Steep learning curve?

[golgi]

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Is it just me or does ophtho have the greatest learning curve of all the specialties? I am in an ophtho rotation and feel overwhelmed by all the knowledge and equipment. It seems that everyday I learn something that I have never even heard of before (weird anatomical terms) and I look like like a ***** when trying to figure out the different parts of the slit-lamp. Can someone please reassure me that this feeling is normal? I feel like I am learning a new language! I still think it's way cool but I am hoping someone will confirm that learning the basics is the hardest and that after that, it's not too bad.

Good luck to all in the match this year!

 

[Visionary]

Also keep in mind that ophtho is very different from most of what you generally do/learn in medical school. The exposure to ophtho is scant unless you seek it out. The farther you get from medicine, peds, general surgery, and OB/gyn (the foci of medical school training), the more foreign your residency will initially seem. However, it's amazing how quickly you pick things up once you are doing/seeing them day in and day out. You'll get it. 👍

 

[golgi]

Thanks to both of you guys for the encouragement!

 

[Pike]

Resurrecting this old post to ask a similar question as the OP - I have similar concerns but mostly in regards to technique. I "know" how to adjust the slit lamp, but I have a really hard time seeing anything in the retina when using the 90 lens with the slit lamp, or for that matter the 20 with the indirect too. I feel like I'm holding it up there just like the attending, but something is not happening for me. Granted I have little experience, but as far as good visualizations of the retina goes, I'm like 2 for 30. Is this part of the natural learning curve or should I just give up and go into....hmmm I don't know what else?

 

[sjkpark]

Resurrecting this old post to ask a similar question as the OP - I have similar concerns but mostly in regards to technique. I "know" how to adjust the slit lamp, but I have a really hard time seeing anything in the retina when using the 90 lens with the slit lamp, or for that matter the 20 with the indirect too. I feel like I'm holding it up there just like the attending, but something is not happening for me. Granted I have little experience, but as far as good visualizations of the retina goes, I'm like 2 for 30. Is this part of the natural learning curve or should I just give up and go into....hmmm I don't know what else?

I have very similar experience but fortunately I had a very patient medical retina specialist teaching me. I started with 90D at the beginning of the year and after 6-7 clinics (I go to clinic one morning/week then doing lab research) I could see with 66D. When I set myself goals for this year pretty much everybody said it would be difficult to learn to do Volk exam but I feel much more confident now. Only do retinal exams on well-dilated patient without much cataract, otherwise you might become very frustrated and lose your confidence. (At least for me) I always found that I have to take my time too. If the patient seems too prickly I don't even try.

I still fumble around with slit lamp, always have trouble adjusting beam width and length. I read slit-lamp primer but it's just not the same thing. Maybe next time I go I go in early and play around with the controls.

I never used indirect. Looking forward to using it.

 

[DOapplicant]

indirect is amazing. the retina doc i worked w/call directs 'toys'. you'll see so much better than you ever have.

it's very humbling to say the least as a med student in the optho clinic.

i'm now ms iv talking a year "off" to do research so please continue to post so i can live vicarioulsy through your clinical experiences. 🙂

have fun and best of luck in the now not so distant match process.

 

[rubensan]

practice, practice, practice. the more you do, the better you'll be! i saw the ora serrata for the first time today!

Resurrecting this old post to ask a similar question as the OP - I have similar concerns but mostly in regards to technique. I "know" how to adjust the slit lamp, but I have a really hard time seeing anything in the retina when using the 90 lens with the slit lamp, or for that matter the 20 with the indirect too. I feel like I'm holding it up there just like the attending, but something is not happening for me. Granted I have little experience, but as far as good visualizations of the retina goes, I'm like 2 for 30. Is this part of the natural learning curve or should I just give up and go into....hmmm I don't know what else?

 

[xaelia]

The direct is great for the amount of magnification you get, but it's so hard to keep a stable view. I've gotten good views with the 20D, and even been able to keep people going around the clock and getting views of all quadrants, and then sometimes I just see blurry distortion. Same with the 60D and 90D at the slit lamp...sometimes I'll get a nice view of the macula and the nerve, and other times I'll get nothing, and I really have no clue what I'm doing differently from one patient to the next.

Now I know why they only give our PGY-2s four patients a day in resident clinic!

 

[PBEA]

The direct is great for the amount of magnification you get, but it's so hard to keep a stable view. I've gotten good views with the 20D, and even been able to keep people going around the clock and getting views of all quadrants, and then sometimes I just see blurry distortion. Same with the 60D and 90D at the slit lamp...sometimes I'll get a nice view of the macula and the nerve, and other times I'll get nothing, and I really have no clue what I'm doing differently from one patient to the next.

Now I know why they only give our PGY-2s four patients a day in resident clinic!

I dont' want to come down too hard on you guys, but you only see 4 pts a day as a pgy2? Holy crap, your in the second year of an ophthalmology residency, and seeing 4 pts a day!!!! What does that leave like 1 or 2 years to learn and try and practice all the various ophthalmic surgeries that are available? I never want to hear anyone of you guys coming down on OD's regarding skill or experience. 4 pts a DAY!!! Unbelievable!

 

[xaelia]

I dont' want to come down too hard on you guys, but you only see 4 pts a day as a pgy2? Holy crap, your in the second year of an ophthalmology residency, and seeing 4 pts a day!!!! What does that leave like 1 or 2 years to learn and try and practice all the various ophthalmic surgeries that are available? I never want to hear anyone of you guys coming down on OD's regarding skill or experience. 4 pts a DAY!!! Unbelievable!

The PGY-2 ophthalmology residents have been in residency for 3 weeks now, following the completion of their general medicine internships.

"Interesting" response.

 

[PBEA]

The PGY-2 ophthalmology residents have been in residency for 3 weeks now, following the completion of their general medicine internships.

"Interesting" response.

Let's see if I get this straight. First year of ophthalmology residency (PGY1) is a general medicine internship? So PGY2 is really the first year of ophthalmology training? Then you have 1 or 2 years more of ophthalmology training, right? Wow, here I was thinking MD's receive more training then OD's in ophthalmic care, but this does not seem to be the case. I hope the legislature doesnt hear about this, they might pass a law RESTRICTING the care an MD can render to the eye. Perhaps this is a good thing, less unecessary surgeries being performed, would lead to less surgical complications.

 

[xaelia]

Let's see if I get this straight. First year of ophthalmology residency (PGY1) is a general medicine internship? So PGY2 is really the first year of ophthalmology training? Then you have 1 or 2 years more of ophthalmology training, right?

For more information on the curricular content and graduate medical education requirements of an Ophthalmology residency, please refer to:
http://www.acgme.org/acWebsite/downloads/RRC_progReq/240pr106.pdf

 

[PurpleMD]

Let's see if I get this straight. First year of ophthalmology residency (PGY1) is a general medicine internship? So PGY2 is really the first year of ophthalmology training? Then you have 1 or 2 years more of ophthalmology training, right? Wow, here I was thinking MD's receive more training then OD's in ophthalmic care, but this does not seem to be the case. I hope the legislature doesnt hear about this, they might pass a law RESTRICTING the care an MD can render to the eye. Perhaps this is a good thing, less unecessary surgeries being performed, would lead to less surgical complications.

Oh, here we go again, back to non-constructive criticism. I thought we were just leaving it in the "Optometry School Attracting the Elite" post, but I guess not.

 

[vanelo]

Let's see if I get this straight. First year of ophthalmology residency (PGY1) is a general medicine internship? So PGY2 is really the first year of ophthalmology training? Then you have 1 or 2 years more of ophthalmology training, right? Wow, here I was thinking MD's receive more training then OD's in ophthalmic care, but this does not seem to be the case. I hope the legislature doesnt hear about this, they might pass a law RESTRICTING the care an MD can render to the eye. Perhaps this is a good thing, less unecessary surgeries being performed, would lead to less surgical complications.

OMG !!!! What a crappy argument!!!

 

[Olddog1]

Let's see if I get this straight. First year of ophthalmology residency (PGY1) is a general medicine internship? So PGY2 is really the first year of ophthalmology training? Then you have 1 or 2 years more of ophthalmology training, right? Wow, here I was thinking MD's receive more training then OD's in ophthalmic care, but this does not seem to be the case. I hope the legislature doesnt hear about this, they might pass a law RESTRICTING the care an MD can render to the eye. Perhaps this is a good thing, less unecessary surgeries being performed, would lead to less surgical complications.

You can't blame the opthalmologist for being smart enough to absorb in 3 years what it takes you 4 (of course in those 3 years there is also learning how to operate, suprisingly more to that than a weekend course). Lets check back in with these new PGY2s in about 6 months, I'm pretty sure there skills and knowledge will have increase exponentially.

 

[Frumps]

Let's see if I get this straight. First year of ophthalmology residency (PGY1) is a general medicine internship? So PGY2 is really the first year of ophthalmology training? Then you have 1 or 2 years more of ophthalmology training, right? Wow, here I was thinking MD's receive more training then OD's in ophthalmic care, but this does not seem to be the case. I hope the legislature doesnt hear about this, they might pass a law RESTRICTING the care an MD can render to the eye. Perhaps this is a good thing, less unecessary surgeries being performed, would lead to less surgical complications.

Are you serious 😀 I was actually thinking about providing a lengthy explanation to why our 4 years of medical school + 4-6 years of residency is superior to your 4-5 of optometry school. Huh, I don't think it I'll take the time. Thanks for providing the MDs a laugh

 

[PBEA]

You can't blame the opthalmologist for being smart enough to absorb in 3 years what it takes you 4

Ha,Ha that's a good one

(of course in those 3 years there is also learning how to operate, suprisingly more to that than a weekend course).

Yeah, I'll agree. I know I could'nt operate my way out of a paper bag

Lets check back in with these new PGY2s in about 6 months, I'm pretty sure there skills and knowledge will have increase exponentially.

I hope so, for my own sake, I'll need CE someday and these stats are not encouraging.

 

[PBEA]

Oh, here we go again, back to non-constructive criticism. I thought we were just leaving it in the "Optometry School Attracting the Elite" post, but I guess not.

You are right, these comments are exactly the kind of rhetoric that piss me off. Dont you just love the title of that thread?

 

[PBEA]

Are you serious 😀 I was actually thinking about providing a lengthy explanation to why our 4 years of medical school + 4-6 years of residency is superior to your 4-5 of optometry school. Huh, I don't think it I'll take the time. Thanks for providing the MDs a laugh

Thanks, for not wasting time. I've heard it all before. We dumb, you smart ooh,ooh,aah,aah.

Just an honest question: The acgme link posted earlier stated that 36 months was the time required of an ophthalmology residency, where do you get 4-6 yrs? Unless you were including fellowship, but those are limited, so I don't think they really change the average time much.

 

[Olddog1]

Thanks, for not wasting time. I've heard it all before. We dumb, you smart ooh,ooh,aah,aah.

Just an honest question: The acgme link posted earlier stated that 36 months was the time required of an ophthalmology residency, where do you get 4-6 yrs? Unless you were including fellowship, but those are limited, so I don't think they really change the average time much.

Following medical School:
PGY (Post Graduate Year) 1 - Internship in peds, surgery, medicine or transitional
PGY 2, 3, 4 - Ophthalmology residency
Now you can sit for the national board exam
PGY 5-6 - 1 - 2 years of subspecialty fellowship if desired.
So at a minimum to be a practicing ophthalmologist you need 4 years of training after medical school.

 

[Mirror Form]

Thanks, for not wasting time. I've heard it all before. We dumb, you smart ooh,ooh,aah,aah.

Just an honest question: The acgme link posted earlier stated that 36 months was the time required of an ophthalmology residency, where do you get 4-6 yrs? Unless you were including fellowship, but those are limited, so I don't think they really change the average time much.

It should be 3 to 5 years after internship. It's 4-6 years after medical school. I've heard that approximately 50% of ophthalmologists do a fellowship.

 

[EYESURG]

Thanks, for not wasting time. I've heard it all before. We dumb, you smart ooh,ooh,aah,aah.

Just an honest question: The acgme link posted earlier stated that 36 months was the time required of an ophthalmology residency, where do you get 4-6 yrs? Unless you were including fellowship, but those are limited, so I don't think they really change the average time much.

Don't answer or reply to this idiot. Thank you all.

 

[futureOPTO]

Don't answer or reply to this idiot. Thank you all.

Sarcasm is one thing---but name calling is something else....You need to refrain from making comments like this on a professional site. PBEA was being berrated and frustrated by the fact that some of your cohorts fail to realize the high level of training OD's get. I will report you to the moderator for future posts of this derogatory nature.

 

[Pike]

Sarcasm is one thing---but name calling is something else....You need to refrain from making comments like this on a professional site. PBEA was being berrated and frustrated by the fact that some of your cohorts fail to realize the high level of training OD's get. I will report you to the moderator for future posts of this derogatory nature.

Hijacking a thread = unprofessional

I think some of us might have been frustrated by the fact that PBEA expressed astonishment (i.e. "holy crap!") after reaching the conclusion based on misunderstanding a post that ophthalmology training is seriously lacking...and this on a forum for ophthalmologists and those who want to be ophthalmologists.

 

[Eyesore]

I dont' want to come down too hard on you guys, but you only see 4 pts a day as a pgy2? Holy crap, your in the second year of an ophthalmology residency, and seeing 4 pts a day!!!! What does that leave like 1 or 2 years to learn and try and practice all the various ophthalmic surgeries that are available? I never want to hear anyone of you guys coming down on OD's regarding skill or experience. 4 pts a DAY!!! Unbelievable!

I don't want do get in a pissing contest here, but as someone who has completed residency training, I may be able to lend some perspective on this issue. During my 3 years of ophthalmology residency, I conservatively saw at least 12,000-14,000 patients in the clinic setting. This does not include surgical cases, on-call patients, and inpatient consults.

 

[UABopt]

I don't want do get in a pissing contest here, but as someone who has completed residency training, I may be able to lend some perspective on this issue. During my 3 years of ophthalmology residency, I conservatively saw at least 12,000-14,000 patients in the clinic setting. This does not include surgical cases, on-call patients, and inpatient consults.

It is truly unfortunate that this thread had to be hijacked by a colleague of mine. I find flame wars unproductive and uninteresting to follow. I enjoyed reading about how the OMD residents were struggling to learn the skills essential to eye care. Just as we all have struggled to learn precornial fundus lens, Gonio, slit lamp, BIO, retinoscopy etc etc etc… the list goes on and on, it is interesting to hear that opthalmologists struggle to gain compentency as well.

What I find most intriguing is that how we get to the final product is very different. In optometry school generally in addition to our full load of basic science classes the second year is also dedicated to learning these fundamental skills of eye care. We all practice on each other, over and over and over and over again. I went for almost 6mos being dilated nearly everyday, sometimes several times a day. Durring our second year we try to perfect these skills learning on each other rather than on patients. Each skill is tested several times in 15 or so practicals spread throughout the year. These practicals are set up in a “national board style”, meaning we get a list of procedures to perform during the practical and have a strict time limit for each skill, an attending optometrists watches us perform these skills and grades us on both our technique and our ability to orally describe our findings. As second years at UAB we also spend one morning a week in clinic and one morning a week in community vision service. At first our role is very limited and we act as just a tech, but little by little as we learn more skills we are allowed to do more and more. We spend the summer before our 3rd year studying for part one of boards (basic science and optics) and also seeing patients 3-4 full days a week in clinic doing full eye exams. While certainly far from perfect by this time we are able to perform an exam and come up with a diagnosis and plan. Of coarse there is always pathology and even normal anatomical variation that we are unfamiliar with, but that is what the attending is there for, to watch over your shoulder. So as you can see while we may not have seen 1000's of patients by the time we start our third year of optometry school, we certainly very well might have performed 1000 or so DFEs among other procedures.

So when an ophthalmologist trains he basically is learning all the skills for the very first time on a real live patient? I could see where this would be beneficial. Doing eye exams on classmates is a far cry from doing an exam on a real live patient. How well do the patients tolerate residents learning how to perform a procedure on them? I know we have several patients who get frustrated that they have to go through DFE and BIO exam 2 times once with the student and one time with the attending OD.

 

[xaelia]

I can't speak for resident clinics at other hospitals, but for the most part, the clientele of the clinic at my hospital is prisoner, indigent, and in-house patients requiring more than a bedside exam. We also have a VA hospital rotation. These patient groups aren't always thrilled to have several people looking in their eyes over the course of, sometimes, hours, but I imagine the price is right....

 

[PBEA]

Hijacking a thread = unprofessional

I think some of us might have been frustrated by the fact that PBEA expressed astonishment (i.e. "holy crap!") after reaching the conclusion based on misunderstanding a post that ophthalmology training is seriously lacking...and this on a forum for ophthalmologists and those who want to be ophthalmologists.

You're right, unprofessional, I am as capable of taking things out of context (like the newbies learning process ), as anyone else. However, sarcasm should be obvious when it occurs (although in its written form it can be easily confused). Hey you residents, I apologize for any slight you may have felt, dont' worry about "the steep learning curve", you'll get over it. But like I said before, dont' ever let me hear you come down on OD's regarding skill or experience.

 

[PurpleMD]

Hey you residents, I apologize for any slight you may have felt, dont' worry about "the steep learning curve", you'll get over it. But like I said before, dont' ever let me hear you come down on OD's regarding skill or experience.

Without the unnecessary threat, I am thinking you are trying to say that the OD's and OMD's both go through a lot in terms of training and that it is not a "walk in the park" in either profession to learn the necessary skills and knowledge needed. I believe a majority of us would agree.

 

[PBEA]

Without the unnecessary threat, I am thinking you are trying to say that the OD's and OMD's both go through a lot in terms of training and that it is not a "walk in the park" in either profession to learn the necessary skills and knowledge needed. I believe a majority of us would agree.

Your a good person purple, maybe even a good doctor, maybe I'll consider consulting your opinion on some of the dozen cases, requiring an ophthalmologist, that I've seen in the last week (depends on your focus, of course).

 

[rubensan]

So when an ophthalmologist trains he basically is learning all the skills for the very first time on a real live patient? I could see where this would be beneficial. Doing eye exams on classmates is a far cry from doing an exam on a real live patient. How well do the patients tolerate residents learning how to perform a procedure on them? I know we have several patients who get frustrated that they have to go through DFE and BIO exam 2 times once with the student and one time with the attending OD.

at usc, the first year ophthalmology residents spend the majority of the year in the county hospital clinic. these are patients with little or no financial resources who have waited 9 months to get their eyes examined. many have never been to an ophthalmologist before. by the time i see them, they are grateful just to be seen and are very tolerant of us looking again and again/ "wait was that 1+ or 2+ NSC? was that cup 0.8 or 0.9 let me look again...." they are patient as we bring in the senior resident to look, and then bring in the attending or fellow to look and then bring in other residents to look at "the interesting finding." sure, occasionally you get the county patient who thinks they are a VIP and wants to be seen by the attending and no one else, but they are few and far between. for the most part, my work is best of both worlds. i mean, i walk away at the end of (sometimes a very long) day feeling like i have provided a service that ordinarily would not have been provided and i am learning a ton.