How To Excel in your Ophthalmology Rotation: A Practical Guide
Updated 8/22/2022
It is such a privilege to rotate through ophthalmology. This is a practical guide for those interested in maximizing their learning experience. Although I am writing this with rotating students in mind, these tips are applicable to interns and early residents as well! On top of all of this, remember to be respectful to everyone, be on time, express your enthusiasm, and be yourself!
Before each day
Know what subspecialty you’re on and the attendings, fellows, and residents you’re working with
The Lens Pod (podcast) has great “big picture” episodes on each subspecialty rotation you may encounter (oculoplastics, retina, glaucoma, peds, etc.). These episodes cover the High Yield topics you should look up before you go. Listen to it on Apple Podcasts, Spotify, or wherever you find your podcasts.
Preview the schedule and read about the patients and conditions you’re seeing
Tim Root is the best starter resource for ophthalmology. Definitely check out:
Cartoon-style video lectures about the slit lamp exam, cranial nerve palsies, retinoscopy, tropias and phorias (very high yield for peds), etc. He also has very nice slit lamp videos from lids to retina, so you can get a sense of what you should be seeing through the slit lamp. All super high yield. If you like reading, he has his entire OphthoBook on his site for free!
Eye Basics 101 is a 2-part podcast series on the basic eye exam and eye anatomy. Find it where you get your podcasts. I actually have these 2 episodes downloaded on my phone because it’s such a nice high yield review.
Eyeguru is popular for their Anki decks, and I think they also have a great “Ophthalmology Essentials” page that covers common pathologies and imaging techniques in ophthalmology. Start learning how to interpret imaging! Eyeguru’s videos are nice too — very Boards and Beyond style.
Eye Fly MD is an educational site created by Dr. Matt Hirabayashi, who was a senior of mine in medical school. He was integral to my interest in ophthalmology, and he has compiled all of his daily teaching sessions on this website.
AAO’s OKAP Review Slides are intended for residents studying for their in-service exams, but I found them to be helpful when I was rotating as a medical student. Start with the New Ophthalmologist (NOOB) slides. All slides are available in PDF and PPT form. Find specific topics using the table of contents.
Neuro-ophthalmology with Dr. Andrew G. Lee is one of my favorite ophthalmology YouTube channels. I started watching his videos as a first-year medical student during my neurology block.
Preview the surgeries you will be observing and potentially helping on.
Know your anatomy!
EyeRounds Video Atlas - for all subspecialties
Cataract videos with Cataract Coach Dr. Uday Devgan
Dr. Devgan has an excellent video curriculum for young ophthalmologists in-training.
Cataract Surgery for Greenhorns by Dr. Thomas Oetting - pdf for reading
Glaucoma and Complex Anterior Segment videos by Dr. Ike Ahmed
Work out the logistics for the next day
When are you expected to show up?
Where exactly are you expected to be?
How long does it take to get there?
What are you supposed to wear?
Where do you get scrubs for the OR?
What to bring to clinic
White coat
Scrubs vs clinic clothes (depending on the attending and institution)
Notebook and writing tool
Ophthalmic lenses (my home institution allowed us to borrow 90 D and 20 D from the department)
Laptop
A thirst for learning
Useful ophthalmology apps for medical students
AAO Ophthalmic Education for quick access to EyeWiki and Will’s Eye Manual
OE Acronyms for a dictionary all the acronyms you may see within ophthalmic documentation
During the clinic day
Establish expectations with your attending right away.
What is your expected role in their clinic? Sometimes, it’s only shadowing, but don’t hesitate to ask to do more. Find ways to demonstrate your interest and love of self-directed learning. Some extra things you can ask to do include:
shadowing techs and learn how they room patient and perform exams
helping to room the next patient and offer to work up patients if comfortable
dilating patients
learning how to present patients in clinic
helping with patient turnover
offering to scribe for attending if there’s no scribe or tech helping in a room
maybe even writing notes if your attending is comfortable with it (I wrote a lot of neuro-ophthalmology notes when I rotated!)
Familiarize yourself with clinic flow and position yourself to facilitate flow.
Ophthalmology clinics are super busy (triple booking patients sometimes!). Do anything in your power to improve clinic flow and avoid hindering clinic.
Introduce yourself to everyone on the team. You are part of the team now, so try your best to remember everyone’s names and roles. Everyone likes to be called by their name. If you don’t understand what someone’s job is, then simply ask and you might get to shadow them briefly!
Observe how your attending likes things done. Do they give you space to look through the slit lamp after they look, or do they want you to evaluate the patient before they go in? Are they comfortable with you popping around to various patients and seeing them on your own accord, or do they want you to see patients with them?
Figure out where the high utility equipment, drops, or samples are located. If your attending often hands out particular samples (like artificial tears), you can stash some in your white coat and have them handy in the patient room. Here’s a nice eye drop color chart that might be helpful!
Write down your questions in a notebook to save for later. Avoid asking questions in patient rooms or asking too many questions between patients especially if it would slow down clinic flow — the best time to review questions is at the end of the clinic day when your attending will ask what questions you have. You can even send your attending an email after the day is over to summarize your thoughts and ask any additional questions.
Read about pertinent topics when you have free time between patients. You can review what you learned from your reading with your attending at the end of the clinic day and ask about their input. A great way to engage in an interesting conversation and help the knowledge stick!
Take every opportunity to practice your skills
Taking a pertinent ocular history
Physical exam skills (8 part Ophtho exam)
visual acuity
confrontation visual fields
extraocular movements and alignment
measuring pupils and looking for RAPD
checking IOP with tonopen
how to dilate the patient (and what drops to use)
Slit lamp skills, including how to use lenses (like 90D and gonioscopy), and applanation tonometry (if you’re brave!)
I like this article on 7 Key Skills to Learn on EyeGuru’s site
Check out this video series by Dr. Andre Ali-Ridha, MD FRCSC from McGill
Indirect ophthalmoscopy (video by Doctor Eyeball)
Retinoscopy on pediatric ophthalmology rotation (video by Dr. Tim Root)
Comprehensive Pediatric Eye Exam (video presentation by my colleague and good friend Dr. Christopher Le)
Optics and glasses prescriptions in ophthalmology - Ophthalmologist uses “plus” cylinder, while optometry usually uses “minus” cylinder (academic optometrists who work a lot of ophthalmology might use “plus” as well). Dr. Root explains in this lecture how to convert them.
Manifest refraction using the phoropter (video from Moran CORE) - unlikely you’ll have to do this as a medical student, but it’s good to know! You’ll need to do this as a resident. Lensometer is used to find the prescription of glasses that patients might bring into clinic
Lensometer (or lensmeter?) can be used to find the prescription of a pair of glasses a patient brings into clinic. The clinic I’ve been in had manual ones, so that's what I have linked here.
Dr. Richard Allen has a great YouTube playlist on accessory testing in ophthalmology, such as how to appropriately apply eye drops, stain with fluorescein, etc.
Evaluating eyelids and brows on oculoplastics, measuring MRDs, measuring level of exophthalmos with Hertel exophthalmometer
Offer soft skills and hone your chair side manner
Practice listening to and comforting patients.
Never make diagnosis or talk about the plan in front of a patient. Defer to your attending. Sometimes your attending may ask you to explain the pathophysiology of a disease process to the patient in the room, and this is a great opportunity to demonstrate patient-centered teaching and your communication skills!
Advocate for you patients
When you see patients on your own, get a sense of of their goals, needs, worries, and understanding. Synthesize what your plan would be and present your plan to your attending. More often than not, my attendings have either gone with my plan completely or implemented aspects of my plan into their plan.
Help the newer staff around you
Sometimes there are new staff members — like new scribes or techs — who might not be as familiar with ophthalmology. If appropriate, be willing to teach and explain ophthalmology topics or “translate” ophthalmology notes to them.
Ask for feedback early and often
Elicit feedback from your attendings, fellows, and residents outside of the formal evaluation. As much as working with different preceptors can feel like moving target, try your best to find the common themes in the feedback you receive and actually act on the feedback to improve your performance.
After the day
Read, watch, and find out more about the cases you saw today.
Practice suturing
Go to add-on cases or on-call cases that may occur later in the day
These are the unique experiences that I feel are life-altering — and they are often great experiences to talk about in interviews
Take call with the residents
A great time to bond with residents at the program and have the opportunity to practice your skills
Go to resident hangouts, wet labs, grand rounds, and other departmental events
A great way to meet new people and see whether your personality meshes with the residents at your program
Let me know if you have any feedback on this post, and please send me any additional questions you may have. My contact information is located on the page header.
Do your best and take care of yourself,
emxu
