Tips for your first year as an Ophthalmology Trainee

Sean Zhou, Rynda Nitiahpapand, Binita Panchasara, Twishaa Sheth

Incoming ST2s, NHS HEE East of England Deanery

The time of year has come again, where a fresh batch of ST1 Ophthalmology Specialty Trainees (OST) start their seemingly epic journey. Firstly, congratulations and welcome to the incredible world of Ophthalmology, but also prepare for what is often an extremely steep learning curve. Thankfully Ophthalmology is a friendly specialty and we hope these little tips will help you navigate the tricky first year, even for those with prior experience.

“What I wish I knew a year ago!”

Sean Zhou, Rynda Nitiahpapand, Binita Panchasara, Twishaa Sheth
Incoming ST2s, NHS HEE East of England Deanery

1: Know yourself

A lot of skills in Ophthalmology are new, and not taught at medical school. It is quite easy to say “I’ll check the vision, pressure, examine the retina…” but each step requires a tool and a skill that comes with practice. It may be embarrassing to say, but it took many of us new ST1s a whole month before we could even say we saw the retina clearly with a 90D lens. Do not be put off, many skills like gonioscopy and even simply checking pressure takes time and being systematic is key to not missing signs.

“Be patient and be honest with yourself & others”

Sean Zhou, Rynda Nitiahpapand, Binita Panchasara, Twishaa Sheth
Incoming ST2s, NHS HEE East of England Deanery

As a new ST1, seniors will have appropriate expectations and understand how hard it can be. The language can feel like a whole new world (rather than knowing what you are doing most of the time for F1/F2, you are now starting from scratch!) so don’t be too hard on yourself if you find things overwhelming in the initial months. Ask for help and try to learn from every case! The more cases you see the more confident you will be in identifying a normal from an abnormal eye. You may find keeping a record and following up interesting cases you see for reflection, use as a CBD or teaching presentation. Keep reading and not just for your exams. Ophthalmology is all about pattern recognition.

“Make good use of simulation and online resources”

Sean Zhou, Rynda Nitiahpapand, Binita Panchasara, Twishaa Sheth
Incoming ST2s, NHS HEE East of England Deanery

Sign up for wet labs and take advantage of access to simulation models, practice to improve skills and repetition to build up muscle memory. Arguably nothing beats doing the skills for real once you feel confident enough to, but practice makes perfect!

You will find many a video on YouTube & check out these other free online resources we found helpful:

“Approach surgery with practised confidence”

Sean Zhou, Rynda Nitiahpapand, Binita Panchasara, Twishaa Sheth
Incoming ST2s, NHS HEE East of England Deanery

It will always be a scary experience operating for the first time as no-one wants to cause a complication. Engage with the mandatory RCOphth phacoemulsification course & EyeSi/local wet lab to gain confidence. Get to know the operating equipment (including basic things like how to turn it on!) and scrub in with the nurses to build confidence and team work. Always remember – listen to your trainer, they will keep you safe and debrief afterwards. We would recommend you record every case so you can watch it back & reflect.

You may not learn all the skills in Ophthalmology or have completed several cataract cases in your first year and that is okay. Make sure not to compare yourself to others – everyone has their own pace, and everything will even out over 7 years!

2: Know your environment

Ophthalmic clinics are one of the busiest clinics in the outpatient department. One way to help you get through busy clinics is planning. Make a habit of checking your clinic notes and pre-emptively booking patients for dilating/OCTs/visual fields tests etc to save you time! The day-to-day work of Ophthalmology can be very intense, it is important to make sure you are well fed and watered. Your senior trainees/staff grades, nurses and consultants will take excellent care of you.

When you start a rotation, make your life easier by familiarizing yourself with:

  • Radiology (MRI/CT) – how to request imaging urgently and how to obtain the results
  • TIA/Stroke clinic referral pathway
  • GCA pathway
  • Uveitis protocol/pathway
  • Where blood forms are kept
  • Referrals/bleep numbers to other specialties e.g. rheumatology, ENT, medical registrar, paeds
  • How to book patients out of hours to clinic the next day
  • How and where to see patients out of hours and where equipment/drops/drugs will be
  • How to book emergency theatre out of hours

Find out preferences of emergency subspecialty consultants and how to refer urgent cases to them

  • Vitreo-retinal (VR) cases like retinal detachments
  • Trauma cases like orbital fractures – is surgery/follow up done by maxfax, or local oculoplastic team
  • Acute angle closure local guidance – or generic guidance from will’s eye manual/oxford handbook etc
  • WHERE THE TEA/COFFEE/SNACKS ARE – This one is super important.

Learning how to do these simple IT tasks can save you time

  • Sort your ID badges and IT access early on
  • How to find and print patient lists for clinic/theatre (so that you can prep them in advance!)
  • How to check which patients have turned up for your clinic
  • (If your referrals are online) How to check referrals and reply to them

Service provision vs Training opportunities

Controversial (or not!) unlike foundation training, the phrase “service provision” will become a more familiar term during your first year. It is important to liaise with your educational supervisor, College Tutor, and your managers about balancing your training needs with local service provision. This can become an issue especially during the recovery phase of COVID-19 as services are resuming at reduced capacity, but you should speak up for yourself and keep a record as there are always people to escalate to if your training becomes heavily compromised – ie when you are unable to complete WBAs or portfolio targets.

3: Know your portfolio

Your portfolio will be the story of your educational journey through 7 years of training and a log of your entire surgical experience. However, it can easily be forgotten during the initial months as you try to learn everyone’s names, ophthalmology phrases, how to switch on the slit lamp and probably moving to a new city. The good news is that the portfolio is generally quite easy to navigate and we all found it easier to get through than the foundation training portfolios.

There are two portfolios to become familiar with: the RCOphth trainee eportfolio (non-surgical skills) and the eyelogbook (surgical skills record).

The first requires you to complete certain tasks to attain an outcome 1 (pass) at ARCP, but actually many of the skills needed are things you are already doing in clinic (like checking pressures, using the slit lamp, removing foreign bodies etc). It can be difficult to get busy consultants to supervise you performing these tasks, so if you know you have a foreign body coming, it may be helpful to ask them in advance if they would mind observing during clinic. Start your case-based discussions (CBDs) early and get the most out of them! You will not progress if these targets are not met.

The latter is the eyelogbook, where you enter every single surgical procedure (including intravitreal injections). We would highly recommend you either get the app, or simply save a bookmark onto your phone to allow you to enter data easily. Enter the cases on the day!

Portfolio resources include:

4: Good luck and enjoy

We sincerely hope all the new trainees have an incredible start to their career ahead, ST1 is a fantastic year, an opportunity to learn lots of new skills and is a much-protected time in training. It will be a different experience from foundation training as you are no longer in big teams and sometimes it can feel more isolated. However, there is plenty of friendly staff around including fellow trainees who you will be with in your region for some time. We hope the above tips helps some of you in your journey, although many of them we are sure will be covered in regional/local induction sessions, but these can vary from place to place.

Good luck, enjoy your time in this amazing specialty & join the conversation with other trainees in this Linkedin Group.

Invited authors

Sean Zhou – Twitter: @EyeAmSeanZ
Rynda Nitiahpapand – Instagram: Rynniti
Binita Panchasara – Instagram: binitapanchasara
Twishaa Sheth – Instagram: twi_sheth      Twitter: @TwishaaS

Edited by EyeducationUK

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