• A Program Director’s Thoughts and Advice on Starting Residency

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    Congratulations on joining the absolute best medical community in the world, the community of ophthalmology.

    Your Academy is a member-driven organization that exists to meet the educational needs of all ophthalmologists, from the very newest, like you, to the senior most among our profession.

    Please know that as you start this journey, we have all been there. We know that it can be a difficult transition from intern to first-year ophthalmology resident, and we know that more and more of you are in joint or integrated internship programs that are designed to ease this stress and better prepare you to practice ophthalmology. Here are a few tips based on my experience over the past decade working with residents.

    Take care of yourself. Burnout and fatigue are very real threats to your well-being and to your ability to take the best care of your patients. Try to get good sleep as much as you can and find fun and inexpensive things to do in your city, like going to a park, taking a walk or visiting a museum. Make wellness an active practice by finding the things that help you reduce stress and making sure you do something each week that you look forward to and enjoy.

    Make physical fitness part of your routine, whether it be walking or running, joining a gym or using online fitness classes or apps. Exercise helps memory and reduces stress — plus you need to keep a strong back and core to practice ophthalmology.

    Use your time wisely. This is incredibly important because there is so much to learn, and so little time. A growing body of evidence-based practices can help you study better, not harder. Good short primers on these ideas are Make It Stick, by Peter C. Brown, Henry L. Roediger III and Mark A. McDaniel, and Ultralearning, by Scott H. Young. The most important techniques demonstrated in these books are effortful practice, drilling and varied practice.

    When you work harder to recall something, you will form a stronger memory. When you quiz yourself with practice tests before you study something, you prime learning. Mixing it up — not just studying one topic at a time but changing studying methods and topics with varied practice — helps you remember better. Engage with material rather than just reading and rereading, which really just gives you a false sense of familiarity with the topic.

    Engage with Academy resources. Look to the resident section of the Academy’s ONE® (Ophthalmic News and Education) Network for all sorts of interactive and engaging ways to learn. In the Pediatric Ophthalmology Center, you can practice refraction, retinoscopy and strabismus measurements and try different lenses and prisms on simulated patients. You can also learn how to interpret optical coherence tomography images through interactive case-based modules.

    The Pathology Atlas will help you learn about normal anatomy and disease states through the use of high-resolution slides that you can magnify and study with and without annotations. The ONE Network also has 101 basic courses designed for residents along with a number of flash cards you can download and use to study.

    The Academy’s Committee for Resident Education wants your input too. If you have suggestions for any additional materials you’d like to see on the ONE Network, contact Sarah Page, the Academy’s online education manager, at spage@aao.org.

    Don’t be afraid to ask questions. Residency is three brief years, and there is so much to learn. Don’t just ask questions of your attendings. Ask yourself questions. When you see a patient, think of your differential diagnosis, but then ask yourself a series of questions about the worst-case scenario in order to either rule it in or out: What could kill the patient? What could blind the patient? What doesn’t make sense? What either proves or disproves my hypothesis about the diagnosis? What is consistent or inconsistent with this diagnosis?

    If you keep these key questions in mind, you will know when you need to ask for help from a more senior colleague, or when you need to order a test in order to rule out a dangerous condition. When you talk with the more senior resident or attending, you will have a better and more specific question to ask — rather than just saying you don’t know what’s going on.

    Lastly, keep in mind why you set out on this journey. Remain grateful for the opportunity you have to touch patients’ lives, hear their stories and make a difference at a time when they are vulnerable and scared. Gratitude is an important and grounding act that also helps you to maintain balance through an exciting, but sometimes stressful, time of your life.

    The residents from the Krieger Eye Institute at Sinai Hospital of Baltimore with the department chair and program director during the 2020 Krieger Symposium. Top row: L-R Drs. Malack Hamade, Alex Willis, Brede Skillings, Jason Alvarez, Maggie Wei. Bottom row: Drs. Donald Abrams, Chao Li, Matthew Brink, Krishi Peddada, Brett Campbell, Laura Green.

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    Laura K. Green, MD, is the residency program director for Cornea, Cataract and Refractive Surgery Specialties at the LifeBridge Health Krieger Eye Institute in Baltimore, Md. She is also president of the Association of University Professors of Ophthalmology (AUPO) Program Director’s Council and chair of the Academy’s Committee for Resident Education.