Maximizing Comprehensive Ophthalmology Fellowship
Dr. Aman Khanna, MBBS, MS, FRCS
- Dr. Aman Khanna completed 3 year comprehensive + Vitreo-Retina/Uvea fellowship from Sadguru Netra Chikitsalaya, Chitrakoot.
- He did his graduation from NDMVP’S Medical College, Nasik under Maharashtra University of Health Sciences and his Post Graduation from D. Y. Patil Medical college, Pune.
- Currently he is practicing as a Vitreo-Retina/Uvea and Phaco consultant at Khanna Eye Centre, New Delhi.
- His areas of interest includes Retina Surgeries along with management of Uvea cases.
Q1. Why did you choose Comprehensive Ophthalmology with VR Fellowship?
A1. Since my Post Graduate days of learning the basics of ophthalmology, there was an inclination towards visualizing the Retina and various conditions associated with it. I still remember the curiosity to find a break in case of Retinal Detachment and the happiness when I actually was able to find one. Retina as a sub speciality always fascinated me.
Moreover, during my PG days we did not had a fully equipped Retina department, which even increased my inclination towards this unknown specialty. So, I was very sure that after my PG I had to choose Retina Fellowship.
To be very frank when I went for interview I was looking for exclusive Retina Fellowship and was very confused between exclusive and comprehensive Retina Fellowship as I did not had a good experience in performing Cataract surgeries.
One thing I was clear about, that after my fellowship I have to work in a private set up and to work in a private setup along with a speciality you need to have a comprehensive knowledge of all fields and a good hand in cataract surgery. So all this helped in choosing Comprehensive + Retina as my Fellowship.
Q2. What’s make Comprehensive Ophthalmology with VR Fellowship better than exclusive ones?
A2. I guess there has been lot of discussions on this topic on various platforms. In our institute (SNC Chitrakoot) a comprehensive Retina Fellow works in various specialties and general OPD for a period of 18 months during which we get trained in Cataract surgeries and by the end of 18 months you have had a good amount of experience in cataract cases, which I personally feel helped me a lot in reducing my Learning curve in VR Surgery.
Second point I want to share is that after fellowship whether you want to work in an institutional setup or want to work in Private practice, in case you want to do a Private Practice in future, doing a comprehensive Fellowship gives you an advantage as you will have to see and treat cases of all the specialties, so you have to be competent enough to manage those. It also depends on the fact that still there are many colleges/institutes where you don’t get enough basic exposure to various specialties during PG training.
Third is that after doing this combined fellowship it gives you more confidence be it as a phaco surgeon or as a Retina Surgeon as you can manage your complications by yourself
Q3. Why did you choose Sadguru Netra Chikitsalaya (SNC) – Chitrakoot for your fellowship?
A3. So, there is a word which is very common amongst young ophthalmologists i.e. “CUTTING”, particularly amongst those who probably did not get decent surgical exposure during PG days, which applied to me also and SNC was a place which is famous for volumes and probably this reason had a very important role while I was deciding for my fellowship training.
Secondly some of my seniors were pass out from Chitrakoot, who guided me. Also at present there are not many institutes that are offering a comprehensive VR fellowship.
But working in SNC changed my entire outlook. My mentors, consultants and colleagues actually reshaped my thinking which was earlier only focused on numbers, during my fellowship it changed to learning in Clinics, Academics, Presentations and discussions, all this ultimately makes you more confident as an Ophthalmologist and as it is said once you start moving in right direction everything starts falling into right places.
Just to add many people while thinking about SNC, Chitrakoot have a reservation about the place and how you will be able to stay there, to end this I would just say that more than the place what matters more is the Environment to Learn and SNC gave me that and I will always be obliged that I got the opportunity to work there.
Q4. What were your areas of interest?
A4. My areas of interest were always Retina Surgery as it was very fascinating to visualize the Retina and its details intraoperatively along with managing cases of Uveitis.
Q5. Is it mandatory to have had some surgical experience before joining Comprehensive Ophthalmology Fellowship?
A5. Not really because probably that is the reason why some people opt for comprehensive fellowship, most of the institutes offering comprehensive fellowships have their training structure designed in a way that they start from the very basics, plus you should be always true to yourself and your trainers about your past surgical experience.
Q6. How important is wet lab/simulator training according to you?
A6. “Tell me and I forget, teach me and I may remember, involve me and I learn.” This quote by Benjamin Franklin holds very true in any surgical field. For Retina surgery hardly any Institute in India have simulator training. Cornea and Phaco Surgeons are lucky in this aspect. I had experience of wet lab training in phaco and personally felt that it gives you more confidence as you learn to coordinate hand and foot movement simultaneously and also you learn the dynamics about the machine you will be working on, which will make you at ease while operating. This can indirectly be helpful in VR surgery as you need bilateral hand and foot movement.
Q7. Clinics, Research, Conferences and Surgery – please elaborate on each, your challenges and how you tackled them and experiences.
A7. I think all the above things are interrelated. If one looks at research as something that is a burden, then it will be. If one works by asking questions and try to find answers then it becomes more interesting and its easier to publish the answers to your questions. Moreover, working on case reports becomes easier in a high-volume center with good mentorship. The more you work in Clinics, more opportunity and ideas you get for research and more chances of your work getting selected in various conferences, hence giving you more opportunity to attend conferences.
One has to work diligently and see many patients as possible to get more experience.
Surgery is an ever learning art. In beginning of this experience I would say assisting your seniors and consultants in OT lays the foundation stone. As a Fellow you should try to assist as many cases as you can, as 50 percent of skill development begins there. Also, watching videos of seniors operating and reading along with assisting ample number of surgeries usually does the trick. Make a note of your complications (collect videos of your complications) and discuss it with your seniors where you went wrong, discussion definitely helps. Picking up small nuisances and making a difference makes a super-specialist!
Q8. How to build a good rapport with your mentor?
A8. Mentors are very experienced and they can identify a person who has a genuine interest and works hard. You cannot fool them. I have observed even if you are not an extra-ordinary surgeon but if you are a hardworking and an honest doctor, mentors can see that and everyone gets ample opportunity to do surgeries. No matter what complication happens, do not hide it from your mentor. Definitely, publication is a cherry on the top.
Q9. How important is the support of your colleagues?
A9. Not only fellowships I would say that in any stage of your career having a good and a rapport with your colleagues is very necessary for your growth.
Fellowship is a journey where you learn a lot of stuff related to your field and it can be very hectic at times with lot of ups and downs, in surgical related field there are many times you feel very depressed, those are the times when good co-fellows can be of great help and are able to guide you the best because they are also sailing in the same boat.
Often people see their co-fellows as competition but I would rather say that during your lows having a good rapport with them will prove to be your strength and allow you to excel.
Q10. How to cope up with the stress and not let it reflect in your work?
A10. Fellowship phase can at times be very stressful, which may be due to multiple reasons, long working hours, hectic schedule, academic activities plus pressure to learn everything as this is the last phase of your official training period and lot more things, so in these times as I mentioned above your colleagues can play a very important role in maintaining that balance, plus always get yourself involved in extracurricular activities taking place in your institute apart from academics as it keeps you lightened, more over no matter how hectic your day is going try to take out time to have a nice talk with your colleagues and friends.
Q11. Quick checklist for young aspiring Comprehensive Ophthalmology fellows to follow during their fellowship.
A11. Keen interest in retina, patience, urge to learn and read and hard work is important.