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Doctors in Dialogue: The Resident-Fellow Relationship
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Ophthalmology fellowships serve a unique role in the hierarchy of learning and teaching. Previously YO Info covered whether pursuing fellowship is right for residents. Now, turn that question around: “As a resident, do I want a fellow?” How residents and fellows interact surfaces frequently in medical student interviews, perhaps as a courtesy question or a genuine inquiry into the educational process for a specific department. Though the pros and cons depend on perspective, a review of the evidence shows that fellowships undoubtedly can enhance the reputation of a program and the education of its residents.

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Framing the answer. As national standards in many forms of education continue be a topic of interest, the field of ophthalmology as a surgical subspecialty has guidelines outlined by different governing bodies. These serve as quality control for the system. For example, programs compliant with the Accreditation Council for Graduate Medical Education must meet certain benchmarks for residents, while the Association of University Professors of Ophthalmology Fellowship Compliance Committee oversees fellowship programs. Although not all programs or fellowships may participate, the framework provided by compliance with governing institutions helps define the answer to our question.

Gaining exposure. Offering a fellowship program connotes that an ophthalmology department is staffed by subspecialists with interest in teaching and research. This naturally lends itself to exposing residents to mentors who have previously gone through their own multiple mentorships and participated in research or tertiary ophthalmologic care not seen in other venues. Because of the diversity of paths after graduation, fellows may provide residents’ most focused exposure to involvement with such activities. For some, this can even inspire the further pursuit of academics or teaching.

Iron sharpens iron. Fellows frequently provide a bridge between residents and attending surgeons. Many fellows, having either just finished residency or their first few years of practice, bring a wealth of diversity, whether it is from experience at other institutions or learning what comes from day-to-day practice. Fellows are frequently closer to residency training, too, and have acute memories of the nuances of beginning surgery, which they can translate directly to residents. Fellows’ discussions with other mentors also provide an elevated level of tertiary discussion, which necessitates and elevates the level of attending surgeons’ currency as well. In essence, “iron sharpens iron.”

It’s a win-win. Whether overtly or indirectly, medical students, residents and graduate medical education committees all cite the need to protect resident-education requirements. This may best be addressed by looking at the ratio of faculty to residents and fellows. As our department at the University of Buffalo has undergone rapid expansion, it has become clear that the availability of teaching and workload has far exceeded the ability to have a resident work with every attending. By most accounts, this allows for residents to attend a diversity of clinics aimed at targeted learning, both clinically and surgically. The natural or perceived tension at meeting basic surgical requirements downgrades to a lower tier issue and becomes more a question of faculty asking for residents and fellows to teach during their clinic times and surgery — a win-win situation for the resident and fellow.

I propose that the majority of programs that have both fellows and residents rate the relationship and its contributions beneficial to the overall quality of education. In this light, I also encourage all applicants to consider answering my original question: “As a resident, do I want a fellow?”

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About the author: Hoon Jung, MD, is a cornea and external disease specialist at the University of Buffalo, where he directs the ophthalmology residency program and serves as an assistant clinical professor. An Air Force veteran who performed eye surgeries in Afghanistan, Dr. Jung also practices at the Niagara Falls Veterans Administration Hospital and the Ross Eye Institute at the University of Buffalo.

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