Tips to Excel on an Ophthalmology Sub-I
Written by Deena Dahshan
Preparing for an upcoming ophthalmology away rotation is exciting, but can seem daunting. If you can spend some time with ophthalmologists near your home institution (even if you don’t have a home program!) it can help with a sense of familiarity with what to expect on an away rotation. No one expects medical students to have mastery of ophthalmology concepts! Being a team player who is open to learning and able to be spontaneous in new environments can reflect a strong work ethic and great potential. Depending on your assigned rotation, you may be between inpatient consults, outpatient subspecialty clinics, VA clinics, and the OR.
If working in the clinic, your best guide is to ask what your expectations are upfront. Introduce yourself at the start of the day. If you can see patients on your own and present to attendings or residents, this may be more challenging, but it is a greater learning experience! Some clinics have teaching scopes attached to the slit lamp, and residents or attendings may point out findings as they examine the patients. If you have access to the EMR, briefly read about each different condition presenting and try reading about the medications, different surgical
interventions, and pertinent ophthalmic findings. I found that some attendings preferred sending students to see new patients and present as these were better learning opportunities in busy clinics. However, this is attending specific, and some favored students in a traditional shadowing role. Keep in mind that some clinics prefer medical students wear white coats, so pack one just in case!
If working in the OR, read about the procedure, indications, and patient ophthalmic history. Make sure you introduce yourself to the team and feel out your role! Are you shadowing or are you able to scrub in? If you can scrub in, that is super cool and usually means a microscope view. Attendings may have students assist in keeping the cornea moist or providing gentle retraction. Find a comfortable seating/viewing position and recognize what knobs are sterile for adjustments. If shadowing, help the team as you can but be mindful of keeping questions in the beginning or end. In contrast to other surgeries, patients are often awake during ophthalmology cases in the OR and surgeons may be focused on speaking to patients to direct them throughout the process or guiding the resident through the case.
Students are often invited to participate in didactics, and I recommend attending to get more exposure to the department and recognize the teaching culture of the residency program- even if these are virtual! Some departments allow students to use surgical simulators and wet lab resources, and these are great learning tools to check out! Some departments also have students give a grand rounds presentation at the end, and this is an opportunity to present a case sometimes to the entire department. Don’t be afraid to ask residents and attendings for feedback while preparing and reviewing anticipated questions you may be asked. I also recommend practicing with PowerPoint Slideshow Rehearsal mode to help with pacing and delivery.
If you find a mentor that is involved in an area of research interest during your rotation, ask if you can contribute and work on this even after your rotation comes to an end. An ophthalmology away rotation is a great learning experience and exciting opportunity! Enjoy your rotation and remember that being eager and enthusiastic goes a long way!
Some skills to read about, practice, and learn more about on your sub-I:
Ophthalmology presentation format
Bedside eye exam for inpatient consults
Using the slit lamp
Using an indirect ophthalmoscope
Using different lenses to view the optic nerve
Applying fluorescein
How to refract
How to invert lids for a conjunctival exam
How to insert eye drops
How to check intraocular pressure (using Tono-pen at the bedside, Goldmann with slit lamp)
Resources:
Online
Tim Roots Ophtho Book (FREE online introduction to ophthalmology and concepts, with videos!
EyeWiki for quick reading of various pathology
Iowa Ophthalmology Cases
Books
Wills Eye Manual (get an old copy for a much more affordable price or an electronic version for your phone)
Podcasts
Eyes4Ears
Honestly Bilal
The Retina Podcast
