Need advice : quit ophtho residency

[hieyedoc]

Hello.

I'm a first year resident in ophtho. Not in the US though. I know all the first year is hard and stuff, but I do have a thought to quit ophtho. The reason is that I don't like and I'm not good doing the microsurgery. I have difficulties seeing with my binocular vision under the microscope as well. And I know that there are some sub-specialties that doesn't require any microsurgery, but here in my country,most cases (and cash) that a general ophthalmologist dealing with is cataract. I don't think I want to do the rest of my career doing something that I'm not quite enjoy. It turns out that I have a feel for Internal Medicine and Cardiology right now. Is it too early to quit for me? Do you have any thought?

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[NN22]

That's a difficult question, but an important one to answer for you. My gut sense is that it is probably too early to make that determination and quit, but only you can decide that.

It is very common for microsurgery and cataract surgery, in particular, to be very stressful and overwhelming at first, especially for certain personality types. Rest assured you are not alone in that situation. There is a steep learning curve, and it is never really enjoyable when you are not very good at something and stressed about harming someone on top of it. I would say that, on average, as you gain more experience, comfort, and confidence, your feelings towards doing these surgeries will change.

That being said, you do have to make the determination if you want to spend your life doing surgeries that can result complications within a split second and depend on maintaining the integrity of tissue that is only a few microns thick. I'd say most people eventually calm their anxiety about it or at least manage it well enough, especially as their proficiency increases and expectations of complications decrease.

In the meantime, I would focus on ways to improve. Talking to teachers and mentors about the specific difficulties your having intraoperatively is always helpful. Experiences in the wet lab or even visualization of the steps prior to surgery can be helpful. Make sure you take to time to focus and position the microscope and patient adequately, both at the beginning of the surgery and throughout. This is crucial and often is overlooked by early surgeons because there is so much to worry about when learning to operate. Readjusting the focus throughout the case to make sure everything is in clear view is very important. Making sure you PD is set correctly is crucial for stereopsis. These are all small adjustments that can make a major difference. If your nerves are giving you a tremor, you could consider a low dose beta blocker; I had a senior resident that even took a drop of timolol in each eye prior to his OR today early on in training.

I would say keep at it. I would not be surprised if your feelings change significantly within the next year or two.

 

[Slide]

No one is a born microsurgeon. Everyone has the same fears and doubts going through. The above post said everything well of how to get adjusted to it. It is a steep learning curve, but most ophthalmology residents are trainable - though some may need more time than others. The big thing is to find a good mentor who is willing to help out.

If for some reason surgery is not in the picture, you can still maintain a medical practice. You can do general ophthalmology without surgery, uveitis, neuro-ophthalmology, or medical retina. In fact, I would suspect any place in the world will always need another neuro-ophthalmologist because they are in short supply.

 

[pianist]

Surgery doesn’t come overnight, or even in residency, or even in fellowship. It still takes time after training.

Unless there is some kind of organic tremor or stereopsis problem, I think just about any resident can learn if they have good teachers.

As above posters said, get comfortable at the scope before you do anything else. It seems obvious but if you can’t see, you can’t operate. Foot control of the scope has to become 2nd nature, know exactly what is zoom in/out, focus in/out. Be conscious of where you are focusing on; cornea, conj., iris plane, rhexis, etc. keep everything centered in view.

They can be painful to watch, but record videos of youself so you can review.

Don’t get discouraged. There are very few natural surgeons, the same way there are few complete klutzes who are untrainable. Everyone else (95%++) falls in the middle and just has to put in the work and get good teaching.

 

[hieyedoc]

That's a difficult question, but an important one to answer for you. My gut sense is that it is probably too early to make that determination and quit, but only you can decide that.

It is very common for microsurgery and cataract surgery, in particular, to be very stressful and overwhelming at first, especially for certain personality types. Rest assured you are not alone in that situation. There is a steep learning curve, and it is never really enjoyable when you are not very good at something and stressed about harming someone on top of it. I would say that, on average, as you gain more experience, comfort, and confidence, your feelings towards doing these surgeries will change.

That being said, you do have to make the determination if you want to spend your life doing surgeries that can result complications within a split second and depend on maintaining the integrity of tissue that is only a few microns thick. I'd say most people eventually calm their anxiety about it or at least manage it well enough, especially as their proficiency increases and expectations of complications decrease.

In the meantime, I would focus on ways to improve. Talking to teachers and mentors about the specific difficulties your having intraoperatively is always helpful. Experiences in the wet lab or even visualization of the steps prior to surgery can be helpful. Make sure you take to time to focus and position the microscope and patient adequately, both at the beginning of the surgery and throughout. This is crucial and often is overlooked by early surgeons because there is so much to worry about when learning to operate. Readjusting the focus throughout the case to make sure everything is in clear view is very important. Making sure you PD is set correctly is crucial for stereopsis. These are all small adjustments that can make a major difference. If your nerves are giving you a tremor, you could consider a low dose beta blocker; I had a senior resident that even took a drop of timolol in each eye prior to his OR today early on in training.

I would say keep at it. I would not be surprised if your feelings change significantly within the next year or two.

Thank you for your reply. I understand that I could increase my confidence by keep practicing and searching a good mentor. Microsurgery is hard and challenging. But what if this is not the challenge I want to conquer? i've been thinking the last few weeks, I felt that what I am truly missing during my residency in ophthalmology was the comprehensive diagnostic and intensive care of patient, the stokes to help patient in life/death scenario. I really miss all that!
It is wonderful to have a long career helping sight for people, but what if my heart aches for the drama and the challenge of treating a general patient with complicated disease? Do you ever feel that during your residency?

 

[LightBox]

Sounds like a career change is justified. Go for it.

 

[Shambere]

Thank you for your reply. I understand that I could increase my confidence by keep practicing and searching a good mentor. Microsurgery is hard and challenging. But what if this is not the challenge I want to conquer? i've been thinking the last few weeks, I felt that what I am truly missing during my residency in ophthalmology was the comprehensive diagnostic and intensive care of patient, the stokes to help patient in life/death scenario. I really miss all that!
It is wonderful to have a long career helping sight for people, but what if my heart aches for the drama and the challenge of treating a general patient with complicated disease? Do you ever feel that during your residency?

you dont want to trade optho cases for the emergency room drama, in my opinion.
Give it some time, are you being overworked, if you arent, definitely give it some time.

 

[increscence]

It is wonderful to have a long career helping sight for people, but what if my heart aches for the drama and the challenge of treating a general patient with complicated disease? Do you ever feel that during your residency?

I did feel that many times during residency. We had a lot of complex cases that required coordination among multiple ophthalmology subspecialties, as well as specialists from other departments (rheumatology, infectious disease, ENT, etc). Sometimes it was life-or-death, sometimes it wasn't, but it was always exciting and thought-provoking.

I know that the first year is a struggle. You're expected to be independent, but you don't feel like you're good enough. You second-guess yourself a LOT. I would suggest that you stick with it until the middle of your second year to see if these are just 1st year blues, or if they're something bigger.

The reason I say that is this: people don't just choose ophthalmology because they don't know what else to do. They choose it because there's something very specific about it that's unique to ophtho; it doesn't exist elsewhere. I've met a few people who failed to match into ophtho, or were ophthalmologists abroad and couldn't get into an ophtho residency when they moved to the US, and their hearts were broken forever. I mean years down the line, even after giving up and completing another residency.

I just don't want you to make a mistake you might regret forever. I don't want you to let momentary insecurities about residency cloud your judgement. I was there just a few short years ago. I almost quit residency in my first year, I was so unhappy. But I stuck it out, and I am SO happy I didn't quit back then.

No matter what path you choose, I hope you find happiness in your career.