Vitreo-Retinal Surgery Fellowship (FNB) review @ Sir Ganga Ram Hospital, Delhi

Duration= 2 yrs

Selection- through NBEMS exam 

Stipend- 1.21 lakh/ month 

Admission fee- 1.25 lakh yearly

Fellows taken per session- 1/year 

You also get phaco on rotation basis with DNB and other SRs, no junior-senior hierarchy in assigning of cases, everyone gets equal turns to operate in a particular unit.

Retinal sx training starts from beginning, I (reviewer) got my first SOR within a month. 

A lot depends on how much you know beforehand. I had some retinal sx exposure in my PG before joining fellowship. 

But overall, they don't delay giving you steps even if you don't know. Gradual approach is followed.

In OT, it's the junior consultants who train fellows in retinal sx. They decide when to give, what to give and how much to give.

You get to give a lot of intravit injections

Retinal lasers- not much, like once in 3 months.

You learn steps for all common surgeries. Some cases like lens drop, RD sx have been given to my seniors to operate independently.

They don't exactly train you one-on-one, if you do well then they let you keep doing steps till you finish or till you get stuck at which point, they take over and finish the case.

OT is a bit chaotic since you need assistants for all retinal sx and the nursing dept never sends them regularly. 

We use contact lenses in retinal sx so an assistant has to be present the whole time the sx is going on, holding the lens above the patient's eye. There is no BIOM (microscope-attached viewing system that lets you see fundus without having to use any contact lens).

It gets frustrating because you're dependent on the assistant to keep your field of view clear but they find it cumbersome to stand the whole time like that.

You get at least 2 phaco chances every OT but it depends on whether you're free to take it up.

If you haven't finished your retina case, but then your phaco turn comes, you have to decide whether you want to continue with your retinal sx or drop that and take up phaco. I prefer retinal sx over doing phaco, so I tell the JRs to do the phaco. It's a question of whether you want to get better in retinal sx or phaco and you decide accordingly. That can mean missed phaco chances.

OPD runs from 9-5/6 pm

Starts with general OPD (9-11 am) which is managed by fellows and residents and then private OPD with consultants till 5/6 pm.

Since General OPD runs only for 2 hours every day and they take all types of cases, this means the actual number of retina cases you see is less.. it takes 1hr for dilatation, you may see at most 20 dilated cases in 2 hours, of which most of them are common pathologies like DR. So clinical exposure that way is limited. 

In private OP you don't manage patients but are mostly involved in doing OCT, fundus photos, NCT, vision and other paperwork like filling insurance forms, preparing OT lists, giving instructions to private patients etc.

ROP screening is done by consultant, they get lot of ROP cases in OPD but fellows don't get to see much. ROP lasers? Forget about it.

There are 2 retina units- Unit 1 (dedicated to Uvea) and Unit 3. You get rotated between the units on a 3-monthly basis. 

Work environment- neither hectic not toxic. 

DNB first years can be difficult to work with and are dismissive of FNB fellows.

Because there are very few residents and since consultants are dependent on residents for workup of private patients, DNBs tend to be favoured over FNBs if any issues arise.

No camp duties.

Night duties 3-5/ month.

One Saturday night duty in a month where you're the sole doctor on duty.  You manage everything yourself including workup like you used to as a first year PG (people post SRship might find it a little difficult initially to work like a first year).

Daily work timings

8-5 pm mostly on OT days, if OT finishes early, then you go back to private OPD of the consultant you are posted with. 

9-5/6 pm on OPD day. 

Academics

Every Saturday there is an FNB class

As there are 2 FNB fellows at any given time, fellow will present every alternate Saturday.

There is an internal exam conducted at the end of 1st year where there is both written and viva exam. Both internal and external examiners come for this.

A similar exam is there at the end of fellowship (2nd yr) along with an interview. Once you clear that, you get the FNB degree.