On being a beginner: When does the fear start to fade?

Key Points

Everyone who enters an ophthalmology residency program in the United States is a smart, high-performing, motivated individual. Each of us typically has been near the top of the class along the way and rarely is unable to meet the various challenges that are faced.

Then we start an ophthalmology residency and realize that although we have a will to learn and perform, we don't have the means. Indeed, it turns out that although our years as medical students and interns helped us acquire general medical skills, time-budgeting strategies, and the ability to speak with patients-as well as much about ocular anatomy, ocular connections with the central nervous system, and the ocular manifestations of systemic diseases-they did little to prepare us for the day-to-day workings of ophthalmology.

The list seems endless.

Of course, that is quite frustrating and universally felt, as my friends at other programs throughout the country will attest quickly. Rationally, we all realize that our skills will improve and that those basic questions will fade away, replaced by more sophisticated ones, but this does not help in the moment. We still stink at clinical ophthalmology during those first weeks in July. Worse, the frustration is complicated by an unwelcome companion: doubt. Did I miss something? Am I actually helping this patient? Do I have any idea what I am doing?

Another endless list.

Now, with doubt on top of frustration, it becomes a little harder to see the bright side of things, but it is still possible. We are expected to need some help in the beginning, and upper-level residents, fellows, and faculty can assist us. Thankfully, they are very responsive to our collective need for help, aid in our growth, and provide needed encouragement. Perhaps they remember what it felt like when they were starting out. Deep down, we know those feelings of frustration and doubt are only temporary.

But incredibly, frustration and doubt are not what make the first year tough. What makes it tough is the realization that your frustration and doubt may lead you to provide suboptimal care to your patients. First-year residents just have not yet seen, read, or been exposed to enough of ophthalmology to provide excellent care consistently. We need more experience. Our patients trust us to make them better, to help them see, to reduce their pain and discomfort. That expectation, in the setting of frustration and doubt, leads to a far more troublesome emotion: fear. Maybe I missed something dangerous. Maybe I should have asked for more help. Maybe I did not help at all. We recall our obligation as a physician, taught on the first day of medical school: primum non nocere. Did I actually cause harm?

A third painfully long list.