At which point do we decide to stop learning? If you are reading this journal, the answer is likely never because we clinicians are always thinking, deducing, diagnosing, and treating.
A better question would be—when do we decide to stop our formal education? For many, optometry school graduation is the final capstone to our coursework. Some of us forge ahead with residency, fellowship, master’s degrees, or doctorates.
For those of us who plunged forward with a residency, some had life- and career-altering experiences. Here is the story of mine.
I wanted more
To rewind, optometry school was illuminating—not just from a basic clinical science perspective but also from an experiential point of view.
We were exposed to such a wide breadth of clinical cases—in pediatrics, binocular vision, contact lenses, low vision, refractive, disease, and more. We learned how to hone in on the major points and the finer points and address them with the patient in an empathetic way.
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The cases that personally fascinated me the most had multiple, sometimes confounding elements. For example, as a third-year student, treating a patient complaining of dryness with simultaneous early cataracts and what seemed like early macular mottling in only one eye posed a true conundrum.
How to make multiple diagnoses and complete a full refraction in under one hour? The odds seemed stacked against me.
The Ohio State University College of Optometry’s program included many fantastic specialty clinical rotations that widened our scope of practice and allowed us to experience real-world tertiary patient management. It was especially after the experience of the focused externships that I wanted to learn to manage tough cases more efficiently. I wanted to be challenged by seasoned clinicians and improve my problem-solving skills.
Jumping into residency
I was lucky enough to be one of four residents to match at Omni Eye Services of New Jersey and New York in ocular disease and surgical comanagament, which boasted of exposure to an extraordinary array of specialties. There was a high-volume artist of a cataract and glaucoma surgeon, a brilliant retinal specialist, two oculoplastics gurus, and even a pediatric/strabismus surgeon. This is not to mention the team of extraordinary ODs that essentially ran the show.
I dove right in with helping to see patients—sometimes encountering up to 60 patients a day. Not only was my work busy during business hours, residents also took after-hours on-call. This required learning how to deductively reason through a patient’s symptoms and gauge the severity and urgency depending on the patient’s words and your own questions. If the call was deemed serious enough, it might require seeing the patient after hours or over the weekend to treat or calling the on-call supervising OD with a succinct diagnosis and well-thought-out questions. To say that my diagnostic capabilities sped up a steep slope—mostly out of fear of missing something—is an understatement.
Diagnosis boot camp
The challenges of diagnosing ocular disease is multifactorial—conditions can widely vary in severity, temporal pattern, patient experience, and visual presentation. Residency in ocular disease was a boot camp of sorts.
After my first weekend of being on-call—which included a central retinal artery occlusion with cilioretinal sparing, a leaking trabeculectomy (to my horror, the Goldmann applanation tonometer was not malfunctioning—the intraocular pressure really was around 1 mm Hg), and a florid filamentary keratitis—I was well on my way to learning to think quickly.
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The monitored independence was a step between being a student and the real world: there was a cushion of specialists whom I could call on, yet preparing for each call required significant thought toward a differential diagnosis. Much like an emergency room, stabilization and accuracy of diagnosis was key before complete treatment or referral to one of our many specializations.
This organization of multiple subspecialties within one practice was illuminating on a myriad of levels. Not only did it provide the comfort of knowing that the patient would receive a high level of continuous care should it be needed, but it allowed a resident to learn how the different subspecialties interrelate. Comprehending the compartmentalization of the MD specializations and sometimes uncanny overlaps was imperative to working as a team—best learned by being thrown into the fire, so to speak.