Published in Non-Clinical

Save, Edit and Collect: How to Build Your Personal Case Bank in Ophthalmology Residency

This is editorially independent content
7 min read

Collecting, editing, and sharing clinical images and videos can help to ease the transition to practicing ophthalmology. Discover the most effective and efficient process, and take the first steps towards being an educator and a leader in the field!
All of a sudden, you are on your own. Just weeks after reaching the finish line, despite the long hours, medical training quickly becomes a fading memory. A new, equally challenging, and exciting journey begins. It is the transition from being a student to becoming a teacher, from being a follower to becoming a leader, and from being anonymous to becoming a brand. Although this can be fraught with many ups and downs, there are some measures that can be taken to smoothen the journey.
One in particular which I have found to be helpful is maintaining a mindful habit of collecting clinical images and videos. The aim of this article is to describe the process by which this can be accomplished and to exemplify how it can pay significant dividends towards launching a career.

What is interesting? Save first and decide later

Many have heard the analogy of “trying to sip water from a fire hydrant” used in describing the digestion of all the new medical information at the outset of residency and fellowship. It is true that current medical training does little to teach graduating students the breadth of eye pathology, let alone the basics of how to practically examine patients. When each case can provide a new learning point, and the goal is simply to not be overwhelmed, one must foster the skill of identifying unique and significant clinical insights.
Moreover, with surgery, the characteristics that can make for intrigue may not be initially clear. It could be an unusual finding once the blood has been cleared with a vitrectomy, possibly a rarely encountered complication that the surgeon would rather forget, or even a nematode surprisingly removed alive (see attached video published in OSLI Retina and presented at American Society of Retina Specialists meeting).
The reality is that it is difficult to know what content colleagues will find interesting when everything is new as a trainee. A good first step is simply to save. Make digital copies of your medical case photos and patient imaging, and keep the ID number so you can later gather the relevant encounter details. For surgical cases, record every case and have the ability to use hindsight for review. Then, at the end of the day, download those with any potential to be of interest onto a high-volume portable electronic storage device.
Given the sheer volume that a resident will encounter, the exercise cannot be procrastinated, but rather should be a pattern you maintain with small, repeated efforts. It’s worth noting that you should be sure to scrape unique patient identifying health information (e.g., names, birth dates) from images and videos so as to maintain patient privacy and confidentiality. Also, ensure your clinical database is encrypted with a password or biometric safeguards.

Watching the game tape and editing to learn

Once the content has been collected, the next step is to edit. It is ideal to shape the content soon after the case while the details are still fresh. Cropping the photos and placing them in a slide presentation along with the case history is certainly tedious. The endeavor to cut the two-hour surgical video into a three-minute digestible summary seems like it will never pay off. There are, however, benefits of this process that are over and above those of sharing the finished product.
In terms of the videos, editing can be akin to studying game footage in sports. Reviewing film has been well-cited as a path to success by some of the greatest athletes of our generation.

From Kobe Bryant:

“I went from watching what happened, to what could have and should have happened. Film study eventually became imagining alternatives, in addition to the finite details of why some actions work and others don’t work.”

In the heat of the moment, when focused on achieving the mission of the surgery in the time allotted, critiquing the methods and technique of oneself or the attending are not at the fore. Yet, once the dust has settled, some of the greatest educational gains can be in a later review, with or without mentors, in a stress-free environment. The analysis of surgical ‘game film’ will help create decision-making ability and build self-confidence in order to prepare for that daunting moment when you finally begin operating alone.

Share with the world!

Now it is time to see how all this work can start to pay off as a newly certified eye specialist. Within ophthalmology, partly owing to the visual nature of the encountered pathology, there seems to be an endless appetite for educational materials. Soon after graduation, the call will come to teach the next generation. Perhaps this is via board review for the residents or as the retina specialist lecturing the neonatologists on the subject of the latest treatments in retinopathy of prematurity.
Teaching is not limited to an academic setting; in private practice, new hires are often asked to give talks to their local optometric colleagues in order to establish themselves as a target for referrals, as well as a key opinion leader in the community. Having this convenient clinical bank to pull vignettes from enables the presentations to be drafted with ease, efficiency, and integrity.
In addition to live presentations, this same content is increasingly being utilized by providers to gain notoriety by sharing with a worldwide audience through professional social media accounts (e.g., Twitter, LinkedIn, Instagram).
Moreover, prominent organizations are likewise beginning to take note of the value of digital media. Both the American Society of Retina Specialists and the Retina Society now contain a session for podium presentations of noteworthy cases at their annual meetings. The highest impact factor journals—Ophthalmology, JAMA Ophthalmology, and the American Journal of Ophthalmology—are similarly publishing and giving citations for unique images, clinical challenges, and surgical videos. Without having to be necessarily skilled in research or statistics, these can be avenues to contribute to the literature and build a curriculum vitae.
There is a clear benefit in saving and editing educational material gathered simply from everyday residency training. The content can be used to develop your knowledge base and skills which will help to ease the transition to practicing ophthalmology. Share your collection with the community, via social media, live presentations, and journal publications as the first steps towards being an educator and a leader in the field!
Nimesh A. Patel, MD
About Nimesh A. Patel, MD

Dr. Nimesh A. Patel specializes in the medical and surgical treatment of vitreoretinal diseases. His clinical interests and expertise involve working with both adult and pediatric patients, He is an active member of the Retina Service at Mass. Eye and Ear, as well as at Boston Children’s Hospital, where he is the Director of Pediatric Retina.

Dr. Patel is an innovator with a passion for clinical research and online education platforms. He has published numerous original peer-reviewed research articles and textbook chapters spanning a range of subjects including surgical techniques, retinal vascular diseases, intraocular lenses, retinal imaging, and ocular infections. He is on the editorial board for the American Journal of Ophthalmology and hosts their podcast. In his spare time Dr. Patel enjoys playing tennis, reading and exploring the world.

Nimesh A. Patel, MD
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