Insights from Moran's First Ophthalmic Hospitalist

Theresa Long, MD, balances her love of teaching with clinical and surgical skills as she guides first-year residents through three months of consult rotations. Ophthalmic hospitalists like Long evaluate medically complex or critically ill hospitalized patients with emergent and urgent ophthalmic conditions and collaborate with other hospital services to provide interdisciplinary care. Here, she shares insights about her new position.

Patient-Based Learning

Doing rounds with ophthalmic residents in hospital settings—from the ER to pediatric wards—allows them to learn how to manage clinically complex patients experiencing a range of ocular pathologies. Because residents actively assess patients, it’s the perfect scenario for patient-based learning.

In most cases, I directly observe the residents taking patient histories and performing exams while I scribe for them. Some residents prefer to watch and learn as I take the lead. It can go either way. Then I ask key questions of the resident. What is your differential diagnosis? What are your next steps in management? What are your plans for follow-up? If they miss something, we work together as a team to address it and identify what it was. It’s terrific training for oral boards.

Theresa Long, MD, left, and resident Mubarik Mohamed, MD, make rounds recently at the University of Utah Hospital. Their fully stocked roller suitcase includes everything from tonometers to a portable slit lamp and toys to engage pediatric patients.

Continuity

The consults rotation requires residents to think like a clinician from day one. They’re assigned a patient and will often follow that patient through his or her hospitalization. The resident may even see the patient in another subspecialty clinic for follow-up once they have rotated off service. At the beginning of each month, we talk about the resident’s goals. After they identify an area they want to gain more experience in, which could be anything from neuro-ophthalmology to oculoplastics or retina, we ensure they have a chance to develop their skill set. It’s an adult learning philosophy where the learner is in the driver’s seat and an excellent confidence-builder.

Collaboration

Since we have access to faculty practicing in every subspecialty at Moran, residents often get unique consulting benefits. A resident, for example, may consult with neuro-ophthalmology for a stroke workup, or with the cornea service while caring for a patient in the burn unit.

At the other end of the spectrum, I learn from residents. That can happen when we’re between cases and talking about papers they’ve been reading, or when they’ve been researching a case and I ask them what they have learned.

I also try to share literature on such things as landmark treatment trials related to the pathologies we’re treating.

The rotation allows me to share pearls for various types of exams with residents in other services, such as ER. For instance, they need to learn the difference between an abrasion and an ulcer, and how to use a slit lamp.

Of course, all of this is only possible with departmental support that prioritizes quality patient care and resident education.

Theresa Long, MD, left, and resident Mubarik Mohamed, MD, discuss a case as part of their consult rounds.

My time on the consult rotation was a richly educational experience. It gave me the confidence to care for a myriad of patients under the supervision of an excellent mentor. Without a doubt, this rotation has enhanced the educational quality of residency at the Moran Eye Center.

—Mubarik Mohamed, MD, resident

Learn More

The Ophthalmic Hospitalist Interest Group (OHIG) provides comprehensive information for ophthalmologists interested in this emerging field. More information can be found at ohig.org.