Maximizing Pediatric and Neuro-ophthalmology Fellowship

Dr. Jenil Sheth, MBBS, DNB, FICO (UK), FLVPEI

Dr. Jenil Sheth is currently practicing as faculty in the Department of Pediatrics, Strabismus and Neuro-ophthalmology at Child Sight Institute, L V Prasad Eye Institute, located at Hyderabad, India.
He did his residency at LVPEI, MTC campus Bhubaneswar and completed his Fellowship in Pediatric and Neuro-ophthalmology at KAR campus, L V Prasad Eye Institute, Hyderabad in 2018. Following which he joined as faculty in Jan 2019. His core area of interests are amblyopia management, complex strabismus and neuro-ophthalmology.
He has keen interest in research in the field of strabismus and neuro-ophthalmology and has publications and presented his work in many national conferences.

Interview

Q1. Why did you choose Pediatric Ophthalmology & Strabismus Fellowship as your Superspeciality of interest?

A1. The 2^nd year of my residency gave me better perspective of what I really want to pursue after my residency. Given I had really good exposure to all subspecialties in ophthalmology during my residency, it was a hard task to choose one. Unlike what most believe, I found strabismus very interesting and at the same time pediatric ophthalmology fellowship gives complete exposure to comprehensive pediatric eye care. With added exposure to neuro-ophthalmology, I guess it gives one a wholesome experience and knowledge.

Q2. Why did you choose LVPEI for your fellowship?

A2. In my opinion, L V Prasad Eye Institute offers the best of all aspects of fellowship training, be it surgical exposure, wet lab training, research – writing and publishing, critical analysis of subject, patient care, academics. Unlike many places country and worldwide, pediatric ophthalmology fellows here at L V Prasad Eye Institute have additional exposure to neuro-ophthalmology, neuro-radiology, general pediatrics, ROP and pediatric cornea to some extent. All in all, it is the one stop for everything you can aspire for.

Q3. What were your areas of interests?

A3. My core areas of interests are complex strabismus, Neuro-ophthalmology and Neuro radiology.

Q4. Is it mandatory to have had some surgical experience before joining Pediatric Ophthalmology & Strabismus Fellowship?

A4. I wouldn’t say mandatory, but one can go early into pediatric cataract training, if one is trained in SICS/Phacoemulsification. Unlike what it is believed, pediatric cataract surgery is far different from adult cataract – both surgical aspects and post-operative management.

Q5. How important is wet lab/simulator training according to you?

A5. My core areas of interests are complex strabismus, Neuro-ophthalmology and Neuro-radiology. Very important. I believe, if one is unable to get enough confidence and surgical exposure in their residency, wet lab is must before you dive into surgeries during fellowship. However, even with past surgical experience, wet lab training is all about learning tricks of trade as well as teaching each other. Right to the bottom of details like holding instruments, adjusting your microscope, maneuvers of wrist, hand-shoulder position during surgery – each detail can be looked into and get yourself accustomed to before you touch a child’s eye.

Q6. Clinics, Research, Conferences and Surgery – please elaborate on each, your challenges and how you tackled them and experiences.

A6. If asked, the most important aspect of your fellowship training – it is your clinics – one can’t learn from anywhere else but from their patients. Surgery, academics, research, conference will follow in this sequence. However, this is my opinion. One can approach in any way; important aspect is to keep a balance in everything you do.

Research: Start with simple case report, photo-essay, target journal where acceptance chances are more. Take help of your mentors. Rejection is a part of this process. Every rejection teaches you more and one gets better and better every time. In the first 6 months of your fellowship target a long-term study – ideally a prospective study. If nothing is feasible, even retrospective study would do. Be clear with your objectives and make sure of doing thorough literature search. Most importantly, make sure at least a manuscript is ready for submission before end of your fellowship.

Conferences: I believe this is another important aspect of your overall training, right from your residency days. Take help from your mentors and seniors, target conferences which focuses on areas of your interests. I believe, one should look ahead for presenting good and robust work in 2 national and one international conference in 2 years of your fellowship. There are plenty of conferences nowadays to look forward to – AIOS, POSN, State conferences and Internationally – AAO, AAPOS etc.

Surgery: End of your fellowship one should be confident in managing all kinds of pediatric cataract and complex strabismus. It might not be possible to do all types of surgeries in your limited time of training; however, key is to learn all aspects from your mentors and consider each surgery case as your last case during your training. This helps to avoid complacency, get more focused and being more attentive to details.

Q7. How to build a good rapport with your mentor?

A7. A lot depends on your mentor during your fellowship training. The mentor-mentee relation is not only during your training, it lasts for your lifetime. I believe one should become a shadow of your mentor during your training period. Though it is important to get opinion and exposure from all, as in this world of super specialty, one person might not be doing everything in area of your interest, but learning from single mentors offers you more focused learning experience and support for lifetime even after your training period.

Q8. How important is the support of your colleagues?

A8. I guess, in certain aspect support from your colleagues, play as much important role as much as your mentor. I believe it really played an important role in shaping up any surgical and clinical skills. Reading, discussions and sharing experiences with colleagues makes your fellowship training period not only fun but very beneficial.

Q9. How to cope up with the stress and not let it reflect in your work?

A9. There is no single mantra. In my personal opinion, pediatric fellowships are not very hectic as compared to cornea and retina. I think there should be enough time for everything, provided if planned well in advance. First 6 months are important but can be overwhelming to one whereas last 6 months can be hectic and stressful. Mantra is to be patient and calm, devise timelines for everything and making sure to give enough time to family and friends.

Q10. Quick checklist for young aspiring Pediatric Ophthalmology & Strabismus fellows to follow during their fellowship.

A10.

Be sure that you really want to deal with children all your life – as much naïve this sounds, it is the single most important factor.
If one is interested in neuro-ophthalmology too, look for institute that offers this combination.
Plan everything in first 6 months – academics, clinics, research, conference for next 18-24 months.
At least one textbook – cover to cover is must to get your basics absolutely clear – Von Noorden, Kenneth Wright, Rosenbaum- you may choose any.
Read all latest journal articles and be updated – JAAPOS, JPOS, JNO, IJO are few important ones.
Please read everything about surgery- wet lab training is must and good- but not enough, reading about techniques, new approaches, management of complications makes a you a better surgeon.
Give your time to clinics as much as possible, be patient, learn art of how to examine a child, watch surgical videos- your own and others – remember you learn the most from others mistake as you would not have enough time to make all mistakes.

That’s it folks! Hope I can inspire some of you!