Dr Claire Quigley is an Ophthalmology Trainee in the Royal Victoria Eye and Ear Hospital in Dublin, Ireland. She talks about the ups and downs of training in Ophthalmology, her plans for the future and how she maintains balance as a surgical trainee.
You were one of those people that always knew that you wanted to practice ophthalmology. How did you decide on it?
I knew for a good while yes. Since early med school it had been on my radar, but I had an open mind until about second year. Early on I heard about it as my dad’s cousin is an ophthalmologist in London. Then, I did an elective in second year with her, and it just seemed like a rewarding job.
What did you like about it?
I like the job satisfaction; when you improve the vision of someone who’s blind, whatever the cause, it’s quite life changing for them. When you treat people, they are usually happy after, although it sounds like a small thing. You can also make an impact without being constrained by the other factors affecting the patient. I think those things are important but it’s nice to be able to focus on one thing in ophthalmology. The diagnostics and in the emergencies we see are also interesting and you can treat them quickly.
How often would you see emergencies in ophthalmology?
It’s quite variable, whenever I’m on call, we sometimes see things like perforating eye injuries but they that don’t come in that much. That being said, you wouldn’t expect to be the primary surgeon for those until you are more experienced. Sometimes we see extreme things. For example, there was a person I saw recently; a farmer who got gored by a cow in the eye, tragically. That was quite a bad injury, unfortunately he is unlikely to regain much sight. And there are occasionally some eye traumas and assaults that would come in. Those would definitely be the more extreme emergencies we see!
Did you get on the scheme immediately after intern year or did you do a stand alone job?
Yes I got on after intern year. I think it had been helpful to know from quite early on in college that I wanted to do it, so I could prepare a good application. One thing that was helpful was being able to take a year in Trinity to do an intercalated masters, in Molecular Medicine. During that year, I worked on an ophthalmology-related project. From talking to some trainees, I knew that most people applying had publications and/or a higher degree so it certainly helped to have that done. I sense that it’s got a lot more competitive since I got on. Some people have to apply multiple times and maybe have a bit of experience before getting on the scheme.
As you say, ophthalmology is a very competitive scheme. What do you think made the difference for you?
One thing was the early interest during college, I was able to focus the things I did on ophthalmology such as electives and the masters. There is also a competitive exam called the Duke Elder. It’s an optional ophthalmology exam that you can do in the UK or Ireland. I think about 600 people do it and it’s a notable achievement to rank in the top 20. I was ranked in the top 5%.
Another important thing, if possible, is doing an ophthalmology job in intern year. There aren’t many where you do a rotation in ophthalmology. I did the one in Galway and that was a really good experience. I think if you’re interested and to really have a good chance, there are a few things to get started on.
If you could wish something away in ophthalmology, what would it be?
Difficult question, as ophthalmology is a pleasure to work in! One thing that comes to mind immediately, and maybe it’s just because I’m coming towards the end of training, is the job security aspect. It’s something to think about when picking a subspecialty. At the moment there are not many new Consultant posts, but maybe that will change. Another aspect is the high volume in ophthalmology. Sometimes that can be nice, because you’re busy and you get into a good flow, but sometimes it’s pressure. When you’re on call and the emergency department is full of people it can sometimes feel never ending, but it comes as part of the training.
Obviously you’ve done well, you got into the scheme from intern year. Do you think there’s an advantage to getting some experience before going in?
I think there would be an advantage to working in the specialty for a while, especially if you’re not certain. And these days it’s gotten much more competitive, to go straight into a training scheme would be unusual. if you can work on research at the same time, as getting experience, that would be ideal.
How do you stay grounded while keeping up with the challenges of training?
Well I have a baby, not a baby actually, now a toddler. So that’s keeping me pretty busy. It has been challenging. But it’s been useful having my husband do the dropping and collecting, he is not a doctor, he’s a lawyer so his hours are better. And the grandparents are fantastic, especially when I’m on call. We’re slowly starting to get back to getting out, and going cycling. We’ve even got a bike seat for the little one!
You got into writing as well…How did you get into it?
Writing was something I got into quite early on in secondary school. For me the question was: Would you go for medicine or pursue something related to writing?. I hadn’t written fiction but I just liked it. I liked Somerset Maugham a lot. Then I realised you could do medicine and write. So at the moment, there is a magazine that I’m contributing to. It’s Ophthalmology related, a cataract surgery magazine, with a good circulation in Europe and abroad. It’s about life in Ophthalmology. I’d like to figure out how to flesh out an idea for fiction, but I have not gotten my head around it.
Talking about the difficulties that women would face in surgical careers. How much of it do you encounter in ophthalmology?
Yeah I think it is an important thing. People don’t talk about it that much, but if you want to have kids and do surgery then they’re things that you need to think about and plan out. There might be situations where people delay having kids and then have problems starting a family in future. So I think it is good for people to be facilitated to start during training, if they want to. I found talking to people who are ahead of me who had done it really helpful, as well as having good supports around.
There’s the concern that you miss a chunk of time depending on how much time you take off. I certainly had a little fear- would I become rusty with my surgical skills? I was reassured from moms that are surgeons, that actually you won’t deskill. It’s a bit like riding a bicycle. And I found that to be true.
If you could improve something, about training in ophthalmology in Ireland, what would it be?
I think the training here is great, especially compared to the limited exposure and surgical training that I have heard can happen in some other countries in Europe. You’ll get your hands on training, it’s just accessing it that is tricky. I think it will always be a bit competitive. It is a wonderful career, that will continue to be attractive. I think there could be a bit more clarity for applicants, with regards knowing what their chances are and what they should focus on. It could help people in making alternative plans if they need to.
What major advances do you see coming in ophthalmology?
Well one thing is AI for optical coherence tomography. In the UK, research groups are finding AI can diagnose retinal conditions fairly accurately. The machines are still very expensive, but if they get smaller and cheaper, that will make a big difference.
Then there is the femtosecond laser, which is used to replace manual steps in cataract surgery. But it’s a large expensive machine, and at the moment it doesn’t improve outcomes versus traditional manual phacoemulsification cataract surgery. Femto isn’t widely in use in Ireland or in the UK in cataract surgery. Maybe if they get the machine a bit smaller; at the moment I don’t think it would even fit in our operating theatres!
What advice would you give someone that wants to go into ophthalmology in med school, or in intern year? What would be the important thing for them to start doing now?
So in med school, the Duke Elder exam is something you can do. It doesn’t matter how many times you do it, but it has to be done before you graduate. And then think about doing a higher degree, like either a master’s or an MD. Some people go straight for a PhD but I think it’s worth working in ophthalmology before committing to that.
One thing I didn’t think of when I was applying, is whether you actually have good enough vision and depth perception. You need to have good stereopsis, and you can test that. Every ophthalmology department has equipment for testing stereo vision. So you can screen yourself, or get screened; Frisby plates are handy for testing yourself. I think it is tested in the UK, for prospective ophthalmology trainees, but not tested yet in Ireland. It is important for the job, but you certainly don’t need 20/20 vision unaided, a lot of us are myopic.
