Published in Cornea
Cornea, External Disease, and Refractive Surgery Fellowships: An Inside Look
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What does it take to excel in a fellowship (and how do you land one in the first place)? We asked Dr. John Berdahl, MD, and Dr. Daniel Terveen, MD to give us the scoop.
Dr. Daniel Terveen is an eye surgeon specializing in refractive cataract surgery, advanced corneal disease treatments, glaucoma care, and laser vision correction. Currently a fellow under the tutelage of leading international cataract surgeon Dr. John Berdahl, Dr. Terveen will join Dr. Berdahl at Vance Thompson Vision in Sioux Falls, South Dakota upon completing his fellowship in advanced anterior segment surgery.
We sat down with both of these highly accomplished ophthalmologists to talk about the cornea, external disease and refractive surgery fellowship experience—and get their tips on how to maximize this incredible opportunity for professional growth.
Note: This interview has been edited for length and clarity.
Dr. Berdahl: This is the tip of the pencil of 30 years worth of education. This is the most important year that you're going to have in all of your training. Give it everything you’ve got. And when you say you're going to do something, let that word be gold—get it done, and get it done faster than you said you were going to get it done. Also, always look for that extra way that you can contribute.
On the other side, the biggest key to providing an exceptional fellowship involves recognizing how talented these people are and helping them exploit that talent for the greater good of society, not for filling out paperwork.
Dr. Terveen: Always be observant. The reason I did a fellowship is because I wanted to go from becoming a great ophthalmologist to becoming a world-class ophthalmologist. My teachers Dr. Berdahl and Dr. Thompson have gone to that next level, and I wanted to know how they became who they are. So I think the real key is to always be watching the subtle things that they do. When Dr. Berdahl is talking to a patient, I'm watching his every move, his eye contact, his body language, the words he's using. I’m watching how they interact with the staff, and how they perform surgery. As a fellow, it’s easy to get overwhelmed with the work and you miss out on those little details, but they have real value.
Dr. Berdahl: Number one, you have to have good social skills. Fellowship is an apprenticeship, and you're sitting next to the same people every day for a whole year, so don’t be annoying. Number two, you must be self-motivated. At this level, you should be able to figure out what the work is and do it. Number three is inquisitiveness—be curious! And number four, follow through. If you start a project, don't leave it hanging.
Also, challenge your mentor. They don't have a monopoly on the truth and what they say is not gospel, so challenge them. An apprenticeship relationship is a give-and-take relationship.
Dr. Terveen: Exactly—and it goes the other way too, of course. It’s about adaptability. You learn something in residency and you think, “This is gospel. This is how it has to be done.” But then you realize nobody has a monopoly on truth and there's more than one right way to do things. Being very adaptable to other people's styles and beliefs is really important, and can help you stand out.
When it comes to standing out on an application or in an interview, know how to tell your story and talk about your why. If you can tell the story about why you are who you are and why you do what you do, that's very compelling.
For example, I could say, “My why is to meet unmet needs and everything I've done in residency and medical school is a reflection of that. I did a research project about eye screening in South Dakota because of the really high rates of amblyopia, and we're one of the few states that doesn't have any vision screening. I saw an unmet need and I approached it.” Having a concise story that you can fit your accomplishments into really resonates.
And I know I already said it, but I’ll say it again—being very observant is one of the most important qualities in a fellow.
Dr. Terveen: Everyone has their own techniques—and when you get to a residency or a fellowship, you’re at a point where you know how you learn. I tend to learn really well by reading things. Also, I built memory houses [a.k.a. memory palaces] in medical school and in residency, and I still do that sometimes—for example, I build memory houses for all the medications. I find that that technique works well for things that involve a lot of categories.
When it comes to staying up-to-date, I follow people and organizations on Twitter, like the AAO (American Academy of Ophthalmology) and EyeRounds. It’s a great way to get snippets of important information and keep up with what’s happening. I also read every journal’s summary, and if there's something that catches my eye, I go back and read the full article.
In today's day and age, you don't have to memorize a lot of things. What you have to be able to do is know how to find the answers and have a sense of what to look for.
Dr. Berdahl: The best way is to think of yourself as an independent surgeon during your fellowship. You own this case. You own this practice. Have that ownership mentality going in.
One thing that we do—and that I think is helpful—is charge every fellow with bringing a new technology on board. They do the negotiating, the talking to reps. They figure out how it adds value and they’re the first ones to do that procedure, so they learn by doing and take those skills with them when they leave the fellowship.
Dr. Berdahl: We're honored and privileged to be entrusted with the most precious of human senses. Remember that privilege—even when you get a call in the middle of the night. Also, part of what we do is become capable before we're capable. So, act like you're capable and you will become capable. It's going through that refiner's fire that brings you out on the other side, and gives you the ability to handle the myriad things that are going to come at you.
Dr. Terveen: This kind of picks up on what Dr. Berdahl was saying. The hardest part of being on call as a fellow is that—for the most part—I'm the ultimate decision maker. That’s a change from residency, where you have a couple of levels above you. So having the confidence to say, “I know when I'm right, and I know when I need help” is the best thing that you can do. Sometimes there's no clear answer, and it's okay to get a second opinion.
Dr. Berdahl: As a fellow, you may be responsible for someone else's work for the first time. If you’re working with a resident, giving them autonomy while being responsible for their work can be difficult for people, but it's an important part of becoming a leader of any type. You can't do it all yourself. And frequently, you're able to connect better with residents because you're closer to their situation than an attending may be. If an attending is similar to a father or mother or uncle, a fellow is more of the big sister or older cousin. I would look at that relationship like this: You're responsible for their work, but you're also trying to encourage them to do that work. The benefit of all of that is they may be the person who’s looking through 200 case charts to write the case report, and you're just editing it. So if you can learn to leverage that, that’s a valuable skill and it can save you time.
Dr. Terveen: Also, it's a very guided, stepwise autonomy that you have. When you're a first year resident, you're not responsible for anyone. The second year, you're responsible for your first year residents. And as a third year, a chief resident, you’re responsible for the other residents and especially those on your service. So by the time you reach fellowship, you’re prepared well for it. I think most people can make the transition from chief resident to fellow fairly easily if they put the time in to really understand what their residents need. That's really all it comes down to, putting in the time and being willing to listen to the needs of the people that you're in charge of.
[Dr. Berdahl] is an amazing communicator, and that’s been one of the biggest things I’ve learned during my fellowship—communication is so paramount to leadership. I've also learned that the converse side of being a good communicator is being a really good listener. You have to be able to ask people the tough questions, listen to their answers, and do something about those answers. That, to me, has been so powerful, to see how important it is to really listen to people and be able to communicate.
Dr. Terveen: Really it's just asking. If it’s been done before, there's a world expert on it (and usually Dr. Berdahl knows them).
That’s one way to do it—and also, there’s so much good educational material out there. You just have to prepare. I'll watch all the videos I can. I'll read all the material I can.
Dr. Berdahl: Yes, the best fellows know what's coming on the surgical schedule and prepare for that. And to Dr. Terveen’s point, one of the advantages in ophthalmology is that we have such good surgical videos that you can learn from.
I don't expect anybody to feel comfortable with a surgery they've never done before.
It's always going to be uncomfortable the first time you're doing a new surgery, especially in a high stakes area, but you're doing this to become the go-to person for this surgery and you have to get comfortable with being uncomfortable.
Dr. Terveen: I'll sometimes draw it out. If it's a sutured lens, I'll draw out what their eye looks like, how their current lens is. And I'll say, “Okay, here's where my paracentesis is going to be. Here's where I'm going to take down the conjunctiva. This is the suture I'm going to use for this.” I played college sports, and it's kind of like visualizing the shot before taking the shot. I will mentally go through that surgery, because what the mind knows, the hands do.
Dr. Terveen: There are a lot of answers to that! One thing that Dr. Thompson and Dr. Berdahl and Matt Jensen, our CEO, talk about is the team. Your employees come first, and there's a couple of reasons for that. Your team members place their entire life in your hands, not just one patient experience, but 40 hours of their life every week. And so you have a big responsibility to them.
And how does that generate revenue? If you treat that person nice, and if you really care about that person, one, there's going to be a lot less turnover and turnover is expensive because it's expensive to train new people, and it's expensive to keep having to hire new people.
Also, my tech spends more time with the patient than I do. So if my tech is really happy and nice to patients, that reflects well on me. One of the things I hear a lot is, “Everyone is so nice here.” That word of mouth doesn't cost you anything, but it can bring a lot of revenue through the door. So I think one thing that fellows should really focus on is how important the team is, and caring for the team.
Dr. Berdahl: I'd add a couple things. One is do the right thing, and everything else will follow. Number two is don't waste time. Be efficient. Approach the ball quickly, take as much time as you need with your swing, but don't doddle between patients. The third thing sort of ties back to the team idea that Dr. Terveen brought up—you don't have to do everything. Whether it's working with optometry or training staff, you're playing a long game. The more you pour into your people up front, and maybe take a little more time, the more you'll benefit from that for the next decades.
The last thing I’ll say is that we’re in the best sub-specialty of the best profession within all of medicine, in the best country in the world. We get so much, so work every day at finding ways that you can give back.