Ophthalmology is a great specialty that offers an excellent blend of medicine and surgery, coupled with a good work-life balance. Regardless of where you are in the world, it is a competitive specialty. Residency in the United States is notoriously difficult, especially as an International Medical Graduate (IMG). Only fourteen IMGs (4% of total ophthalmology IMG applicants) successfully matched to a residency training program last year.
Medical electives/clerkships provide a fantastic opportunity to learn, enjoy and explore new countries and their respective healthcare systems. But to IMGs set on residency training in the US, medical electives at US-based institutions really open the door to a successful application. This article will share my personal elective experience in ophthalmology with Weill Cornell Medical School (WCM) at New York Presbyterian Hospital.
Before starting, I highly recommend answering the following questions:
By already knowing where you want to do your elective (US) and preferred specialty (ophthalmology), you’ve already dealt with the most important aspects of organizing your elective, and you should really seize an ophthalmology experience offered without thinking twice! But if you are blessed with several options, it is a good time to think about where you’d want to do residency and choose your elective placement accordingly. Usually, most IMGs end up matching to institutions where they’ve done an elective or research in the past.
The second question will help to define your goals and learning objectives. If you are serious about ophthalmology residency, you ideally want a letter of recommendation (or two) and substantial research output. Developing the skills to do a complete ophthalmic examination independently (more on this later) and managing your patient list is an added bonus but will realistically depend on your baseline ophthalmology knowledge and experience. However, it is important to consider these factors as this will affect the type of elective you pursue; Harvard and John’s Hopkins both offer excellent ophthalmology electives with a strong research basis, for example. On the other hand, Wills Eye Hospital, associated with Thomas Jefferson University in Pennsylvania, is world-renowned and would be a great place to develop your clinical skills while meeting amazing ophthalmologists too!
Lastly, ensure that you are fully aware of the cost and entry requirements for each program. Recently, more medical schools are beginning to use the Visiting Student Learning Opportunities (VSLO) platform to advertise their visiting elective rotations and require your home institution to be part of this. While USMLEs aren’t mandatory, medical schools prefer you to have done them and may restrict access to patient notes otherwise!
Once you’ve successfully secured a spot in an ophthalmology elective program, it’s time to make the most of your experience. This really begins before you start, and the following are a few recommendations you should consider.
Firstly, ensure you have a good grasp of basic ophthalmology concepts. While your elective experience will provide you with some foundational knowledge, it’s important to have a solid understanding of the anatomy and physiology of the eye so that you can hit the ground running (and impress the fellows and attendings!). Tim Root’s lectures are a fantastic resource and a great introduction to clinical ophthalmology in the US – his slit lamp lecture is a must-watch. Demonstrating an understanding of the management guidelines for the main ocular diseases will not only allow you to ask more insightful questions but also score brownie points with your supervising physicians. This will definitely help when you begin to seek a letter of recommendation at a later stage.
Secondly, make sure to take get in contact with your sponsor well in advance of your start date to organize research. Most projects have a lengthy planning stage, and your elective time is limited; having everything ready by the time you start is crucial. An ophthalmology elective is competitive, and you’ll be working alongside other students who are equally motivated to learn and willing to impress. As an IMG seeking residency, there will be extra pressure to stand out, so be proactive and take the initiative to learn as much as possible.
My ophthalmology experience was brilliant. I was incredibly fortunate to have residents, fellows and attendings who went out of their way to teach me. Having a previous IMG as my supervisor was an added bonus – he tailored my schedule to my liking and continuously advised me on how to make the most of my time at WCM. In turn, I hope the following tips will guide you to maximizing your elective experience.
Use your first week wisely. I spoke with my supervisor in the week prior to my elective and together we created a timetable for the first week that allowed me to dip my toes into each subspecialty. General ophthalmology and oculoplastics clinics are a great place to start if you are unfamiliar with using the slit lamp and fundoscopy lenses. Neuro-ophthalmological and retinal clinics are best for learning about ocular pathophysiology and will have the most resemblance to traditional medicine, but the learning curve is steep. When attending theatre, choose a day with several lists, so that you can move in between operating rooms to see cataract, vitreoretinal, glaucoma and oculoplastics procedures. Ideally, the first week should give you an idea of which subspecialty interests you, so that the remaining weeks of your elective are spent under the supervision of the same attending.
| Day of Week | Morning | Afternoon |
|---|---|---|
| Monday | General ophthalmology clinic | Glaucoma clinic |
| Tuesday | Consults | Consults |
| Wednesday | Cataract theatre | Oculoplastics theatre |
| Thursday | Cornea clinic | Residents teaching & grand rounds |
| Friday | Neuro-ophthalmology clinic | Retina clinic |
During my placement, I had several goals, with research being a priority. Upon arrival, I spoke with residents to identify which professors and attendings were most active in research and willing to supervise a medical student. This saved me a lot of time and was definitely a key reason in getting a positive response from my supervisors. I also explored the possibility of continuing research with them when I returned back to the UK (I’m now working on several exciting projects remotely!). Oculoplastics and neuro-ophthalmological clinics are a great source of interesting case reports; most attendings will be happy to supervise writing up literature reviews and book chapters too. Furthermore, with little microsurgical experience under my belt, I decided to spend time outside of clinics and theatre practicing my surgical skills on the EyeSi simulator and in wet labs. I would also recommend going to grand rounds as this was a great opportunity to meet with leading ophthalmology experts from other institutions (we were visited by professors from John’s Hopkins, UC San Diego, and UC San Francisco to name a few).
For the majority of IMGs seeking residency, obtaining a strong letter of recommendation is the ultimate goal. Although this is heavily dependent upon building a good relationship with your supervisor, there are a number of steps you can take.
Aim to build a relationship with your mentors and attendings by asking for their feedback on your work and take notes on their advice. This will help you to better articulate your experience and skills when asking for a letter. During your second week, it is a good idea to mention to your supervisors that you are working towards receiving a letter of recommendation as you are considering working in the US in future. By doing so, they will keep an eye out on your progress. Ideally, stay attached to the same attendings for the remaining weeks of your placement and arrange a research project with them to continue upon return to your home country. This can give you a chance to showcase your skills and work ethic while making your letter even more robust.
Overall, I had an amazing experience and wouldn’t change a thing. Both Weill Cornell Medical School and New York City lived up to their names and exceeded my expectations. By planning well, being proactive, and taking the right steps after completion, you can make the most of your experience and set yourself up for a successful residency. More importantly, use this as an opportunity to explore your interests and enjoy it!
