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vitreoretina: A few words about Ophthalmology
作者:USMedEdu
发表时间:2015-04-08
更新时间:2015-04-08
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发信人: vitreoretina (surgeon), 信区: MedicalCareer
标  题: A few words about Ophthalmology
关键字: Ophthalmology
发信站: BBS 未名空间站 (Tue Apr  7 18:39:45 2015, 美
东)

Recently, I was happy to see quite a few people are
interested in 
Ophthalmology. I’d like to share my two cents with
folks who are 
considering Ophthalmology residency, and for how
much I appreciate all I 
learned from all of you and our pioneers in this forum.
I apologize for 
using English, my typing in Chinese is embarrassingly
slow..

Know your competition

As you know, Ophthalmology has been a competitive
residency for many reasons
, which are also why you may be extremely interested.
Moreover, recent 
development in healthcare policies in US changed the
popularity of some 
specialties among ROAD. As a result, more AMGs are
increasingly considering 
ophthalmology as their top choice. Together with
Dermatology, Orthopedics, 
Neurosurgery, and plastic surgery, a residency
position in Ophthalmology has
been challenging to secure. Besides working hard and
aiming at good 
performance during their clinical rotations in
Ophthalmology, many AMGs opt 
to take off a year or two, usually after their 2nd year in
med school, and 
work on clinical research projects in Ophthalmology
to enhance their 
publication profiles and establish strong connections
with one or multiple 
important faculties who, once convinced, will speak
strongly for them during
application and ranking. AMGs will also have strong
letter from their 
rotations such as in internal medicine to show their
good clinical ability. 

Dilemma for IMGs

The competitiveness of Ophthalmology residency for
IMGs is further elevated 
by our rather limited options. For fresh graduates still
in their home 
countries, lack of clinical and research experience,
and thereby lack of 
connection in Ophthalmology in US pretty much shut
the door. Visiting 
scholars may have some advantages in establishing
connections after they 
come to US and usually work for stellar vision
research scientists. However,
it is difficult to find and directly land a paid position
working for 
really accomplished ophthalmologists and leaders,
such as department chairs 
who often focus more on administration than
research. Although most 
outstanding vision research scientists, can help
during your application if 
they would like to, their best effort, which should be
deeply appreciated, 
may not be sufficiently game changing due to their
limited administrative 
responsibility and power. Calls may get you a few
courtesy interviews, it 
does not suggest the chance with those programs is
absolutely great. That 
being said, doing well in vision research, together with
any previous 
experience you may have, is still really important. It
will be a strong 
evidence in showing your potential, commitment and
high standard, and may 
help you establish new connections as the next step.
It is definitely 
challenging to pump out good papers while preparing
for USMLE, both are time
consuming and demand major effort. By no means of
being discouraging or 
arrogant, it is helpful for any of us if we could give
ourselves a 
reasonable assessment in how much we could handle
and make sure we will DO 
WELL. Some visiting scholars have previous residency
training in 
Ophthalmology. It may seem to be an advantage,
although for two reasons I am
not 100% sure. First, known to have previous training,
you are expected to 
be truly knowledgeable in Ophthalmology in
comparison to US-trained 
residents or fellows, and you are also expected to talk
and behave like a 
well-trained physician despite in a different culture
and with a second 
language. I am not sure if everyone could successfully
do so in his/her 
first two years. Secondly, many top programs are
reluctant to re-train those
who have already trained in Ophthalmology, their goal
is to train excellent
fresh AMGs with POTENTIAL to become future
leaders in the field, and they 
are confident to match with candidates from a pool of
applicants with good 
potentials, whereas previous experience in clinical
Ophthalmology shows 
commitment and interest, it is pretty much not needed
in many programs, I 
might be wrong though.

For IMGs, the best chance, if not the only chance, is to
secure an extremely
strong connection with decisive administrative power,
to pull you into the 
specific program, and these connections have to be
established with strong 
performance in research, strong enough to get you in.
Of course the 
interview is also important and try to win over other
committee members so 
multiple persons can speak for you. Should you have
strong research 
experience and could show some achievements, the
only programs that may be 
interested in considering you as a candidate are those
top academic 
departments. Unfortunately, many middle- and most
low-tier programs are not 
extremely interested in vision research experience if
you don’t have direct
connections. This dilemma really limits the options in
programs. Most 
likely we have to compete for top-middle programs.
Obviously, top programs 
in Ophthalmology can choose among 1) superstars; 2)
their excellent internal
candidates, often AMGs from top medical schools.
They will likely be ranked
higher even IMGs have the strongest possible
connections and are excellent 
in almost every way, except reasonable concerns
about IMGs. In January you 
will need lots of luck.

My very limited personal point of view –those old
IMGs with long experience
in vision research and perhaps with a PhD, who are
sometimes joked as the 
futureless postdocs, might have a slightly better
chance (life is fair when 
you feel it may not be). Presentable achievement in
research requires solid 
learning and hard work, it takes time, much longer
than anybody would like. 
Depending on who, how much, and how reasonably
they want to know and 
evaluate you, extensive and in-depth research
experience can demonstrate a 
strong commitment and a desire in quest of
excellence and refusal to 
compromise. After many many years of hard work,
when you present yourself in
your interview, one of the questions waiting for you
will be why you are 
considering the residency now. This is when you can
let your colleagues know
more about you, your goal is to become an
accomplished clinician-scientist 
and you don’t quit prematurely before you can see
some benchmarks 
indicating you are ready for the component of
independent vision research in
your future career. I hope you mean it and this is
exactly what you are 
going to do despite the temptation of making way
more money in private 
practice. 

Improve ourselves

A few years ago I thought I was ready. Looking back I
know I was far from it
. We’d be happy to improve, for ourselves as a positive
philosophy and for 
your connections who would be more than happy to
speak for you. When you are
recommended to the admission committee by your
mentors and friends, your 
advocates hope they mean it. Therefore, do your very
best to give them some 
good reasons so they can help you on their ranking
lists.

USMLE: really important, especially Step I. I have seen
many discussions in 
this forum about when to take it, whether USMLEworld
+ first aid are 
sufficient. The question for you is: do you want your
Steps scores as 
something your connections can talk about during
interview and ranking? A 
good score does say something about you. It is
challenging to score high but
this is perhaps the only component under a
reasonable control in your 
package. Many other components are much harder to
deal with.

Spoken English: perhaps more important. Everybody
understands the accent 
issue, however, don’t you agree that it is polite to
speak with a close-to-
native accent? In addition, physicians are expected to
speak in a well-
educated fashion. It will give the program a lot more
confidence that you 
are less likely to miscommunicate, that your English is
not too 
uncomfortable to listen to, and that you are not
reminding everyone as a 
very different person in the team. Remember to
improve spoken English 
whenever you have a chance. It won’t be perfect but
our desire to improve 
and do well should be a built-in.

Academic discussion: it is hard to ask impressive
questions in a well-spoken
and fast English in clinic. With a second language,
your questions usually 
cannot come out of you instantly, and often they may
be asked by other 
residents and students. A possible solution is to
prepare ahead of time by 
reading. In specific areas and subspecialties you can
push yourself hard and
read slightly more, and perhaps you could ask some
unique and good 
questions at the right time. 

Choosing target program: this is tricky. It should be
approached very 
carefully with extensive and frank discussion with
your colleagues and 
mentors. As I mentioned, give yourself a reasonable
assessment in whether 
you can handle all the tasks, do well, deliver
impressive work, and convince
your mentor(s) to speak for you without any
reservation. Remember those who
can potentially do so are usually academic leaders
with extraordinary 
vision and wisdom. They have seen and worked with
many truly outstanding 
clinician-scientists, fellows, residents, and students.
They are not easy to
impress. Although this is not achievable in a short
period of time, a post-
graduate training should be able to help you engage
insightful discussion 
and critical thinking even outside your field. Also, be
frank with your 
connections, let them know well you need help.

Living with your dream: it was the toughest for me, I
don’t know how I did 
not give up, only know I was stubborn and it will be
even harder for me to 
live a life without a dream. At the end, I was truly
touched by seeing how 
much I was helped by my mentors and friends. They
never gave up on me.

Bless you all

Again, by no means I was trying to be discouraging or
exacerbate the 
challenges and risk ahead of you. These discussions
are only my very biased 
two cents. There should be many possible successful
approaches unknown to me
, and there are many routes to an enjoyable life with
your families, friends
and colleagues, and insisting on chasing a dream may
not be the only 
solution. I should have done much better in taking
care of my family. Having
said that, I still hope to see more talented and
hardworking students and 
scholars from our country, who, after taking all the
risks into 
consideration, are still passionate to pursue a career
in Ophthalmology or 
any other your favorite specialties. Many of us are
first-generation 
immigrants, however that is not the reason to
compromise too much when 
choosing the future. We may be lucky enough to earn
a little recognitions 
among our colleagues through solid contribution to
Ophthalmology, our talent
and hard work, our commitment and determination,
our desire to improve 
ourselves constantly, our pleasant, friendly and
helpful personalities, our 
appreciation to all the understanding and help from
our mentors, friends and
families, and our choice of Ophthalmology as the
lifetime career.  Best 
wishes to all of you!

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