Reflection on Career Goals: Becoming an Ophthalmologist

1. Please provide evidence of activities and achievements which demonstrate your commitment to a career in this specialty and/or which have led to the development of skills relevant to a career in this specialty.(250 words)

• My inspiration for becoming an ophthalmologist stemmed from working in DARUL-HIKMAT DARUL-SHIFA, a charity eye hospital in Pakistan, which I have attended biannually since first year in medical school. There I observed how a small procedure brings a remarkable improvement in the quality of a patient’s life.
• Out of my own interest, I undertook 2 ophthalmology electives. I was privileged to observe practice on an incredible elective at MOORFIELDS EYE HOSPITAL. It was a great experience and further motivated me to become ophthalmologist. I achieved Distinction in Ophthalmology during my MBBS.
• As a Foundation year doctor, I regularly attended eye clinics and theatres in my free time. I did a week of a TASTER SESSION and managed to arrange a SPECIAL MODULE in ophthalmology during my GP rotation.
• I have made several international presentations and have published in peer reviewed journals.
• I have excellent hand to eye coordination and dexterity. I am competent in Objective & Subjective Refraction.
• The combination of medicine and surgery, along with the variety of cerebral and fine motor skills necessary has drawn me to the specialty. It is the only specialty that has satisfied me to practice medicine at the highest level. Sight is the most valued of senses for many people, and to be in a position to improve and restore sight, as well as prevent eye disease, gives me great pleasure.
• I am a dedicated, hardworking, and energetic person. In addition, I have passed RCO exams and my experience in ENT, neurosurgery, diabetics and oncology make me a great candidate.

2. Please provide details of outstanding achievements outside the field of medicine. (250 words)

I have regularly arranged clinical courses for the junior doctors and GP since 2008. The courses consist of “ECG interpretation day” & “Pain Management Course” & “Eye & ENT day”. This involves a great deal of organizational and managerial skills. This has also given me experience of developing a successful business plans and dealing with the finances, which will be very beneficial for me, in the future, to set up new services in the NHS. Following additional demand, I have setup a company with a name of AR MEDICS to organise courses more widely.

We won the first prize of £5000 in South Asian Federation (SAF) Quiz competition, 2004.

As Sports Coordinator at Medical College, I reformed the Sports Society and wrote its new rules and regulations. For the first time in its 25 year history, I arranged sports fixtures with other universities and introduced new sports. This improved college sports reputation remarkably. I was the captain of the basketball team and was awarded “Colours”. I learned to cope under pressure and improved my leadership & decision-making skills.

I enjoy hiking & mountaineering. I have hiked up to the base camp of Nanga Parbat- the worlds 7th highest peak- and won first prize.

3. Clinical Audit: What experience of clinical audit do you have? Please state clearly where and when this was undertaken and indicate specifically your role. (250 words)

“Evaluation of Glaucoma Management Services” M Amjad, R Job, S Walker. 01/02/2009 at Leighton Hospital.

I initiated the study and formulated the pro-forma and collected data, which was presented in the Divisional Audit Meeting. I made recommendations to improve the system. I then re-audited to complete the cycle of the audit.. My material was later presented as poster at the Royal College of GP Annual Congress Nov 2009.

A pilot Glaucoma care pathway was initiated from my recommendations., and Glaucoma Medisoft was installed to document and print clinic letters instantly. Improved documentation was made available for the GP

‘Management of Eyelid CA’ M. Amjad, S Raja. 01/09/2008 at Blackpool Victoria Hospital.

Once again, I initiated the literature research, formulated a pro-forma, collected data, and analysed it. I presented this in the departmental audit meeting.

“An Audit of Ophthalmology Emergencies presenting in A&E” M Amjad, W Khan. 30/03/2007 at Blackpool Victoria Hospital.

I researched the literature, formulated a pro-forma, collected, and analysed data. My conclusions were presented in the Divisional Audit meeting.

“Management of Corneal Abrasion in AE” M Amjad, W Khan. 01/04/2007 at Blackpool Victoria Hospital.

Again, I researched literature, formulated the pro-forma, collected, and analysed data, all for a presentation in the Divisional Audit meeting. Guidelines from King’s College Hospital have now been taken up inn the AE department.

‘Management of Gastro-oesophageal CA – six years audit” M Amjad, MU Javed. 01/03/2007 at Blackpool Victoria Hospital.

I researched literature, formulated a pro-forma, collected, and analysed data. A presentation was made at the North West Regional Meeting for Upper-GI Carcinoma.

“Major Limb Amputation, Environmental Study” M. Amjad, MU Javed, G Riding. 01/06/2007 at Blackpool Victoria Hospital.

I designed pro-forma, reviewed literature, collected and analysed data for a presentation in the Divisional Audit Meeting.

2. Managing Teams: Please provide evidence of leadership skills, managing and/or working in teams. You may give examples from both inside and outside medicine. (250 words)

I was elected as a Sports Coordinator at Medical College in my final year, which was a great honour and position of responsibility. In order to make this successful, I needed a good team and representatives from each year, whom I appointed. Working through the team and using my leadership skills, I was able to make significant changes. I reformed the Sports Society and devised its rules and regulations. For the first time since its foundation, I arranged fixtures with other universities and introduced new sports. I took on board ideas from team members and organized sponsors and a concert to generate funds. Our efforts improved the college’s sports reputation.

This was because of the good management, delegation of responsibilities to team members and proper use of the recourses generated. I also captained the basketball team and was awarded “Colours.” This experience not only improved my team working and leadership skills, but also improved my ability to perform under pressure and make clear decisions.

5.Teaching Experience: What experience do you have of delivering teaching? (250 words)

I have attended the “How to Teach Course”, in order to learn new teaching skills and develope a methodology.

I have been regularly organizing and coordinating a full day study course for junior trainee doctors and GPs on “ECG interpretation” & “Pain Management” & ‘Eye and ENT day’ since 2008. The feedbacks has been excellent and the courses are very popular.

I regularly delivered formal lectures to foundation and AE doctors on the use of slit lamp and management of acute eye problems. The feedback has always been good and higher than that given to my peers.

I organized formal teaching and mock OSCE for final year Manchester medical students.

In addition, I regularly present and attend the weekly regional teaching to keep up-to-date with advances within the specialty. My written feedbacks from the sessions have been very encouraging. I enjoy teaching and endeavour to continue it.

6. Research: Please provide evidence of research whether past or in progress. If you have undertaken or are undertaking a research project, please give details and indicate your involvement. (250 words)

I worked as a junior Research Fellow Gastroenterology under Prof M Umer in Holy Family Hospital. I was involved in two projects, both presented as poster and also published

“ CHRONIC HEPATITIS-C RESPONSE TO ANTI-VIRAL COMBINATION THERAPY”

A prospective study of 200 patients. The objective was to study the response of chronic hepatitis-C patients to combination antiviral therapy. I reviewed the literature, collected and analyzed data using SPSS. The results showed that combination therapy with interferon and ribavirin for CAH-C helps to treat the disease as well as to improve the symptoms of the patients.

“SYMPTOMATOLOGY OF CHRONIC HEPATITIS-C”

A case control study involving 1000 patients. The purpose was to study the common symptoms in patients with Chronic Hepatitis-C. I formulated the pro-forma, collected data and analyzed using SPSS. This was my first experience in research. Moreover, it was presented internationally. It gave me a lot of confidence and motivation. I learned the skills needed to search the literature, design a research project and to statistically analyze the results. It also improved my communication and presentation skills.

Recently I was involved in two small studies and presented them as poster in RCO annual congresses. They are “ The Impact of GDX in the management of new glaucoma referrals” and “Post-operative ocular complications after acoustic neuroma surgery”

7. Additional Achievements: Please note any prizes, awards and other distinctions (include specialty and qualifying distinction) which you may have. Please indicate – undergraduate or postgraduate award, the awarding body and date awarded. (250 words)

Grade A+ in MBBS Examinations, Rawalpindi Medical College, Jun 2005

Distinction in Ophthalmology (MBBS Exams), Rawalpindi Medical College, Apr 2004 Distinction in Forensic Medicines & Toxicology (MBBS Exams), Rawalpindi Medical College, Jan 2001 Awarded Gold Medals for best in academics, Education Board, Jan 2000

Won Merit Scholarship for 5 years, Education Board, Jan 1999

8. Presentations: In this section please provide details of your most relevant presentations at local level (state whether departmental, hospital or trust). Please give a statement about your personal contribution to the work. (250 words)

I have initiated these projects and presented the using PowerPoint at different meetings.

Morbidity and mortality meeting. Presented in divisional meeting. 2009

“Negative dysphotopsia: Long-term study and possible explanation for transient symptoms.” Oral presentation in Journal Club, Leighton Hospital 2008.

“Management of Eyelid CA” M. Amjad, S Raja Presented in departmental audit meeting in Sept 2008

“Major Limb Amputation, Environmental Study” M. Amjad, MU Javed, G Riding Presented in departmental audit meeting in Jun 2007

“An Audit of Ophthalmology Emergencies presenting in A&E” M Amjad, W Khan Presented in departmental audit meeting in Apr 2007

“Management of Corneal Abrasion in AE@M Amjad, W Khan Presented in trust annual review meeting in Mar 2007

“Management of Gastro-oesophageal CA – six years audit” M Amjad, MU Javed Feb 2007

9. Presentations: In this section please provide details of your most relevant presentations at regional and/or national level. Please give a statement about your personal contribution to the work. (250 words)

I have initiated, written and presented the following work.

“Patient with previously undiagnosed Autoimmune Hypophysistis (AH) presenting with bilateral recurrent cystoid macular oedema secondary to Intermediate uveitis.” M. Amjad, A Sachdev, V Kotamarhi

Submitted for Poster presentation at Royal College Ophthlmology Annual Congress, 2010.

“Post operative complications affecting eyes after acoustic neuroma surgery.” A. Garrick, M. Amjad, I Marsh, C Noonan.

Submitted for Poster presentation at Royal College Ophthalmology Annual Congress, 2010. “Restructuring and Innovating the Glaucoma Services. Role of Primary and Tertiary Care.” M. Amjad, R Job, A Asghar, S Walker.

Poster presentation at Royal College of GP Annual National Conference, Glasgow, 2009.

“The impact of GDX in the management of new glaucoma referral.”’ M. Amjad, R Job, S Walker

Poster presentation at North of England Ophthalmology Society, Allensford UK, June 2009. “Patients’ perspective of new Intra-vitreal Anti-VEGF treatment” V. Kotamarthi, M. Amjad

Poster presentation at Royal College Ophthalmology Annual Congress, Birmingham 2009.

“Chiari malformation with the symptom of photopsiae as the only ocular symptom and no ocular signs.” M. Amjad, V. Kotamarthi

Poster presentation at The 10th Congress of International Ocular Inflammation Society, Prague. May 2009

“Value of Ultrasound in detecting pathology in vitreous haemorrhage.” T. El-kashab, M. Amjad

Oral presentation The 10th Congress of International Ocular Inflammation Society, Prague. May 2009

“A Case of Idiopathic Sclerochoroidal Calcification associated with Primary Open Angle Glaucoma.” M. Amjad, T. El-kashab, R Job, A Needham

Poster presentation at The 10th Congress of International Ocular Inflammation Society, Prague. May 2009

1. Communication and interpersonal skills: Please give a recent example that demonstrates that you possess these skills. (150 words max)

A 59 year old gentleman was referred over the weekend with a six month history of left temporal ache. All the examinations and bloods were normal, except for a disc swelling on his left side. I informed my consultant and devised a plan. Then, I liaised with the ENT and on call radiologist to review the patient. I kept the patient and his partner informed about all the progress throughout this time. After arranging an urgent scan, which showed a mass compressing his orbit, I arranged for the admission and booked theatre for removal of the mass compressing orbit. As the focal point of communication between concerned groups, I enabled us to work as a large team, efficiently and effectively, to save the patient’s eye from future complications. My ability to communicate and delegate facilitated the effective success of a multi-disciplinary team approach to patient care.

1. Initiative: Please give a recent example that demonstrates initiative. (150 words max)

In October 2008, I attended a busy eye camp in Pakistan. During my stay, I was astonished to find that operations are cancelled on-table by the surgeons due to high IOP. Only high risk patients were having their IOP checked due to high patient turnover. This resulted in a huge waste of resources. After discussion with the management, I took the initiative to provide a solution to this problem. After research and discussions with senior doctors visiting the camp, I proposed to use a puff tonometer to check IOP of all patients undergoing surgery. This method doesn’t require extraordinary skill to use, hence it is effective in a busy camp. This proposal was accepted by the supervisors. It had been a great success with surgical cancellations dropping by more than 95%. I received a letter of thanks. Making such a difference in patient care makes me proud.

PAPER 2

Describe how you realised that you wanted to become an Ophthalmologist? [Edit]

My inspiration for becoming an ophthalmologist stemmed from working in DARUL-HIKMAT DARUL-SHIFA, a charity eye hospital in Pakistan, which I have attended biannually since my first year in medical school. There I observed how a small procedure brings a remarkable improvement in the quality of a patient’s life.

Out of interest, I undertook 2 ophthalmology electives and I was privileged in observing practice on an incredible elective at MOORFIELDS EYE HOSPITAL. It was a great experience and further motivated me to become ophthalmologist.

Achieving a Distinction in Ophthalmology during my MBBS, I joined Rawalians’ Research Forum during my final year in medical school, where I published two research papers. Since then I have been actively involved in audits and clinical studies. I have presented 14 papers in international and national conferences. In addition, I have several published articles in many journals.

Most notably during the Haematology, I was involved in ‘randomized control trials’. As a Foundation year doctor, I regularly attended eye clinics and theatres in my free time. I did a week of a TASTER SESSION and managed to arrange a SPECIAL MODULE in ophthalmology during GP rotation.

I have excellent hand to eye coordination and dexterity. I am competent in Objective & Subjective Refraction. In my recent job I have done 53 Phacoemulsifications,6 Squint Surgeries, 23 IV injections, and 64 argon & YAG laser procedures.

The combination of medicine and surgery, the variety of cerebral and fine motor skills necessary has drawn me to the specialty. It is the only specialty that has satisfied me at the highest level. Sight for many is the most valued of senses and to be in a position to improve and restore eyesight, and prevent eye disease gives me great pleasure. I am dedicated, hardworking, and energetic person. In addition, I have passed RCO exams and my experience in ENT, neurosurgery, diabetics and oncology will make me a great candidate.

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What do you think are the main issues in solving global blindness by 2020? [Edit] Approximately 314 million people worldwide live with low vision and blindness. 90% of these blind people live in low-income countries. 80% of blindness is avoidable. Without effective, major intervention, the number of blind people worldwide has been projected to increase to 76 million by 2020.

The major causes of blindness in the world are cataract (50%), refractive errors (15-30%), Trachoma, Onchocerciasis, Glaucoma, Diabetic Retinopathy, Age Related macular degeneration. According to WHO, restorations of sight and blindness prevention strategies are among the most cost-effective and gratifying interventions in health care.

In 1999, WHO launched VISION 2020 – The Right to Sight. It is a joint programme of the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB) with an international membership of NGOs, professional associations, eye care institutions and corporations.

It aims for control of avoidable blindness by 2020; to achieve the aim the following issues need to be addressed. HR development: adequate and purposeful training of all eye care personnel is a key factor. Apart from ophthalmologists, the ophthalmic nurse, ophthalmic medical assistants and especially refractionsists should be recruited and trained appropriately. Infrastructure & Equipments development: facilities should be equipped according to the tasks. Local entrerpreaunership should be encouraged to participate to reduce cost and enhance sustainability. Awareness & Education of local community: community participation is vital and this can be achieved by creating awareness in the public about the diseases and the facilities available to treat and prevent them. Funding: regular and new funding sources should be explored.

Outside medicine, what personal attributes make you a good candidate for a career in Ophthalmology? [Edit]

I possess combination of qualities through which I have not only achieved over and above the required competencies mentioned in the RCOphth curriculum for ST1 and F2 but also a good working relationship with the colleagues to prove as a good and successful ophthalmologist. I maintain good rapport with patients. During my foundation training, I had experience of caring for terminally ill patients, breaking bad news and discussing the patient’s care and resuscitation status with their family, which I was able to do in an empathetic and sensitive manner. I am actively involved in audits, and publications to maintain good medical practice alongside the tough demands of clinical work. This requires refinement of my time management and organizational skills. I believe in sharing the skills and experiences, which I do by not only involving myself in teaching but also in charity and voluntary work. I possess qualities of a good team leader and an effective team player, which I have gained through my clinical and non-clinical experiences. I prioritize work and this helps me in coping when working under pressure. I am making most of the opportunities to gain experience and refine my personal skills and will do my best to become a good ophthalmologist.