 8:30. How many consults do you get in the average day/week? (Consults, btw, eat up a LOT of time and are of very little educational value).

--Finally, look a resident in the eye and ask him/her "Are you happy here?" Ignore what they say with their mouth, and watch the expression on their face. This is worth a thousand words, and will be a reflection of how you will feel for the next 3 years.

Second, realize that ALL programs lie. All programs want to attract the best residents, so they will downplay their weaknesses and up-play their strengths. Even the most honest resident will have trouble telling applicants what their frustrations are about the program. Try to take everything they say with a grain of salt, and realize that they are doing this.

You should understand going in that ophtho at most places is not a cushy residency, especially at first. The lifestyle once you get out may be nice, but in residency there are a lot of late hours, night time calls from the ER, and you still have to work the next day, even if it's Monday and you have been up all weekend. I am going in tomorrow (Saturday) to see an unfinished consult, finish dictations from clinic, and read studies. And I am not the one on call.

It is also worth it, IMO, to call a resident from any program you are considering closely, and talk to them some more. They are more likely to be honest with you on the phone, since you are obviously interested and they are away from the "interview environment".

Hmmm....that's all I can drum up for now. Anyone else?
 
I think this is excellent advice. I would also add:

--how many hospitals do the residents cover? at my program, we just cover one. some programs cover 3-4. i like being central and not having to drive all over a big city like LA.
 
I would also watch out for programs that only do their operating at a VA. Sure, you may crank out some numbers, but there will be no variety. Plus, there is a paucity of female patients at VAs and women have eye diesease too 😉
 
1. i also think that this is another excellent point. one of the most frequently asked questions during interviews is "how many cataract surgeries do your residents do?" as an applicant, it is really impressive to hear "250." but also ask what that # means. are they all clear cornea phacos? granted this is what you will mostly be doing in the community, but i also believe it is important to know how do extracaps well. learning how to approach cataract surgery from many perspectives will only make you a better ophthalmic surgeon. also, ask how many surgeries other than cataract do the residents do. don't underestimate muscle, plastics and glaucoma surgery.

2. also, ask yourself what type of learner you are? do you learn best by doing independently? or do you want a program where you work one on one with attendings in their clinics all the time? the best programs will combine both or integrate independence gradually. either way, know what you are getting into and get a feel for the environment when you are interviewing. i'm at a program that combines both, but definitely throws you into clinic, consults and call from the first week and expects you to swim. i wanted this, but it is by no means ideal for everyone.
 
rubensan makes a very good point. Your first year out of residency your phaco skills will improve, but there are only so many cataracts to go around in geographically popular areas. I also do a lot of pterygia, probably more than 95% of ophthos out there about 2-3 a week. you should be able to convert to an extracap if the situation calls for it. Depending on where you are you may also do a lot of complex cataracts, I average 1.5 a week. It's ridiculous, i do about 4 mature or brunescent cataracts no red reflex a month, and occasionally a flomax floppy iris and dense post synnechiae with 2 mm pupil, about 1 pseudoexfoliation a month (often with compromised zonules). If you can't convert to extracap, guess what your phaco can't cut every cataract, especially the count fingers brunescent black cataracts. It probably happens only once every 6 months or so for me. Make sure you're comfortable doing all laser procedures. I have large asian population, and see at least one or two narrow angles a week.
 
This is an EXCELLENT summary TKD!!! I couldn't have said it better myself. I'll stick it for now.
 
I'll add a couple of points, since I've been through two rounds of being interviewee (residency and fellowship), and I'm going into my 4th round of being on the interviewer side. Some of these are common sense, some not as much:

If the program does dinner the night after or night before the interviews, don't get wasted. It's OK to have a glass of wine, and you don't want to be uptight, but it's not a good idea to have 5 or 6 glasses of wine. It should be common sense, but it's not.

Be courteous to the program coordinators and secretaries. They are usually not officially part of the committee, but if you're rude, you can be sure they'll give feedback to the people who are, and you would be amazed at how far this can knock you down a list. Again, should be common sense, but it's not.

Thank you letters. I sent them to everybody. From the other end, I realize that it doesn't make much difference unless you have new, crucial information you want the program to have before the final meeting. If you do, personalize them. Don't just send a generic "Thanks for interviewing me. Sincerely." It's a waste of paper and stamps. And if you do it, do it promptly. Most people who do it get them back within a few days, so it doesn't look as good if you send one 2 weeks later.

Telling a program you're going to rank them #1. Be VERY, VERY, VERY careful about this. I think it's a bad idea. While it may brush their ego a little bit, it usually won't make a difference where they rank you. If they want you, they'll rank you highly. If they don't want you, they won't. If you go through the match algorithm, you'll see that they don't have to change anything based on that knowledge.

If you do match end up matching there, it's fine. However, if they're planning on you matching there, and you end up somewhere else (ie, you ended up ranking somewhere else #1, whether you were lying or changed your mind), that can come back to bite you. Most people feel, well, if I match somewhere else, who cares what some other program director thinks of me. The fact is that you never know what will happen.
Here's one situation: You tell the program director that you will rank his program X first, but then you rank program Y first instead, and end up matching there. A year later, program director changes affiliations, and now works at program Y. Now you're working with a staff who feels they can't trust you, and it's a difficult working relationship. If you don't think this could happen, I know two instances where it has.
Another situation is that the program director stays at program X, but a few years later you find yourself wanting to do a fellowship there, and you might be a little blackballed.

I've talked to 4 different program directors about this issue (because I was curious), and they could all think of people who had done this to them (and knew the applicants by name). In one instance, a few years later that applicant was applying for a fellowship that was run by the program director he had lied to before (he was promptly rejected).

For the surgical numbers, I touched on this in another post. Make sure that when you get numbers, you're getting the class I numbers. You don't care how many class III cataracts someone has been involved in (wetting the cornea). Also try to find out what "class I" means at that particular institution. If you talk to 10 program directors, you'll get 11 different explanations, and it can make a significant difference in the numbers.

I completely agree with Rubesan about knowing what you want and what learning style will work best for you. This is a 4 year commitment, and you need to make the choice that is in your own best interest.

I also agree with TDK. You want to be somewhere you'll be happy. Residency is hard work, and there are times when you'll wonder why you went into medicine, but the overall balance should still be on the side of being happy.
After my interviews, I had sheets of information from each program; surgery, call, salary, books, benefits, equipment, everything. In the end, my final list came down to very subjective opinions. There were some places that, if you go by pure numbers, should have been higher on my list, but I just couldn't picture myself enjoying it there. Most of the people I've talked to went through a similar process.

I'm sure I'll come up with some more after I submit this.
Dave
 
Thank you for your contribution! Its always nice to have opinions of someone "on the other side"!
 
thank you for all the help! it really is appreciated. it's hard to know what to expect, what to ask, etc.
 
This may be a dumb question, but can someone explain what the difference between Class I, Class II, and Class III cataracts are?
 
kulkarka said:
This may be a dumb question, but can someone explain what the difference between Class I, Class II, and Class III cataracts are?
Click to expand...

Here's how I understand it:

Class 1 Procedures are those which the resident performs as the primary surgeon.

Class 3 Procedures are those which are done primarily by the attending surgeon but with the assistance of the resident. To me, this means prepping and draping the patient and squirting BSS on the cornea while you watch the attending phaco and place the IOL in the bag.
 
I thought of a couple of more gimmes:

Don't be late. It just looks bad. If you're in a new city, ask people at the hotel how long it will take to get to the hospital at the time you want to get there, then give yourself some extra time. I generally shot to get there about an hour early. Most of the time I was the first one there, and just brought something to read with me. Yeah, it can be a little annoying sitting there for a while with nothing to do, but it's much better than getting there 15 minutes into the program director telling everyone else about the program, and then having to ask questions about things that were already covered. If you are going to be late (accident on the freeway, or something like that), call and let them know. That simple courtesy will make up a lot of ground.

Make every possible effort not to leave the interview early to catch a flight. Ask the program coordinators ahead of time what time the interview day is expected to finish, and then arrange your flight schedule accordingly. It often comes across by the people interviewing you as a lack of serious interest in the program. It's not a make-or-break you thing, but it could be the deciding factor in a close call between you and another applicant. Sometimes it's impossible to avoid, since we don't have control over the flight schedules, and if you have to do it, tell the program ahead of time.

I mentioned above to be careful about telling a program you'll rank them first. Also be skeptical of any program telling you they're going to rank you first. While it wasn't for ophthalmology, there was one program that told 4 of my medschool classmates that they would be ranked 1st. In a large program, that can be done (since the top 5 spots in a 5 person program are all equivalent). The problem was that this program only had 3 spots. The one of those students who did want to go there, put it first, and ended up matching at one of his backup programs. The problem is that if you hear this, and you like a program, there's a tendency to sort of take it easy with the rest of the interviews (and even cancel some, if you're really sure). So take what you're told with a grain of salt.

Also, if you don't hear anything, don't despair. Many programs will ignore some of the rules about contacting applicants after the interviews, but many of them are by the book, so not hearing doesn't mean a lack of interest on their part.

Double, triple, quadruple, quintuple check your rank list and the program numbers. I have mild dyslexia, so I also had two other people check mine to be sure. Another classmate story. She knew where she wanted to go for peds, and ranked them first. She was rotating with them on match day, and the program director came and asked her why she didn't want to go there, because they thought she was happy there, they liked her, they ranked her first and she didn't match there. They went back and checked, and their program coordinator had transposed two of the numbers in her match ID#, so she went to her second choice program (no, there is nothing that can be done to repair this afterwards).
Now, obviously you don't have any control over what happens on the program's list, but you do have control over your own. You'd hate to miss out on your top choice because you typed 265378 instead of 263578 on your list.

Dave
 
rubensan said:
Here's how I understand it:

Class 1 Procedures are those which the resident performs as the primary surgeon.

Class 3 Procedures are those which are done primarily by the attending surgeon but with the assistance of the resident. To me, this means prepping and draping the patient and squirting BSS on the cornea while you watch the attending phaco and place the IOL in the bag.
Click to expand...

That's right. Class 2 was unsupervised procedures, but this has been removed from the ACGME for ophtho.

The problem with the class I and 3 system is in the grey areas. If you only squirt the cornea, it's easy: class 3. If you do the whole thing, it's easy: class 1. It's that grey part where you do some of the case, but the staff does some. Say you open, do the rhexis, remove the part of the nucleus, but the staff takes over and removes the rest (for whatever reason) and finishes the case. Is that a class 1 or a class 3? That's where things vary from program to program, and each program director has a different viewpoint on where the line should be drawn. That's why it's important as an interviewee not just to find how many class 1 procedures they do, but also what they consider class 1 at their given institution.

Dave
 
Oh, and one more thing: Be sure to ask about benefits, especially if you have a spouse/children who will depend on the health insurance you will provide. There are a *very* wide range of monthly premiums you will have to pay, from nothing all the way to 400+ per month! That takes a wicked bite out of your monthly paycheck when you have only one income. I did not ask enough and I should have paid more attention.

I also think it's worth it to look at whether a program has moonlighting, if that is important to you. It is nearly impossible to drum up your own moonlighting as an ophtho resident, so if the program has something, that is a plus.
 
what are good questions to ask the attendings? i think i feel comfortable asking residents about call, etc but i'm just not sure what are good prep questions to ask the attendings/PD, etc. Thank you!
 
this is probably a stupid question, but do program directors or other interviewers ask questions to see how much you know about ophthalmology? what i mean is do they start quizzing you during the interview to see how much you know?
i'm assuming other questions they'll ask is about your research or elective experience, why you chose ophthalmology, why you chose medicine.
 
I know this is unrelated, however, I'm new to this forum and wasn't sure how to post.. But, does anyone have any thoughts regarding the St. Vincent's program? Is it an interview worth canceling other interviews for?
 
Thanks for the excellent comments Dr. Crandall! Im new to the forum and going over old posts, which I initially thought would be non-productive, but is now a welcoming part of my day....
 
Correct me if I'm wrong, but the whole class 1,2 and 3 classification scheme has been eliminated. At least on the ACGME website when you log in procedures, you have two options only: Primary or secondary surgeon.

The definition of primary surgeon (at least per my PD) was if you did 50% or more of the critical components of the case, you could log it as a primary procedure.

This is not a perfect classification as there is a lot of gray area as to what you or the attending would define as "critical component" of the case and weather or not you did 50% of it.

Just wanted to clarify.
 
stillhere said:
this is probably a stupid question, but do program directors or other interviewers ask questions to see how much you know about ophthalmology? what i mean is do they start quizzing you during the interview to see how much you know?
i'm assuming other questions they'll ask is about your research or elective experience, why you chose ophthalmology, why you chose medicine.
Click to expand...

I was only asked an ophthalmology question once during my residency interviews. I was asked by an interviewer what the ocular manifestations of Steven Johnson's syndrome were.
 
MstaKing10 said:
Correct me if I'm wrong, but the whole class 1,2 and 3 classification scheme has been eliminated. At least on the ACGME website when you log in procedures, you have two options only: Primary or secondary surgeon.

The definition of primary surgeon (at least per my PD) was if you did 50% or more of the critical components of the case, you could log it as a primary procedure.

This is not a perfect classification as there is a lot of gray area as to what you or the attending would define as "critical component" of the case and weather or not you did 50% of it.

Just wanted to clarify.
Click to expand...

I agree, the lines can be blurred sometimes. If, like early on, I had to have myself saved during cataract surgery but then took back over, I call that primary. But if I get to throw a couple of sutures during a PK, that is an assist.

My big question has always been with retina surgery, seems traditionally residents don't do much if anything but I guess since I want to do retina mine have allowed me more to do. Still if during a macular hole\ERM I place ports and do the core vit, but then of course they do the rest, is that a primary PPV but not membrane peel??
 
MR1 said:
I agree, the lines can be blurred sometimes. If, like early on, I had to have myself saved during cataract surgery but then took back over, I call that primary. But if I get to throw a couple of sutures during a PK, that is an assist.

My big question has always been with retina surgery, seems traditionally residents don't do much if anything but I guess since I want to do retina mine have allowed me more to do. Still if during a macular hole\ERM I place ports and do the core vit, but then of course they do the rest, is that a primary PPV but not membrane peel??
Click to expand...

I would count that as primary PPV.

As far as cataracts go, I feel that I want to at least do the capsularrhexis, sculpt, crack, remove at least 2 fragments before I would consider counting it as primary.
 
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