Congratulations! You’ve finished residency and made the excellent decision to further refine your skillset and subspecialize in ophthalmology. Fellowship affords only one or two years to learn as much as you can about your subspeciality before you’re on your own as an attending. Here are a few of my tips for how to make the most of your fellowship experience.
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Come in Ready to Learn
One of the most interesting aspects of fellowship is that you go from feeling like a relatively autonomous senior resident back to feeling like a semi-newbie. It’s different from starting residency where you came in with minimal knowledge. Now you’ve probably managed similar diseases and formulated your own practice patterns. I remember a few times as a new fellow thinking “that’s not how we did it in residency” when discussing management plans for patients. It’s easy to get stuck in your ways with practice patterns and habits, but one of the best perks of fellowship is getting to pick the brains of your fellowship mentors, some of the leading experts in your field! A few of my favorite conversations in fellowship were sharing my residency practice patterns and hearing why my attendings did things differently. It challenges your practice dogma and also creates opportunities to expand your skill setfor managing complex diseases. Different attendings may also have different practice patterns or surgical approaches, even in the same department.
Wilmer Cornea Fellow Cherie A. Fathy, MD (third from left) stands with her 2021-22 faculty mentors and other fellows. Left to right: Albert Jun, MD; Esen Akpek, MD; Cherie Fathy, MD; Daniel Daroszewski, MD; Ekta Patel, MD; Kraig Bower, MD; Yassine Daoud, MD. Photo courtesy of Cherie A. Fathy, MD.
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Write Down Everything
Fellowship is jam-packed with pearls and practical tips for patient management and mastering surgery. However, between keeping up with clinical notes, your in-basket and orders, it can be easy to let your learning take a back seat.
One of our attendings, Dr. Albert Jun, used to make a point of writing everything down after every surgical case. Ask any Wilmer Eye Institute cornea fellow what one of Dr. Jun’s first comments to you would be after a case. Odds are they’d respond, “Are you going to write that down in your book?” Every Jun fellow would have a notebook filled with drawings and surgical procedure notes. It’s a fantastic way to reinforce your learning right after a case and to review before an upcoming surgery. Using an app to keep “notebooks” and “folders” of information can make it easy to jot down notes in the moment and keep them stored for easy access when you want to revisit it later.
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Record Your and Your Attendings’ Cases
Similar to writing everything down, there is incredible value to reviewing videos of your surgical cases. I tried to do this weekly to pinpoint specific steps that I wanted to improve upon. I would also look up alternative techniques on the Academy’s ONE® Network, YouTube, EyeTube, etc. to see if we could incorporate different methods into our OR routine.
I also created clips from my surgical videos to highlight key steps so I could quickly review them in a pinch. I would also create clips of steps I found tricky so I could pull them up to review with my attendings, which was an efficient method for getting their insights. I would then jot down notes underneath the video with their comments.
I also recorded and saved my attendings’ surgical videos. This collection has become a compendium of masterclass videos that I can also refer back to before a case.
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Build a Great Relationship With Other Fellows
One of my favorite parts of fellowship was meeting and working with my co-fellows. My cornea co-fellows and the fellows in other departments served as such a stabilizing force for me during this whirlwind of a year. Be sure to support your co-fellows and also lean on them for help — exchange surgical tips, pearls that your attendings shared, and review cases together as well.
I really appreciated that my co-fellows and I were very open about our experiences in the clinic and the operating room. This allowed us to share our great experiences and what led to those experiences, and also to be vulnerable in sharing our more difficult experiences and what we learned from them. We were also very open about the job search and our contract negotiation experiences.
I know that I will continue to seek out my co-fellows’ experiences and advice as I progress throughout my career and I am excited to watch their careers grow.
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Your Last Year of Training — Try It All and Ask Everything
I’ve read before that fellowship is the last year of “training wheels.” I think that’s such a fantastic analogy. It’s the last year that you will have supervision as you perfect your current routine and your last chance to try out new techniques with someone by your side to talk through it. Especially if you operate with many different attendings, be open to trying their techniques in surgery. This will create a wider toolbox for you when it comes to tackling cases in the OR that need a unique surgical approach.
Ask all your questions now! Take a second to think about why your attending chooses a certain protocol or postoperative management plan. There is also so much that happens behind the scenes before a patient gets to the operating room — make sure you ask for a list of surgical tools for each procedure, each doctor’s “preference cards,” etc. <
Overall, fellowship is a fantastic year. It was probably one of my favorite years in training! Although the hours can be long, keep the end goal in sight: This is one of the most practical years of training and one in which everything you learn is directly applicable to your future daily practice. Take the opportunity to challenge yourself and to soak in all the knowledge there is to be had from the mentors around you. You won’t regret it.
Cherie A. Fathy, MD, joined the
YO Info editorial board in 2022. She completed her residency at Wills Eye Hospital in Philadelphia and is finishing her cornea fellowship in 2022 at Wilmer Eye Institute at Johns Hopkins Hospital in Baltimore.