A window into the Ophthalmic training experience in India - All India Institute of Medical Science (AIIMS) New Delhi
Dr. Itika Garg, MD
Postdoctoral Research Fellow, Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA
Medical School: Government Medical College, Chandigarh, India (top 10 in India)
Ophthalmology Residency: All India Institute of Medical Sciences, New Delhi, India (#1 residency program in India, and the biggest center in South Asia, also accredited by WHO as a center for fighting blindness)
‘Open Globe Talk’ chats with Dr. Itika Garg, MD who is currently a postdoctoral research fellow and an Applicant for the US Ophthalmology Residency Match Cycle. In this blog, we get to learn how her training was like as an Indian Ophthalmology Trainee as well as her current research interests in the quest to be a physician-scientist!
What made you decide to pursue ophthalmology?
Ophthalmology drew me closer in two aspects. First, during medical school, I really enjoyed my time in the strabismus clinic (as a part of my third-year ophthalmology rotation). I was fascinated by the precise calculations and use of prisms for every patient’s individualized work up and correction. This reminded me of my childhood passion for solving difficult mathematics and physics problems. Secondly, I really loved dancing as a child, the fancy footwork and choreography required for every scene. This combined with my love for oil painting made me fascinated with ophthalmic surgery, at the time, most strikingly the precise hand and foot control required for cataract surgery. By end of medical school, it was clear that there was no other field that could strike the perfect combination of medicine, surgical finesse, mathematical application, and constant innovation and advancement in the field of medicine.
How long is ophthalmology residency in India?
Ophthalmology residency lasts for three years in India. Since internship is integrated into our medical school curriculum, once selected into a program, residents directly advance to ophthalmology specialty-based rotations.
What were some unique aspects to your residency program and how was it structured?
Though the overall structure of residency is similar, there are several aspects that are unique to my program in India. Among the various high-patient-load clinics, several of them are purely resident run, where trainees get broad exposure to various infectious and inflammatory ophthalmic disease manifestations. In terms of operative experience, within the first 6-7 months of trainings, residents are trained in extracapsular cataract surgery, and after that, they start performing phacoemulsification. In addition to this, residents have access to the wet lab comprised of 6 Infiniti device and simulators for practicing capsulorhexis and other key steps. Also, direct ophthalmoscopy is very much alive in the curriculum of resident training in India. The hospital is equipped with over 300 inpatient beds taken care of by residents and fellows under the supervision of faculty. This provides us an opportunity to take part in twice-weekly case presentations for multiple beds allotted to us, along with discussion on wide range of related topics. Besides, it gives a great learning platform to practice clinical skills in the evening for the admitted patients. There is a huge emphasis on resident didactics, where residents present various inpatient findings as case presentations, journal clubs, and grand round presentations. Our program had a 24-hour ophthalmology emergency department, where residents would evaluate critically ill patients besides trauma. Strikingly, as residents, we get to see and manage open globe injuries very commonly, being the apex referral center for the country.
What was the patient burden like working as a trainee?
I was fortunate to train at the apex referral center of the country. Receiving referrals from all corners of India, we were indeed exposed to a wide variety of disease manifestations. On a busy clinic day, residents would have to evaluate nearly 50-60 patients in half a day. This number would go up to 100 in specialty clinics (retina/cornea/oculoplastic/glaucoma, etc. depending on the ongoing rotation). The inpatient wards comprised of over 300 beds, in various ophthalmic sub-specialties.
Seeing that AIIMS-New Delhi is the apex for ophthalmic services, how did you deal with patients coming from the various cultural and language backgrounds?
Yes, as mentioned, patients from different parts of the country would travel long distances to be treated at our center. Most of the surgeries were performed free of cost, hence allowing for people to receive treatment irrespective of socioeconomic background. With the magnitude of patients, and the diverse cultures, ideologies and languages spoken, one would expect it to be difficult to manage patients without interpreter services. Although this was not available, residents would learn basic conversation skills by the day from colleagues or nurses, to successfully communicate with patients. Also, English is a language which is commonly spoken by people all over the country that can remove above barriers. Lastly, having a diverse workforce meant that you had one person on the team that spoke or was fluent with the patient’s culture and dialect, leading to a fruitful encounter with the patient.
What inspired you to come abroad to the US and pursue further training here?
At the end of my residency training, I was determined to further my research training in addition to my clinical skills. To pursue my goal of being a surgeon scientist, leading an academic career, I realized that the United States was the perfect place. Despite the COVID pandemic, and the visa issues, my resolve for continuing my research grew stronger, at the Harvard Retinal Imaging lab, and later this year, I will be applying for ophthalmology residency in the US.
What are your current research interests?
My current research interest is focused on diabetic retinopathy, and the identification of novel retinal imaging biomarkers for grading and prognostication of DR. We are currently using wide field swept source optical computerized tomography angiography scans to identify non-perfusion areas and its implications.
Lastly, and on a fun note, what are some outside hobbies that you like to indulge in (you mentioned dancing, tell us about that)?
From childhood, I have been fascinated with Bollywood dancing. The fast, energetic, flamboyant, and fun dance steps are what draws me to this particular style of dancing. It transports me to a colorful and magical land, where I can express myself in my true form and be myself. As an additional benefit, it is an excellent work out. I was part of a dance troupe in medical school and took part in and won several competitions. I have also explored Zumba dancing on and off throughout my life, continuing my enthusiasm for fast paced high energy music. Now in the pandemic, I continue to dance at home in the evenings, encouraging my husband to dance along and instilling some Bollywood flair into him.
