The value of an intern year has long been a topic of debate among ophthalmology residents. This discourse has been further fueled by the recent integration of internship into ophthalmology residency programs. Questions of utility, effectiveness, and necessity continue to surround conversations about a medical or surgical intern year.
As a PGY-2 ophthalmology resident who recently emerged from the world of general medicine (my intern year format), I now see this training experience through a new lens. Although the field of ophthalmology is commonly considered to be its own microcosm, I find that the more you are immersed in ophthalmic patient care, the more you draw on your general medical knowledge.
Identifying as a Doctor
The day I received my medical doctorate was, in reality, not the day I felt like I became a physician. This identification did not come until my intern year, while I was working in the emergency department. Not far into the year, I asked a nurse where all the doctors had gone, referring to the attendings and fellows. She responded, “You are the doctor.” As silly as it may sound, intern year forces you to grow into the new shoes you must fill as a physician. Learn to have confidence in your decisions and trust your own knowledge while still having a safety net.
Understanding Disease
Many ophthalmic issues are associated with systemic conditions—diabetic retinopathy, uveitis, hypertensive retinopathy, and optic disc edema, for example. Uveitis is a prime example of how knowledge of systemic infections (syphilis, tuberculosis, toxoplasmosis, etc.), sarcoidosis, and malignancies is imperative to determining a disease’s etiology and ensuring that nothing is overlooked.
With nonarteritic anterior ischemic optic neuropathy, an important part of an ophthalmologist’s job is informing patients about mitigating risk factors, such as obstructive sleep apnea and hypertension. Knowledge of a patient’s general medical history, such as the presence of sickle cell disease, can be important in determining their glaucoma medication plan. Although the eyes are the best part of the human body, they are not the only part!
Learning to Read Imaging
The ability to interpret computed tomography, magnetic resonance imaging, ultrasonography, and other imaging modalities can be practiced and honed during intern year. These skills are commonly used in ophthalmology, so take time to develop them before you are reading images while on call in residency.
Mastering Your Environment
Now that all US ophthalmology programs are combined or joint, many residents are finding the utility of learning the electronic health record (EHR) system, hospital layout, and administration in preparation for ophthalmology residency. You do not want to get a consult overnight in your first month of ophthalmology PGY-2 and be unable to find the right patient room. With EHR, half the battle can be understanding how to order what you want to order; the faster you get and the more shortcuts you learn on your EHR system, the more efficient you will be. Finally, during intern year, you will meet many residents and attendings from other specialties, including those you will interact with in residency (otolaryngology, plastics, neurology, and neurosurgery, to name a few).
Testing the Waters
Most residency programs have implemented a few months of ophthalmology training into their intern year curriculum. Take this opportunity to learn to use the slit lamp and indirect ophthalmoscope and perform an ophthalmic examination. Also practice performing gonioscopy, refraction, and scleral depression. While many (me included) would prefer to have even more time for this training during intern year, it is a valuable introduction to ophthalmology in a lower-pressure setting.
Conclusion
The deeper into ophthalmology I tread, the greater the value I see from my intern year studies. From learning skills such as EHR and image analysis to simply being able to find the emergency department, intern year provides grounding and security. As a young doctor just learning to step into the shoes of those who came before me, I have found the benefit of understanding my patients and their diseases beyond the eyes. The interplay of the body and its diverse functions permeates every aspect of ophthalmology, and the only way to treat ophthalmic disease is to see it within the ecosystem of the entire human being.
