The comprehensive rotation is designed to provide third-year residents with a fantastic surgical experience. Residents work exclusively with four comprehensive attendings with high surgical volume and excellent case turn-over. On average residents operate two full days per week. The schedule is such that the resident is scheduled in the attending clinic with whom they operated the day following cases, which provides for excellent follow-up and continuity of care. In addition, many common office procedures (YAG capsulotomy, YAG peripheral iridotomy, and laser retinopexy) are performed during this rotation. Residents have the opportunity to learn various surgical techniques and can add to their surgical “tool belt” during this rotation. Finally, residents have the opportunity to manage common ocular problems in a resident only urgent-care clinic one afternoon per week. During this clinic, residents can build relationships with patients as the primary provider.
Residents spend eight weeks on the cornea service during both the second and third years. There is great exposure to common cornea and uveitic entities, as well as refractive surgery. Resident participation in surgery is common, with an emphasis placed on cataract surgery, pterygium excision, PKP and DSEK surgery. We are one of the few residency programs in the country where all graduates are LASIK certified. Third year residents are provided with LASIK training, and then given the opportunity to be active in the entire process from patient screening and surgical planning to performing the procedure and overseeing post-operative care.
During the glaucoma rotation, second-year residents work with three attendings and the glaucoma fellow in the OR and in clinic. Surgical opportunities include glaucoma drainage implants and cataract cases. Throughout the rotation, you become very comfortable with gonioscopy, visual field interpretation, retinal nerve fiber layer interpretation, and management of complex glaucoma patients. Each week you will meet with one attending to discuss glaucoma topics from basic aqueous dynamics to post-operative management of trabeculectomy patients.
Third-year residents travel to Shroff’s Charity Eye Hospital for two weeks in February to learn extracapsular cataract extraction surgery, a skill that is rarely needed in the United States. They see patients in subspecialty clinics, outreach clinics and the operating room. Indian consultants (attending surgeons) and our UW attending surgeons supervise the residents on site.
The neuro-ophthalmology rotation is a six-week rotation during the second year of residency. Residents are exposed to pathology including optic neuropathies, pupillary and motility problems, brain tumors, and unexplained visual symptoms after evaluation by multiple ophthalmologists and sub-specialists. Over the course of the rotation, the resident becomes accustomed to performing various specialized tests like the OKN drum, physician killing refractions, pupillary measurements and drop testing, vestibular maneuvers, and techniques for dealing with difficult patients. The number of patients seen per day is small compared to other clinics, allowing plenty of time for teaching and questions.
The Oculoplastics/Pathology rotation is a fantastic first-year rotation, where time is split between these two services. Residents work with two full-time oculoplastics faculty in clinic and the OR, where you will certainly gain the skills to be the primary surgeon in blepharoplasties, tarsorrhaphies, levator repairs, entropion/ectropion repairs, enucleation and evisceration procedures. You will also first assist in more complicated procedures such as orbital decompressions, orbital biopsies, Mohs reconstructions, and orbital fracture repairs. Most graduates will have far surpassed graduation requirements for oculoplastics procedures. Two half-days per week are spent in our dedicated eye pathology laboratory, assisting in grossing and reading out histopathology with ocular pathology fellows while receiving valuable one-on-one instruction.
Pediatric Ophthalmology/Strabismus Rotation
The pediatric ophthalmology rotation is the most unique rotation of the first year of residency. In general, residents will be much less independent in clinic (especially compared to the VA), but learn to feel more comfortable working with children and parents in a very busy clinic setting. Faculty and staff will orient you to the nuances of the pediatric eye, explain the conditions and diseases common to children, and introduce you to the various treatment options. While on the rotation you will be responsible for all weekday pediatric ophthalmology consults at the American Family Children’s Hospital, with follow up visits scheduled after clinic with the pediatric fellow or attending. In addition, the pediatric ophthalmology resident can expect this to be a great surgical experience.
During the first year of residency, you will have three weeks of protected research time between the pediatrics and retina rotations. Residents will begin a research project that is continued throughout residency training. Faculty compile a range of possible topics including basic research and clinical research opportunities, and each incoming resident is given the opportunity to select a project based on his/her own interests. Additional protected time is devoted to research during the second and third years. The primary objective of this rotation is to complete a project that will allow for presentation in poster or oral form at AAO or ARVO, with the eventual goal of publication.
During the first year, the retina rotation exposes each resident to the interesting world of medical retina, as well as provides the opportunity to participate in a wide range of surgeries from retinal detachments to vitrectomies for vitreous hemorrhages. You will alternate your time between clinic and OR, and reap the benefits from working with each of the faculty. In the OR, you may get your first experience performing retrobulbar anesthesia, basic wound suturing, and perhaps late in the rotation, some aspects of the actual vitrectomy surgery. Many attendings also involve the resident in attaching scleral buckles, as well. Didactic sessions throughout the rotation add to your knowledge base as you learn and discuss interesting and complex cases.
Each resident will spend four months of every year at the VA. The design of having a first, second and third-year resident at the VA at the same time allows great opportunities for teamwork, team building, and getting to know your fellow residents. Most days involve comprehensive ophthalmology; however, there are sub-specialty days including glaucoma, retina, oculoplastics, cornea and neuro-ophthalmology. The clinical experience at the VA is an excellent opportunity to work on exam skills, efficiency in patient care, and clinical decision making.
The VA also provides excellent surgical opportunities for each year of the residency. The first-year resident is provided the opportunity to assist in the OR on retina and oculoplastics cases, and learns IOL insertion and viscoelastic removal while working with the third-year resident. The second-year resident has 15 guaranteed surgical opportunities on cataract cases under the “back in” approach where you begin with cortex removal and lens insertion and gradually progress to full cases depending upon your skill level and prior cataract experience. In the final year, you are very busy surgically and once proficiency in cataract skills has been demonstrated, the third-year resident is allowed to also perform femtosecond-assisted cataract surgery. The VA Hospital purchased the LenSx platform to perform femtosecond laser-assisted cataract surgery (FLACS) in 2013. Our staff surgeons perform 5-7 FLACS cases on one Friday morning per month at the VA. Once the senior residents at the VA become proficient in standard phacoemulsification cataract surgery, they complete Phase 1 and Phase 2 LenSx training with a vendor representative and begin performing FLACS in their final month of surgery at the VA. Our program’s goal is for residents to graduate with 10 FLACS cases, meeting requirements for LenSx certification.
Call and Consults
Inpatient Consult Responsibilities
Adult in-patient consults during daytime hours are handled on a rotating basis by all residents. Consults coming in between 4:30 PM and 8:00 AM are fielded by the primary on-call resident.
Pediatric in-patient consults are handled by the resident rotating on the pediatrics rotation in conjunction with the pediatrics fellow
First-year residents serve as the primary on-call (home call) resource for UW Hospital and Clinics on a rotating basis: 4:30 PM to 8:00 AM and all day Saturday and Sunday. However, second-year residents will alternate for primary coverage one day each week. Primary call schedules are flexible and determined at the discretion of each first-year class. Second call (back-up) and VA call are provided by the second and third-year residents on a rotating basis with the schedule created by these residents, as well.
Basic Science Lecture Series
All residents attend a weekly half-day didactic session, designed as an 18-month curriculum to cover all topics in the Basic and Clinical Science Course (BCSC) published by the American Academy of Ophthalmology. Faculty members specializing in each respective topic present the lectures, which are recorded and available for review when a resident is absent.
Residents and faculty present interesting, “classic,” or difficult cases to an audience of department and community ophthalmologists, technicians, researchers and other interested parties including veterinary and medical students. Every resident is required to present at a minimum of two Grand Rounds during the first year, while second and third-year residents should expect to present three Grand Rounds per year. Residents work closely with faculty as they develop their presentations and prepare for a brief question and answer period that follows their talk. Occasionally, visiting lecturers, often experts in a subspecialty, are invited to speak. These conferences offer CME credit for ophthalmologists and optometrists.
February 28 @ 7:00 am - 8:00 am
One evening per month, residents collaborate with a subspecialty service in the presentation and discussion of contemporary and classic journal articles. Responsibilities to moderate and present rotate among the residents throughout the academic year. Faculty members and fellow(s) from the specific service attend, as any other interested faculty, and they generate questions and participate in the discussion.
Monday Morning Case Conference / M&M
Residents present cases in an informal setting designed to encourage discussion among residents and faculty. Often interesting on-call cases from the previous weekend provide timely material for discussion, as do clinic cases and surgical complications. This also offers the opportunity for morbidity & mortality discussions on a regular basis.
While on the neuro-ophthalmology rotation, the resident presents an interesting patient or unusual case for the benefit of all other residents. Discussion and teaching will occur with neuro-ophthalmology faculty in attendance.
Pediatric Ophthalmology Journal Club
The resident on the pediatric rotation, the pediatric fellow, and the faculty gather to discuss contemporary articles in Pediatric Ophthalmology.
Resident Curriculum Committee (RCC)
Members of RCC include all residents and the Residency Team, and meet once a month to discuss residency program issues, provide a forum for suggestions and new ideas, and address any resident concerns.
Each week, retina faculty provide a curriculum designed to cover classic retinal pathology using case presentation format. Ancillary testing including fundus photographs, OCTs, fluorescein angiograms, ICG angiograms are used to illustrate. All residents participate in the discussion which offers excellent practice in reading all retinal ancillary testing and making diagnoses.
Vitreoretinal Case Conference and Electroretinogram (ERG) Conference
The current retina resident, retina fellows and faculty meet to review current cases, as well as electroretinograms from clinic patients.