Ophthalmology training and teaching in India: How these young ophthalmologists can become leaders of tomorrow?

Sir,

The editor and editorial board of Indian Journal of Ophthalmology deserve applause for publishing excellent editorial/articles in the June issue of IJO. Residency training is one of the crucial phases in a doctor's life which transforms a theoretical generalist to a practical specialist geared up to take on the responsibility of caring for patients. Ophthalmology offers the adrenalin rush associated with performing delicate sight-restoring surgeries, yet the eye specialists do not deal with stressful life and death situations. Throughout the years, the surgical training process in ophthalmology has progressed from unstructured apprenticeship to limitless period in the past, and then in the 20th century shifted to a Halstedian pyramidal structure and currently on consistent rectangular model with specified timeline.[1] However, the “See one, do one, teach one” concept of the Halstedian model is still ingrained in the residency.

Several authors emphasized that ophthalmology residency training in India still needs to be improved significantly.[234] Without proper and updated residency training system in a majority of medical colleges in India, how would young ophthalmologists become the leaders in their field? In India, 60% residency training for ophthalmology is under government-run organizations while the remaining are private institutions.[5] The imparted training is typically done in various settings such as medical colleges (including regional institutes) and private institutes. There is not a coherent training system followed by all which leads to huge variations in quality of training. It is important to ensure that residents in India observe (and perform under supervision, if possible) a good variety of ophthalmic surgeries.

The shortage of standardization shows the need for a stronger regulatory authority to make these changes and implement them efficiently.[67] It is important to have such a training system which focuses on the actuality of the learning process, human resources, and the infrastructure. In addition, the training system must be need-based. Standards must be established and followed. There is a dire need to emphasize the residents’ role as researches and teachers throughout their residency to encourage them to become leaders.[8] This is one of the major parts of competency-based curriculum for residency training of young ophthalmologists around the globe.[9]

There is a strong need for the authorities to do major rethinking and correction in the curriculum and training system.[10] Numerous ophthalmologists have stressed the need of establishing a fresh training system for the residency students in ophthalmology.[11] Moreover, it has been stressed that the potential of young ophthalmologists of India must be encouraged to take the leadership role. This can be done if the residency students have a great foundation of teaching and training. Two examples deserve special mention here: I-Focus, National Postgraduate Education Programme in Ophthalmology and Academic and Research Committee (ARC) wing of All India Ophthalmological Society (AIOS), both have done commendable work to update residents in basic and cutting-edge ophthalmology and helped them to prepare for leadership role.

Residents in training would play a major role in shaping up in to the future leaders of ophthalmology, if they have all the essential elements – patient care, skill-based practice, practice-based improvement, and learning, professionalism, communication, and interpersonal skills leading to their continuous professional development.[12] The training system must provide them a chance for open-minded learning of comprehensive ophthalmology and a broad-based approach. It is up to the coordinators of residency training and ophthalmology heads of various institutions to come up with the will to make these changes and also to lead this change throughout ophthalmology in India. There are numerous ways these changes can happen – a teaching schedule, one-on-one mentorship for residents, encourage young ophthalmologist to teach, management of their time, and reorganization in the departments.

There are numerous ways through which these young ophthalmologists can become leaders of tomorrow. First, it is essential for them to find the right mentor, someone who is genuinely interested in helping them adapt leadership qualities instead of someone who hardly offers any useful advice. Most importantly, they have to actually listen to their mentors, even if it is a hard feedback. Moreover, young ophthalmologists need to become more proactive if they truly want to become future leaders.[13] There is no point in waiting for someone to hand them the responsibilities; they need to show their mentors and leaders that they have what it takes to be in a leadership role. These future leaders should also be engaged in member ophthalmic organizations and participation in national and international ophthalmic conferences right from the initial stage.[14] Another important thing these young ophthalmologists must consider is stepping out of their comfort zone. They must trust their education and training and must not be afraid to learn new technique and skill that can open more opportunities for them to move on to leadership roles.[15] It is essential to keep in mind that these young ophthalmologists are the future of ophthalmology. Using innovative teaching styles and techniques to help today's technically driven residents to learn more efficiently. We admire sincere efforts of Dr. Santosh G. Honavar and the entire editorial team of Indian Journal of Ophthalmology for publishing valuable suggestions that are needed to be taken to make immediate changes in training and teaching in ophthalmology residency to ensure a bright and prosperous future of ophthalmology in India.

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Conflicts of interest

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