Bored with ophthalmology as medical student

[OphthoDoc]

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3rd year med student here. I am 2 weeks into my rotation and so far I'm not head over heels for ophthalmology.

I though i would be because I really like the eye and enjoyed learning about it during my second yr but on the rotation I'm bored esp cuz I can't do anything. I was really excited during gen surgery cuz I got to scrub in and participate in procedures but I don't do anything for ophtho surgeries for obvious reasons.

So just wondering if this is normal for med students? I like using the slit lamp and looking for pathology. Or is this a sign to start considering other specialties?

 

[fourchambered]

If you find yourself shadowing more than you'd like, I'd get more aggressive and start examining patients on your own and trying to figure out what is going on before anyone else does. That's the best way to stay engaged and figure out if you like it as a profession. Plus it will make you look good. Don't be a pylon.

 

[johnbl]

not uncommon..i worked as a medical student at the NAtional Eye Institute even before my rotations yet really didnt understand what was going on with examining the eye and in surgery. I had similiar doubts. If you have an interest, perhaps you could tag along with an ophthalmologist in the office and in surgery. I realize you wont understand how to use this or that or the surgery..but does the type of work flow and patients and surgery look like something that you would enjoy??

 

[johnbl]

if you can use the slit lamp..be aggressive and look for and ask about the pathology..agree with the above post..you will look good and be more engaged

 

[johnbl]

optho doc..tell me more about your rotation..what are you doing exactly during the day. my 2 wk med school rotation at Vanderbilt was really bad..we werent allowed to try to exam pts, little OR observation, the residents and attendings didnt want to really teach because the rotation was short.. did you like the outpt nature of the discipline?? not really hospital based..(seeing pts in the hospital)..in other words,, ophthalmologists work for the most part in non-hospital settings.. when we operate it is in a physician and/or corporate owned ASC, sometimes hospital outpt asc. We really arent "plugged" into the hospital matrix. is this good or bad in your mind?? these are important observations to glean from your experience.

 

[OphthoDoc]

If you find yourself shadowing more than you'd like, I'd get more aggressive and start examining patients on your own and trying to figure out what is going on before anyone else does. That's the best way to stay engaged and figure out if you like it as a profession. Plus it will make you look good. Don't be a pylon.

I started doing this, but the thing is the doctor I'm with is not a comprehensive ophthalmologist. he is a fellowship trained specialist and that's all he sees. so for me, it's boring because i'd like to see a broad spectrum of pathology.

my complaints are more in regards to the OR. i really like being in the OR and i'm bored out of my mind because i can't do anything or assist in the OR, but it's understandable. i'm just wondering if it's normal for students to feel this way. i'm sure if i could have an opportunity to participate in procedures or even do them myself, it'd be better.

 

[OphthoDoc]

not uncommon..i worked as a medical student at the NAtional Eye Institute even before my rotations yet really didnt understand what was going on with examining the eye and in surgery. I had similiar doubts. If you have an interest, perhaps you could tag along with an ophthalmologist in the office and in surgery. I realize you wont understand how to use this or that or the surgery..but does the type of work flow and patients and surgery look like something that you would enjoy??

i wish i could see more procedures, but the only procedures i see are cataracts.

 

[fourchambered]

I started doing this, but the thing is the doctor I'm with is not a comprehensive ophthalmologist. he is a fellowship trained specialist and that's all he sees. so for me, it's boring because i'd like to see a broad spectrum of pathology.

my complaints are more in regards to the OR. i really like being in the OR and i'm bored out of my mind because i can't do anything or assist in the OR, but it's understandable. i'm just wondering if it's normal for students to feel this way. i'm sure if i could have an opportunity to participate in procedures or even do them myself, it'd be better.

Sure, it's normal to feel bored if you are watching the same procedure over and over. I think that's true for anything. I mean, you've got to understand that these are people's eyes and vision on the line. You wouldn't trust a medical student to participate in the case if it were your grandmother. I think your time would be better spent outside of the OR. Perhaps ask respectfully to spend a day or two in a comprehensive ophthalmology clinic instead of the OR. There are plenty of medical student-friendly activities there. Hang out with the techs and learn how to refract. You can double check what you get with the tech's refraction while the patients are waiting. Borrow a lens and learn how to use the indirect, especially if the patient has a documented retinal pathology. Figure out how to read pachymetry. Don't be shy in communicating the type of experience you want from your rotation and go for it. They'll respect you more for it in the end.

 

[OphthoDoc]

optho doc..tell me more about your rotation..what are you doing exactly during the day.

basically, i talk to the patient and look at their eyes using a slit lamp before the preceptor comes and looks at it himself. i never get to present because he's so busy running his practice. instead, i just remember what i found and compare it to what he writes in his chart.

for the 1 day of the week that he does surgery, i just watch. no participation, but understandable. nevertheless, surgery days are very boring for me. it was exciting the first day, but i think i can pretty do do a cataract surgery on my own now 😀 (not really, but i do know all the steps now).

did you like the outpt nature of the discipline??

i like clinic better than the hospital. i hate rounding and so, i prefer clinic over the ward.

not really hospital based..(seeing pts in the hospital)..in other words,, ophthalmologists work for the most part in non-hospital settings.. when we operate it is in a physician and/or corporate owned ASC, sometimes hospital outpt asc. We really arent "plugged" into the hospital matrix. is this good or bad in your mind?? these are important observations to glean from your experience.

sometimes i miss the hospital setting because i was busy and felt like i was useful, but i know in the long run, i won't be happy. in the long run, i'd be happier in clinic.

your point about not being "plugged" into the hospital matrix... actually that does bother me a little. like i said before, i enjoyed being in the hospital because i felt useful, but i dunno if i'll feel that way in the long run. when i'm there, i start to hate being there, but when i'm away, i start to miss it. it's kinda weird...

i enjoy looking at patient eyes thru a slit lamp now that i'm more comfortable and know what to look for. i think i'd enjoy this month more if i could do surgeries or at least assist, but it's such a small organ and doesn't really require another pair of hands.

i also enjoyed long procedures when i was doing gen surg. i felt "macho" for the lack of better words. cataract surg are very quick and clean. although i prob woudn't mind doing those all day when i'm older, right now because i'm young and eager, i crave those heavy procedures. from what i hear, vitreo-retinal or occuloplastic ophthalmology might satisfy the inner surgeon. what do you think? do i sound naive?

anyway, thanks for your responses. i really appreciate it.

 

[MstaKing10]

I think your concerns are very common. Ophthalmology as a medical student is pretty tough to get excited about done the wrong way. Time in the OR is important but honestly even as residents you don't get to participate in certain procedures. You really don't learn to appreciate how difficult some of the procedures are until you do them yourself, which of course you will not get to do as a medical student. If you are shadowing and not doing anything, the rotation can be very boring. Especially since many things are over your head since you really didn't learn them in medical school.

I enjoyed my rotations for a few reasons:
- Tried to work in a resident run clinics (almost no attendings), so I was really helpful to them taking histories, doing exams, refractions and assisting with minor procedures (ie. pterygium or removing sutures). If you are in a private practice setting following attending only you will not get this experience.
- Got a set of loaner lenses and really learned to do a good indirect and slit lamp based dilated fundus exam
- Would go to surgery once a week just to get a feel for things. Scrubbed in a few times to squirt the cornea, think I cut a stitch once.
- Did as much reading as possible and got a project published in AJO which of course the attendings and residents loved.

Do your best to get involved as much as possible, be proactive and imagine yourself in the shoes of your attending or resident and figure out if that is something you would enjoy.

 

[tm12]

I started doing this, but the thing is the doctor I'm with is not a comprehensive ophthalmologist. he is a fellowship trained specialist and that's all he sees. so for me, it's boring because i'd like to see a broad spectrum of pathology.

my complaints are more in regards to the OR. i really like being in the OR and i'm bored out of my mind because i can't do anything or assist in the OR, but it's understandable. i'm just wondering if it's normal for students to feel this way. i'm sure if i could have an opportunity to participate in procedures or even do them myself, it'd be better.

It's very likely your ophthalmology department has an underutilized wet lab where residents practice cataract surgery. It may be worth your time to ask about it and check it out.

A bit premature to call yourself ophthodoc? 😛

 

[OphthoDoc]

Sure, it's normal to feel bored if you are watching the same procedure over and over. I think that's true for anything. I mean, you've got to understand that these are people's eyes and vision on the line. You wouldn't trust a medical student to participate in the case if it were your grandmother. I think your time would be better spent outside of the OR. Perhaps ask respectfully to spend a day or two in a comprehensive ophthalmology clinic instead of the OR. There are plenty of medical student-friendly activities there. Hang out with the techs and learn how to refract. You can double check what you get with the tech's refraction while the patients are waiting. Borrow a lens and learn how to use the indirect, especially if the patient has a documented retinal pathology. Figure out how to read pachymetry. Don't be shy in communicating the type of experience you want from your rotation and go for it. They'll respect you more for it in the end.

this sounds solid. thanks

 

[OphthoDoc]

I think your concerns are very common. Ophthalmology as a medical student is pretty tough to get excited about done the wrong way. Time in the OR is important but honestly even as residents you don't get to participate in certain procedures. You really don't learn to appreciate how difficult some of the procedures are until you do them yourself, which of course you will not get to do as a medical student. If you are shadowing and not doing anything, the rotation can be very boring. Especially since many things are over your head since you really didn't learn them in medical school.

I enjoyed my rotations for a few reasons:
- Tried to work in a resident run clinics (almost no attendings), so I was really helpful to them taking histories, doing exams, refractions and assisting with minor procedures (ie. pterygium or removing sutures). If you are in a private practice setting following attending only you will not get this experience.
- Got a set of loaner lenses and really learned to do a good indirect and slit lamp based dilated fundus exam
- Would go to surgery once a week just to get a feel for things. Scrubbed in a few times to squirt the cornea, think I cut a stitch once.
- Did as much reading as possible and got a project published in AJO which of course the attendings and residents loved.

Do your best to get involved as much as possible, be proactive and imagine yourself in the shoes of your attending or resident and figure out if that is something you would enjoy.

i'm trying to learn how to do an indirect exam. that's one thing i want to be good at by the end of this rotation.

 

[OphthoDoc]

It's very likely your ophthalmology department has an underutilized wet lab where residents practice cataract surgery. It may be worth your time to ask about it and check it out.

dang! my school doesn't have an ophtho dept. o well

 

[johnbl]

you sure they dont have ophthalmology dept?? they would need to have an ophthal dept to have a level 1 trauma center .. as far as surgery...ophthals do fewer procedures than most surgeons..mainly cataract, LASIK/PRK, glaucoma, pterygium, some lid work. If retina trained..mainly pars plana vitrectomies, scleral buckles.. I know a general surgeon or orthopod may do alot more different procedures..I did 15 phaco cataract procedures today..i am a bit add so the 9 minute procedures are great for me.. My ortho colleagues at the ASC i work are pretty specialized so the hand guys work on hands and some guys concentrate on knees and shoulders..all depends on what you like..