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It is quite worrying how many registrars reach the final years of training without choosing a subspecialty. Sometimes this is because they love everything and cannot countenance giving any of it up, but more commonly this is due to various reasons for hating absolutely every rotation they do.

Sometimes people fall into a subspecialty due to chance and sometimes they choose a career based on an influential consultant or some happy memory completely unrelated to what they would be good at. I have devised here a completely unvalidated tool to help registrars of all levels determine what specialty they would be suited to.

  1. Are you skilled at surgery or believe yourself to be despite your phaco complication audit? Do people sometimes mention pesky extraocular muscles to you and you catch yourself daydreaming of more interesting times? Give yourself one point for Cornea and one point for Vitreo-retinal (VR). Minus one point for Medical Retina (MR).
  2. Are you considered by your colleagues and / or yourself to be particularly boring? Do you enjoy sitting alone in a darkened room looking at optical coherence tomography (OCT) scans of optic discs? Do you catch yourself actually listening to drug reps that tell you one drop is better than another? Do you look up the cited research yourself and wonder with awe at the p-value? Give yourself one point for Glaucoma and minus one for VR.
  3. Are you a sociopath who believes that your main aim at the moment is to be trained by your consultant and the service provision of your job is not so much a distant second as a non-existent tenth? Do you think you are the centre of the universe and that the NHS exists to prop up your future private practice? Do you sometimes catch yourself laughing hysterically at the expense of Jeremy Corbyn? Give yourself two points for Cornea and minus one point for MR.
  4. Does evidence-based medicine confuse you? Do you hate those annoying studies and long for practice which is eminence based and not evidence based? Do you store your cellophane covered copies of Eye in a pile in the garage and never open any of them, even accidentally? Give yourself one point for Oculoplastics and if you place all your copies of Eye immediately in the bin give yourself two points.
  5. Do people regard you as a nice person? Do you get on well with everyone and are usually willing to compromise to reach a happy medium? Did you vote against Brexit? Give yourself two points for Paediatric Ophthalmology, one for Glaucoma and one for MR. Minus two points for Cornea.
  6. Are you dyslexic? Give yourself one point for VR. Are you very dyslexic? Give yourself two points for VR.
  7. Are you generally a confused person? Do you crave certainty in a world of dangerous uncertainty? Do you get breathlessly anxious when doing a capsulorhexis? Give yourself two points for MR and one for Glaucoma.
  8. When a cataract – based complication occurs do you eat yourself up and don’t sleep for days? If you drop a nucleus do you consider jumping off the hospital roof or running away to start an ostrich farm in Argentina? Give yourself two points for MR and one for Glaucoma. Likewise – are you utterly unaffected when cataract-based complications occur? After dropping a nucleus do you yawn and think no more of it? Give yourself two points for VR and one for Cataract Surgery.
  9. Are you strange? Do people sometimes fail to follow your train of thought? Do you sometimes marvel at adult vitelliform macular dystrophy? Do you know what this is? Give yourself two points for MR.
  10. Do you believe in crystal therapy or aromatherapy? Do you enjoy tinted lenses? If someone asked you about homeopathy would you refuse to laugh your head off and dismiss this nonsense for the nonsense that it is? Are you a hippy? Give yourself one point for Paediatric Ophthalmology and minus one point for Cornea.
  11. Do you crave private work? Do you regard Aneurin Bevan as a dangerous leftist radical? Do you bemoan the socialism of Theresa May? Give yourself one point for Cataract Surgery, one point for Cornea and minus one point for MR and VR.
  12. If your clinic has finished and a patient turns up just as you are leaving do you: a) Put your head down and carry on home – give yourself one point for Cornea and Oculoplastics. b) Reluctantly return to the clinic room and see the patient – give yourself one point for MR and VR. c) Joyfully embrace the patient then tell them how glad you are that they have arrived and that they have now made your day completely – give yourself one point for Paediatric Ophthalmology. d) Lecture the patient about the running of the clinic and the unwritten patient doctor contract and how they have broken this. Follow this up with a detailed explanation of how the hospital booking system works and then go home – give yourself one point for Glaucoma.
  13. If a person comes to your clinic with no detectable abnormality whatsoever do you:
    a) Organise 30 separate tests all of which you strongly suspect will be normal – give yourself one point for MR.
    b) Patiently explain to them that they are wasting your time and discharge them – give yourself one point for both Oculoplastics and Glaucoma.
    c) Spend two hours pointlessly staring at their optic nerve – give yourself 10 points for Neuro-ophthalmology.
    d) Try and convince them to have crosslinking therapy for forme fruste keratoconus, privately of course – give yourself one point for Cornea.
  14. Lastly, when suturing a corneal wound do your stitches constantly break and become loose? Do you hate stitches in general? Do you find yourself wondering over and over again what the Loop of Benjamin actually was? Give yourself two points for MR.

And that’s it. It really is that simple. The specialty with the most points is the one for you. Bear in mind that this is utterly without evidence and excludes those people who would be good in genetics or research. I hope you find this useful in choosing your dream subspecialty. Good luck!

These are the views of the author and do not represent those of the editorial board or publisher.




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Gwyn Samuel Williams

Singleton Hospital, Swansea, UK.

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