Fellow Responsibilities

Clinical Responsibilities
In the one-year fellowship, approximately 85% of the clinical fellow’s time is committed to direct patient care on the Cornea Service; the proportion is less and tailored to the individual fellow’s needs/interests in case of the advanced two-year fellowship.  Clinical activities include the following:

Outpatient Clinics
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 MEEI.  Accordingly, extensive exposure to the patients of the full-time staff is required of all fellows.  Fellows will examine patients in the Cornea Service of the Massachusetts Eye & Ear Infirmary (MEEI), 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. 

Clinic Times
Morning Clinics generally begin between 7:30 – 8:30am.  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. 
 
Surgery
The surgical experience of the cornea fellow 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. 

Please refer to the section in this package with respect to the Fellow’s preoperative and postoperative surgical responsibilities.

Refractive Surgery Service
The cornea fellows actively participate in the refractive surgery service.  Fellows are responsible for evaluating refractive candidates, and presenting their findings to the appropriate Attending. Fellows play an active role in the intraoperative and post-operative care of refractive patients.  Refractive clinics may occasionally be held on Saturday AM (not more than 6x/year) and fellows (one per session) will participate in these.
 
Emergency Room Attending Coverage
Each fellow is required to provide 24 half-day sessions per year of coverage in the MEEI EW, during which they see patients and teach residents and medical students.
 
On-Call
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 and 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.

Shriners/Burn/SJS-TENS Consults
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 (urgent burn consult necessary to be seen immediately) and the fellow is in clinic or OR the EW should be notified.

Consults called after business hours and on weekends should be directed to the MEEI EW.  They will be seen by the EW junior resident. Many of them can be seen for follow up during the week and these 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 that needs to have cornea service involvement over the weekend or nights the junior resident should call the general CORNEA FELLOW ON CALL. 

Longwood Call
This has been evolving over the last year. There are on call MEEI resident or Joslin fellow at all times. There is also a cornea attending at Longwood during the day for staffing consults. If there are off hours consults seen by the first call (MEEI or Joslin resident/fellow) and they require cornea involvement, the MEEI cornea fellow on call may be paged.

Clinical Research
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, M.D.  The week will be chosen in conjunction with Dr. Jacobs and the Chief Fellow to correspond to Cornea Clinic Faculty vacation and meeting time to minimize 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.

Educational Responsibilities
In addition to clinical activities, the following educational activities are also included in the fellow’s curriculum

Conferences
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 interesting 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.

Teaching Activities
The cornea fellows are an important resource for the education of the medical students and residents.  They have direct interactions in Cornea Clinic, serve as attendings in the EW, and 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