Second year residents undergo a program which consists of rotations in comprehensive ophthalmology, pediatrics, cornea, neuro-ophthalmology, consults, ophthalmic pathology, refractive surgery, private practice and research.
The pediatric rotation takes place at CNMC and MGUH. Evaluation and management of common and unusual pediatric ocular disease occurs in the setting of a busy pediatric referral center and a busy private practice with fellowship-trained pediatric ophthalmologists. Residents evaluate and operate on their own and private strabismus patients, and participate in the management of other acute and chronic pediatric eye disease as well as adult strabismus.
The consult service occurs at MWHC, MGUH and the VA. For this rotation, residents are responsible for the management of all patients who have had a formal consultation requested of ophthalmology by other specialties. They perform all daytime consultations, with attending supervision always available. This experience gives the residents an outstanding opportunity to learn about the interactions of ophthalmology with a multitude of systemic diseases.
At MGUH, residents learn to grossly examine enucleated globes and other ocular tissues, prepare them for histopathologic examination and conduct that examination under the supervision of a fellowship-trained staff ophthalmic pathologist. Also, slide reviews and attendance at the several special ophthalmic pathology didactic sessions provide residents with a strong foundation in ophthalmic pathology. Residents become proficient in the gross and microscopic examination of eyes and other tissue specimens sent for evaluation to MGUH as well as in the correlation of microscopic findings with clinical data, which significantly enhances their understanding of ophthalmic diseases. The residents may participate in research projects analyzing some aspects of these case materials.
In addition, while at MGUH, residents participate in the clinical and surgical care of patients with a variety of anterior segment and cornea problems. They learn to diagnose and manage a variety of common and unusual cornea and anterior segment diseases. For those patients needing surgery, the residents are involved in their preoperative, intraoperative and postoperative care, either as primary surgeon or as first assistant. Direct faculty supervision of all patients occurs. Residents also participate in a tertiary care neuro-ophthalmology clinic, performing the initial examination and suggesting diagnostic and therapeutic approaches. This experience is an excellent adjunct to the neuro-ophthalmology experience at MWHC that occurs throughout all three years of training.
Refractive surgery training and experience is obtained at TLC Laser Eye Center in Rockville. Residents assist in refractive surgery cases in the second year, and may become certified in LASIK and perform refractive surgery procedures in the third year. They gain experience with state of the art laser vision correction, including pre- and post-operative management, first assisting in multiple cases, handling of microkeratomes and programming the lasers, all as excellent preparation for eventually performing their own cases.
During the second year, there is also protected time for resident research, allowing the residents the opportunity to learn research methodology, learn about and utilize the Institutional Review Board (IRB) process, and work on the projects they have designed with their research mentors. They learn the basic principles of research, including how research is conducted, evaluated, explained to patients and applied to patient care. The projects are presented at the annual Residents' Day Conference in June.
There is also a private practice experience during the second year, allowing the residents the opportunity to observe the practice of ophthalmology (both in an office and a surgery center) outside of a hospital-based clinic setting. Experience in providing health care to a needy urban community is achieved during a rotation through one of the area’s community clinics under the supervision of a volunteer attending physician.
Microsurgical suturing is practiced in the eye clinic special procedure room and in the eye operating rooms at MWHC. By the time the residents are ready to perform their first cataract operations, they have assisted in more than 100 private cases, performed a number of segments or the entirety of some cases, done a number of enucleations and eyelid procedures under supervision and have become proficient in the use of the operating microscope and microsurgical techniques in practice surgery sessions. Careful pre-operative and post-operative attention to detail is stressed, and above all, the importance of visual rehabilitation. Residents are made aware that the program has enjoyed a solid reputation based on many years of providing ophthalmologic care to the community, and that each resident is a vital link in this unbroken chain. Surgical experience commences in the second year, with resident cataract surgical cases as primary surgeon beginning at the VA. Resident surgical training is outlined further in the Surgical Curriculum.
At the end of the second year, the residents have augmented and solidified their diagnostic expertise, participated in a mentored basic or clinical research project (presented on Residents' Day), developed facility with the operating microscope and surgical techniques, have attended more than 20 surgical morbidity conferences during which they have learned how to manage all types of operative and post-operative complications, and performed ten cataract and twenty to thirty miscellaneous muscle or adnexal operations. In addition, they have attended an ocular trauma course and a cataract course.