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Cataract Surgery | Jun 2011



Residents add a lot to my practice in terms of quality and quantity of patient care. Being in the learning phase of their career, residents are naturally curious and inquisitive and often help to keep the consultant surgeons on their toes. When a resident is in charge of putting together the patient's work-up, he or she usually spends time examining the case in detail. This thorough process may help to pinpoint some relevant part of the patient's history or examination that otherwise may have been overlooked in a typically more rapid examination conducted by the consultant. In my experience, residents and interns have recognized many rare diagnoses, whereas the consultant is sometimes held back by the age-old adage, “It is rare to be right about a rare diagnosis.”

Having residents in the practice means that we are a teaching hospital, thereby heightening the quality of the consultants we employ. Having to teach and to take classes brushes away cobwebs and makes facts learned long ago once again fresh in the consultant's mind. It also forces the consultant to constantly stay abreast of all the latest research, techniques, and happenings in the field. All these requirements add up to bettering the quality of the consultants and the institute as a whole.

The most tremendous advantage of having residents is the opportunity to give back. It is a great feeling to share the knowledge and the experience gleaned over the years and to be able to improve the skill set of the future generation of ophthalmologists.

Having residents also increases the quantitative capacity of the institute. It is possible to see and treat a greater number of patients than would otherwise be possible for consultants alone. The residents perform simpler procedures, thus allowing the consultants to allocate more of their time to cases that require their expertise. The residents gain by learning basics and making their foundations strong. As they go on to become second- and third-year residents, they participate in the management of more complex conditions and start performing more challenging procedures under supervision. The extra time spent by the consultant in training the residents to perform surgeries is worthwhile, as being able to mentor someone is the greatest achievement any teacher can hope for.

Amar Agarwal, MS, FRCS, FRCOphth, is in private practice at Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India. Dr. Agarwal may be reached at tel: +91 44 2811 6233; fax: +91 44 2811 5871; e-mail: dragarwal@vsnl.com.


One of the distinct elements involved in the practice of medicine is that we teach our competitors. Since the days of the Hippocratic school of medicine, teaching our colleagues is a standard practice and, no question, it is one of the most rewarding standards that we undertake as physicians.

I am always happy to have residents, and especially fellows in training, with me in my practice. The fruitful interaction between physician and resident is like an open window, letting in fresh air. So many times we are focused on our particular opinions that it is surprising how a simple question from the baseline, as proposed to from a colleague, can make us reconsider our position.

Being a part of resident training is also a continual stimulus to update your knowledge and your practical perspectives on your profession. This is especially important in an academic environment, where different approaches are used to teach each classification of professionals. Below is a list of the main issues that, in my opinion, are involved in the interactions that we have with first- through fourth-year residents and fellows in training:

First- and second-year residents. Our role is to teach these students the examination techniques and the basic logic involved in clinical diagnosis and surgical indications. It is essential to include training in the use of the latest diagnostic instrumentation and technologies. I strongly recommend hosting wet labs and practical courses that provide residents with hands-on experimental surgery.

Third- and fourth-year residents. The focus for third- and fourth-year residents is more on the practice of surgery under guided conditions. With training completed in the previous rotations, these residents are real junior colleagues who help manage the volume of our practices. They do an excellent job in follow-up visits and completing procedures such as sutures on grafts, standard cataract cases, ocular surface surgery, and glaucoma. My recommendation here is to involve these residents in a clinical research study to implement their scientific perspective on the profession. To write a scientific paper in collaboration with senior authors is an extremely important milestone in these stages, because the residents will learn how to create a structured approach to analysis. For those interested in academics, I recommend following a clinical research course or a good clinical practice training course.

Fellows in training. These colleagues are looking for their preferred subspecialty, and they are of particular help because they interact with us in clinical and surgical cases, participate in the surgical process, and assist in editing papers and collecting data for clinical studies. My recommendation is that fellows should attend meetings and specialized courses on the subspecialty and become involved in subspecialized societies and meetings. Fellows in training should also gain practical hands-on experience in wet labs such as microincision cataract surgery and keratoplasty techniques (Descemet-stripping endothelial keratoplasty, deep anterior lamellar keratoplasty, and femtosecond-assisted procedures).

Interaction with my young colleagues is extremely fruitful. They help me to maintain a connection with the real world of education, and they—especially the fellows—are part of our junior staff for academic work. I have found immense joy from working with residents and fellows, and I hope that they feel the same about working with me. In most cases, I am dealing with academically oriented junior staff, providing an outlet to project my knowledge of the way in which we understand ophthalmology

Jorge L. Alió, MD, PhD, is a Professor and the Chairman of Ophthalmology at the Miguel Hernandez University, Alicante, Spain, and the Medical Director of Vissum Corp., Spain. Professor Alió may be reached at tel: +34 96 515 00 25; e-mail: jlalio@vissum.com.