Do I suck?

[iDoc12345]

Hey everyone,

I'm kinda having a nervous moment. I'm a PGY2 resident (first year ophtho). When I started ophtho residency on July 1, I obviously didn't know too much about clinical ophtho. But now it's Sept 1, and I still feel like I keep making mistakes in clinic, missing things on exam, or misdiagnosing things on calls.

I'm reading the BCSC series but don't feel like that's super helpful at being good in clinic. Any advice you guys have? Is this normal for other PGY2s out there or am I just awful?

Thank you

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[OphthoApp]

Not at all. The key is to know your limitations and be careful. The most dangerous residents I have seen are over confident and don't understand there is a ton they do not know. If you are always suspicious you might miss something then you will look harder, research more, and be more careful.

 

[airplanes]

Keep your head up. You're doing fine.

Ophthalmology has a very steep learning curve, and at programs where the approach favors a more "thrown into the fire" it can be a rough adjustment early on. You should probably not feel comfortable on call until you're at least 6 months in. It's amazing how many nuances there are to an eye exam. At this point, you should just focus on being thorough. Frankly, you should be missing things right now, that's why residency is three years. You will be okay.

 

[DrZeke]

6 month mark was like a miracle. You're doing better than you think. Keep on trucking. Read in wills or kanski for clinic if there's something you wanna know how to treat. Your upper levels should be teaching you how to think on call... If they aren't then that's unfortunate. But you can still learn. Try to have differentials for the symptoms and findings on exams. Always rule out anything that could kill the patient or be immediately vision threatening. Once that's out of the way you usually can't mess anything up too bad

 

[OPPforlife]

You are totally fine at this point for missing stuff. Just a tip for when you are on call
Ask yourself what is causing the patient's symptoms of signs. Start broad I.e anterior seg vs posterior seg. Is it the cornea? The lens? The retina? The nerve? Believe me when you start thinking systematically it becomes easier and fun


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[iDoc12345]

Thanks for the words of encouragement guys, definitely needed that

I keep telling myself to be patient; it'll all come together soon enough.

 

[The Doctor]

Your thoughts sound similar to what my co-residents and I felt when we were first year residents in ophtho. I am hearing the same things echoed now by our first year residents. In the first several months, the learning curve is so high that you cannot possibly be an expert at everything, know all diagnoses, or even be able to complete higher level examinations such as scleral depression or gonioscopy.

My best advice, to echo an earlier poster, is to complete a systematic and thorough subjective and physical exam. If the patient can't read 20/20, then use the pinhole or a +2.00 lens if appropriate. Check color. Check confrontational visual fields very carefully. Examination each part of the eye, one after the other. Start with the lids and external structures, move to the conjunctiva, each layer of the cornea, check purposefully each time for cell and flare, check the iris, look at all layers of the lens, look at the anterior vitreous, and do the same with the fundus. Look at the nerve, it's shape and color, CDR, the features of the vessels. In ophthalmology, the examination is key and will help to lead you to your diagnosis based on what you see or do not see.

I'm in my last year now, and I am still improving at the little things such as looking at the layers of the cornea. You will get better over time. In the the mean time, I would focus on reading and being a good resident in other ways, such as being prepared for cases, careful with handovers, and helpful in moving the clinic along. I think the fact that you are concerned about your performance is evidence that you will do fine.