In the one-year fellowship, approximately 85% of the clinical fellow’s time is committed to direct patient care on the Cornea Service. Fellows with a serious interest in research (basic or clinical) can elect to take an additional ‘customized’ year to dedicate primarily to their research and academic development for completion of our two-year Advanced Fellowship Program. Clinical activities include the following:
The medical management of refractive, corneal, and external disorders, as well as the preoperative evaluation and postoperative care of surgical cases, are considered the cornerstones of the Cornea Fellowship training at the Massachusetts Eye and Ear Infirmary. Accordingly, extensive exposure to the patients of the full-time staff is required of all fellows. The fellow will examine patients in the Cornea Service at Mass. Eye and Ear, where he/she will perform the initial examination, form a tentative diagnosis and therapeutic plan, and then present the patient to the attending physician for discussion and final disposition.
Morning clinics generally begin between 7:30 – 8:30 am. Afternoon clinics begin at 1:00 pm. Fellows are expected to begin seeing patients at this time. If you are unable to arrive on time for clinic, advance notice must be given to the Chief Cornea Fellow and your Attending.
The surgical experience is derived from the large surgical volume of the Cornea Service faculty. Generally, fellows will operate on all major and minor corneal and complicated anterior segment procedures regularly performed by Cornea Service faculty. Assisting on routine cataract surgery is not a requirement of the fellowship, although there is ample opportunity to be involved in phaco/IOL surgery on select cases. Nurse assistants or residents are utilized for the majority of cataract surgical assisting.
Get more information on the fellow’s preoperative and postoperative surgical responsibilities.
Refractive Surgery Service
Fellows actively participate in the refractive surgery service, and are responsible for evaluating refractive candidates, and presenting their findings to the appropriate Attending. Refractive clinics may occasionally be held on Saturday mornings (not more than 6 times per year). When this occurs, one fellow will participate during each session.
Emergency Room Attending Coverage
Each fellow is required to provide 24 half-day sessions per year of coverage in the Mass. Eye and Ear EW. During these sessions, fellows will see patients, and teach residents and medical students.
One fellow is assigned to be “on-call” for the service each week. This fellow is responsible for all emergency medical and surgical admissions to the Cornea Service faculty during that week as well as cornea consults from the emergency room. An assigned Attending will be on call with the fellow and is available for complicated cases, admissions, or surgical procedures. Any changes to the on-call schedule must be processed through the Chief Cornea Fellow, reported to the operator, and updated on the Google docs spreadsheet. If the fellow is unable to provide on-call coverage on any given pre-assigned week, it is the fellow’s responsibility to find coverage amongst the other fellows and inform the Manager.
The designated cornea BURN fellow (based on the rotation assignment) is responsible for providing consultation services to patients at the Shriners Burn Institute and Massachusetts General Hospital during the weekday. Billing forms and all applicable paperwork are available at the front desk and in the burn bag, and must be completed and returned to the manager immediately after the consult. The following is the official policy regarding burn consults:
During business hours, consults are paged to the Burn Fellow on call who is listed in the online call schedule according to the rotation. When the Burn Fellow is on vacation, the Google docs should be updated so that the Cornea Fellow on call provides coverage for those consults. By communicating with the Burn Service at MGH or Shriners, the fellow will determine if a consult can wait until after 5 pm or when they are free from clinics and OR. If it is absolutely necessary to see the patient before 5 pm and the fellow is in the clinic or OR, the EW should be notified.
Consults called after business hours and on weekends should be directed to the Mass. Eye and Ear EW. They will be seen by the EW junior resident. Many of these patients can be seen for follow up during the week. This information should be emailed, or nonurgently communicated, to the Burn Fellow who will follow them during the week. If there is a patient with a burn who needs involvement from the Cornea Service over the weekend or nights, the junior resident should call the general Cornea Fellow On Call.
The Longwood Call has been evolving over the last year. A Mass. Eye and Ear resident or Joslin fellow is on call at all times. There is also a Cornea Attending available during the day for staffing consults at Longwood. If there are off-hours consults seen by the first call (MEEI or Joslin resident/fellow), and they require cornea involvement, the Mass. Eye and Ear cornea fellow on call may be paged.
Fellows are expected to participate in all clinical research projects in the cornea service. Participation includes becoming familiar with the various active projects and protocols, and performing study assessments as needed. All fellows will need to complete the Collaborative Institution Training Initiative for human subjects.
Boston Foundation for Sight and the Boston Ocular Surface Prosthesis
Fellows will be assigned 1 week of clinic time at the Boston Foundation for Sight, in Needham, under the supervision of Deborah S. Jacobs, MD. The week will be chosen in conjunction with Dr. Jacobs and the Chief Fellow to correspond with the Cornea Clinic Faculty vacation and meeting time. This will help minimize the impact on other fellows and faculty. The goal of this week, in addition to the twice monthly Scleral Lens clinic at the Cornea Service, is to gain familiarity with the Boston Ocular Surface Prosthesis and other types of contact lenses for the rehabilitation of irregular astigmatism and ocular surface disease. There will be opportunity for clinical research for interested fellows.
In addition to clinical activities, the following educational activities are also included in the fellow’s curriculum:
There are several cornea clubs held during the month. Some of these include a refractive club, imaging club, and general cornea club. These are mostly informal sessions in which fellows and attendings meet to discuss interesting cases, and are held in the early evening with dinner provided. The attending assigned to lead each session typically picks a topic for discussion and the fellows prepare and present their cases during the session. The Cornea Service also hosts a visiting professor lecture series (typically 4-6 individuals are invited each year) for lectures and case presentations. Fellows prepare and present interesting cases within the visiting professors’ areas of expertise with live patient examinations. Finally, MEEI has extensive formal didactics including weekly Grand Rounds.
The cornea fellows are an important resource for the education of the medical students and residents. They have direct interactions in Cornea Clinic, and serve as attendings for emergency cornea cases in the EW. The fellow may provide these services independently, or in collaboration with a Cornea Service faculty member, depending upon the complexity of the case and fellow’s level of expertise.
Page Updated: September 15, 2010
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