Fellowship training in India: How to produce leaders?

Abstract

“If a person masters the fundamentals of his subject, and has learned to think and work independently, he will surely find his way,” is what Einstein once said. The quality and structure of the various Retina fellowship programs in our country is quite varied with the result that some of the programs produce “specialists,” but sadly, inadequately trained to manage common retinal conditions in patients. The Vitreo-Retinal Society of India (VRSI) recently conducted a survey of young retina surgeons to get a sense of the prevailing mood among them about fellowship programs in India. Invariably, across all programs, the emphasis is on technical aspects of diagnostics and surgeries. Approximately 20% of fellows had performed < 10 vitrectomies in the entire duration of their fellowship, although > 30% had performed > 100 vitrectomies. More than 25% of them had not done any case of diabetic vitrectomy, internal limiting membrane (ILM) peeling, or epiretinal membrane peeling during their fellowship. More than a third of those who responded were not confident of doing surgeries independently immediately after their fellowship, and felt that their programs needed re-structuring. There is hardly any time allocated for research, critical thinking, and communication with patients. Interestingly, the survey showed unusually high variations among faculty within a single institution. However, compliance with minimum standards is what should be expected from fellowships. It was satisfying to note that all fellows had presented a minimum of five cases or journal articles during their fellowship. However, many of them did not get a chance to attend CMEs or major conferences during their fellowship. Not surprisingly, many of the doctors surveyed wanted to have additional knowledge on trade and industry, which could help them choose the appropriate equipment and consumables when they start their practice. The All India Ophthalmological Society (AIOS) has formed a draft curriculum, which needs further description and has to be shared with all program directors for implementation. AIOS and VRSI should take the lead in ensuring compliance among fellowship programs with these guidelines. The list of compliant programs should be made available on the society websites, so that applicants to these fellowships would be aware of the standards in their programs. This could be used to implement minimum standards among Retina fellows trained in India for clinical, research, and presentation skills. While it may not be possible to ensure strict compliance as the societies are not statutory bodies, voluntary compliance of programs should be encouraged and highlighted. Recently, India has seen a spurt in the number of publications, research presentations, surgical videos, and attendance in general at various national and international meetings. While this is a positive sign, we need to improve the standard of research, for which adequate training has to be imparted. Independent thinking should be encouraged by way of research fellowships and interactive fellow's forum, especially designed for fellows across the country should be initiated. India also has a large pool of patient population, and there is a great scope of conducting network trials. The next step is to have a talent pool of doctors with knowledge of clinical trials and provide a platform for large-scale randomized controlled trials. More importantly, programs also need to think beyond technical training and impart the value of critical thinking and imagination. To quote Einstein again, “Imagination is more important than knowledge,” and we must enable the next generation of Retinologists for the challenges ahead. About the author Dr. Raja Narayanan is the Honorary Secretary of the Vitreo-retinal Society of India. He is also the Head of Operations and Systems, and Director of Clinical Research at L.V. Prasad Eye Institute. He is an adjunct Professor at the University of Rochester, New York, USA. He completed his medical degree and residency in Ophthalmology from Maulana Azad Medical College, and Retina training at the University of California Irvine, CA, USA, with Dr. Barry Kuppermann in 2005. He did his MBA in 2011. Dr. Narayanan is a member of the Macula Society and American Society of Retina Specialists. He is an Editorial Board Member of PLOSOne and Indian Journal of Ophthalmology. He has more than 100 publications to his credit. Dr Narayanan is the Guest Editor for this Retina Special Issue of Indian Journal of Ophthalmology.