What they don't teach you in medical school

Dr Clare Quigley, winner of the 2017 John Henahan Prize for Young Ophthalmologists As a myope, wearing glasses and then contact lenses from the age of 11 or so, I had regular contact with optometrists during secondary school, but I had no awareness of ophthalmology. In school I liked maths and science, and writing always interested me, but medicine was enticing. Leaving secondary school, I had to decide between medicine or a more literary degree. I reconciled my dilemma by concluding that I could be a doctor who writes, as one of my favourite authors Somerset Maugham had done, but I could not be a writer doing medicine on the side. I studied medicine in Trinity College Dublin, and first came across ophthalmology in the summer of my second year. My Dad’s cousin Veronica Ferguson practises as a cataract and squint surgeon in London, and during that summer I opted to do an elective with her, to see what her day job was like. My first day in London started with a trip to the theatre – in the Western Eye Hospital. I was a complete novice to scrubs and the surgical environment; where to stand to avoid getting in the way was my learning goal on the first day. That morning I saw cataract surgery for the first time – blown up on the theatre screen. I found it inescapably nauseating; I recall admitting feeling sick to the other medical student, and retreating to the theatre tea room for a sit-down. I recovered from the initial shock of seeing eye surgery in the flesh, and went on to watch a series of cases. Over the morning list I got used to seeing blades slicing corneas, and instruments manipulating cataracts out and lenses in, to the tune of Magic FM playing out softly, and the low hum of the phaco machine. I saw that the surgery was neat and clean, and I became familiar with the repetition of steps, case after case. During the elective I was lucky enough to be allowed access the EyeSi machine upstairs in the Western Eye. Playing with the simulator, I learned that the movements, initially unfamiliar and overly minute, with practice got smoother and easier. During that fortnight, I watched Mrs Ferguson perform elegant, life-changing cataract or squint surgeries, admiring her handiwork. In the following academic year we formally began ophthalmology in college. Our lecturer, Professor Lorraine Cassidy, was an impressive woman. She frightened us with unmissable eye emergencies, and enthralled me with the prospect of a specialty where the diagnosis was in plain view, and efficient, effective surgeries were performed. We moved from didactic lectures to our hospital placements; mine took place in the Royal Victoria Eye and Ear Hospital. My tutor there, Sorcha Ní Dhubhghaill, had an encyclopaedic knowledge of her subject. She was kind enough to take a small group of enthusiastic students for extra teaching sessions during her free time on Saturdays, to prepare us for the optional Duke Elder Prize exam. It was easy for me to rule out the other medical specialties after seeing how exciting ophthalmology was; with the added bonus that ophthalmologists seemed a content group overall, with a decent work-life balance. A period of investigating the postgraduate route towards eyes encouraged me, but also impressed on me how competitive the job market would be. Ophthalmology was a popular choice, and the number of training posts were limited. I knew that I would need to get good grades, and add in some extras, including research, to get onto the training pathway and progress. In my third year of college, I sat the Foundation Scholarship, or schols exam, available to Trinity students. I was awarded the schols bursary, and that provided me, along with accommodation and meals through college, the funding to take a year out to do research. I settled on a Molecular Medicine MSc, incorporating an Erasmus sojourn in Strasbourg, France. In Strasbourg, I did laboratory research in a retina lab, characterising the elusive intrinsically photosensitive retinal ganglion cell. This gave me an appreciation of the resolute determination required 
to carry out research in basic science, when disappointingly often the cells might die, or the experiments would fail. After medical school and a year of general internship, I started as a junior doctor, or basic specialist trainee, in ophthalmology in Galway University Hospital. The learning curve was steep – at the start I did not know what I did not know, and that was frustrating. Happily, I always worked as part of a team with a registrar and consultant. I had some very patient colleagues who could be called on day or night; they taught me how to examine, how to deal with emergency referrals, and they walked me through my first steps in cataract surgery. My enjoyment of my work increased with each new skill acquired. I learned what I now consider to be most important in my approach to work, something not overtly taught in medical school; a good attitude towards my patients and colleagues. Since early days of medical school my writing had been left aside, and I wrote only in my research, bowing to the time demands of medicine. Lately I got involved with producing the newsletter for the European Society of Ophthalmology – Young Ophthalmologists section, but otherwise I was not writing. Luckily, an ad for the John Henahan Prize caught my attention last year. I found the topic interesting and easy to write about, and was delighted to be nominated, and honoured to be ultimately awarded the prize. I did not realise it would include, on top of a generous bursary to travel to the ESCRS annual meeting, a fine trophy, in the shape of a palpebral fissure-framed eyeball – awaiting pride of place on display when I eventually have my own office. This dream became a little more real since I won the writing prize, as I was just this year awarded a post as a specialist registrar in ophthalmic surgery in Ireland – a progression not guaranteed to those who start out as junior trainees. Now I look forward to continuing to learn and develop my skills, topping off my training with a subspecialist fellowship abroad soon, alongside continuing writing.

• Clare Quigley is a third year resident in Sligo University Hospital and was the 
2017 winner of the John Henahan Prize

Tags: training, young ophtalmologists