Introduction: Ophthalmology Residency Application
Ophthalmology is a great field! Here are some good reasons:
- A comprehensive ophthalmic exam allows you to diagnose 80-90% of your patients- it is objective and scientific in many ways.
- Direct visualization of the pathologic process- it is amazing that ophthalmologists can see arterial venous crossing changes from hypertension and saccular dilatation of blood vessel wall of an aneurysm.
- Many systemic diseases have ophthalmic manifestation and it is clinical challenging and satisfying to assist other physicians with the diagnosis and treatment of difficult cases.
- Ophthalmic micro-surgery is challenging but at the same time enjoyable and very satisfying. It amazes me that we can manipulate the delicate ocular tissue and operate in such a small space- the intraocular content is only 5cc! Successful surgeries can restore lost vision and make a tremendous impact in a patient's quality of life.
Choosing a residency is a difficult process. Most believe certain personality types fit with certain specialties in medicine. A common generalization is that if you like to
think and enjoy spending time with patients, you should go into internal medicine. On the other hand, if you don't like to think or talk as much but enjoy working with your hands and getting
things done, you should go into a surgery. These generalizations may have a certain degree of validity, but it is really up to you to decide what specialty is the right fit for you after you
have had first hand experiences on your clinical rotations. How much you enjoyed a specific rotation- including the science and practice of that specialty, the patient population, and how well
you get along with the residents and attendings- are all good indicators of how much you may enjoy that specialty as a career.
Ophthalmology has both clinical and surgical components and may give you the best of both worlds. There are multiple subspecialties within ophthalmology and the practice of each subspecialty can differ significantly from each other. Neuro-ophthalmology, for example, mirrors medicine in that a thorough history is important and an initial consultation may take an hour to perform. Comprehensive ophthalmology, on the other hand, may involve less history taking and more time spent on examination for glasses and detecting diseases such as cataract, glaucoma, and macular degeneration.
In order to enjoy and succeed in ophthalmology, you need the following two characteristics:
- Objectivity- as stated above, 80-90% of ophthalmic diagnosis come your office exam (pattern recognition). You need to be able to look at a cornea and diagnose fungal infection or examine a retina and detect macular edema from diabetes. A good comparison would be radiology- you need to be able to look at films and objectively make your diagnosis. Although there are ancillary tests, we still largely rely on our examination skills to direct us. It is quite different from other specialties where you usually rely on ancillary tests (blood work) to guide your diagnosis and treatment.
- Initiative- learning ophthalmology is a very difficult process initially. Often times, I see medical students who are interested in ophthalmology not taking the initiative to examine the patients. Instead, they confine themselves to shadowing residents and attendings. These people will not do well in ophthalmology. Ophthalmic examination and surgery are difficult to teach. When I use words to describe how to recognize a pathology or how to perform a surgical maneuver to you, it does not translate into you knowing how to perform the same tasks yourself (as opposed to teaching someone how to interpret blood work results). Once you have gained a conceptual understanding of the process, you'll need to practice on countless number of patients and spend many hours in the microsurgery lab in order to perfect your skills. You should start learning as much ophthalmology as you can in medical school because you wil be expected to quickly develop these skills with minimal amount of guidance when you become a resident. Having the drive and initiative to perfect your clinical and surgical skills are prerequisites for someone to enjoy and succeed in this field.
Unfortunately, most medical students have very little exposure to ophthalmology- some may rotate on ophthalmology for only 1-2 weeks while others may not have the rotation at all. If you think you may be interested in ophthalmology, I suggest you take an one month elective rotation as soon as possible. You may have to make a special arrangement with you student affairs office- if you wait until all of your core rotations to be completed prior to taking your electives (May to June in most U.S. medical schools), you will not have adequate amount of time to prepare for your application (ophthalmology is part of the early match).