Third-Year Rotations (PGY-4)
The goal during the third-year of the Harvard Medical School Department of Ophthalmology Residency Program is refinement of knowledge, judgment, and technical skills, which were learned in the preceding two years. Additionally, residents will develop their professional maturity, which is essential in becoming a well-trained, capable ophthalmologist.
The third year is divided into 8 different rotation blocks, each 6-7 weeks in duration. This part of the program offers a period of intensive ophthalmologic surgical training. Residents build on surgical skills acquired in the first two years of residency by performing cataract, glaucoma, anterior segment, open-globe, and retina surgeries. Every operative case is staffed by an attending surgeon, and the quality of teaching in the operating room is stellar.
Residents also have an international ophthalmology elective rotation. Many choose to go to the Aravind Eye Hospital in India, where they are exposed to an exceptional array of ocular pathology and participate in cataract surgeries on a daily basis. Other residents choose to use this block for research or set up an independent international rotation.
In general, third-year rotations are constructed around experiences with individual attendings. This allows the senior ophthalmology resident to examine patients in clinic, participate in the pre-operative evaluation, perform the patient's surgery and then see the patient in the immediate post-operative period. Through these experiences the resident becomes not only an excellent surgeon, but also an exceptional clinician.
Senior residents are assigned night float shifts for the first three months of the academic year (10-12 nights on average) during which time they supervise the junior resident in the MEEI Emergency Department (ED). Residents are free from clinic and daytime responsibilities the day before and after a night float shift.
For the remainder of the academic year, night and weekend call for the senior resident is home-call and is divided evenly amongst the senior residents to provide back-up for the junior resident working in the ED. The senior residents perform all open-globe repairs under the supervision of the chief resident and supervise the first year residents in minor procedures such as simple eyelid laceration repairs. On average, each resident performs 15 open-globe repairs in their senior year.
Comprehensive Ophthalmology Service
Attendings: Sherleen Chen, MD, Matthew Gardner, MD, Carolyn E. Kloek, MD, and Scott Greenstein, MD
The senior residents perform cataract surgery with each of the attendings listed above. By the time residents enter their third year they should already be experienced cataract surgeons because of the step-wise introduction received during their second year. Senior residents also gain expertise in complex cataract surgery. Techniques include use of trypan blue, PXF, Flomax, iris hooks and Malyugin rings.
Attendings: Louis Pasquale, MD, Teresa C. Chen, MD, and Douglas Rhee, MD
Senior residents on the glaucoma service focus on the surgical management of glaucoma. They perform trabeculectomies, insertion of tube shunts, and other miscellaneous procedures under faculty supervision. Senior residents also spend time refining their skills of the medical management of glaucoma.
Boston VA Medical Center
Supervising Attendings: Mary K. Daly, MD, Joanne Haney-Tilton, MD, Milhim I. Aswad, MD, Donna Siracuse-Lee, MD, Christine S. Ament, MD, Babak Eliassi-Rad, MD, Li-Wei Lin, MD, and Nabil I Jarudi, MD
Clinical Experience: The third year rotation at the Boston VA Medical Center is a cataract intensive rotation. The senior resident plays an active role in the pre-, intra-, and post-operative management of the cataract patient, and assists in the general ophthalmology and subspecialty clinics at the Boston VA. Residents also gain experience in the use of toric IOLs. For eligible patients, senior residents are responsible for the pre-operative workup, lens calculations, and surgery that places the toric lens inside the eye. This is a unique experience for a resident because “premium IOL cases” are often reserved for attendings.
Surgical Experience: The residents are in the OR every other day where they serve as primary surgeon for cataract and glaucoma surgeries.
Call Responsibilities: The third year resident provides back-up coverage for the first year resident on home call every other day.
Togus VA Medical Center
Supervising Attending: Jeffrey Dempski, MD
Clinical Experience: Similar to the Boston VA, the Togus VA Medical Center is a regional referral center for ophthalmology in the state of Maine. Residents are exposed to a broad range of ocular disease during this rotation.
Surgical Experience: Residents spend one or two full days each week serving as the primary surgeon for cataract surgeries. They also dedicate one full day per week performing minor procedures, including eye plastics procedures, and glaucoma and retina laser procedures.
Call Responsibilities: There are no call responsibilities on this rotation.
Housing: Residents are provided housing on the Togus VA campus. Residents have a three bedroom house with kitchen and laundry facilities to themselves, allowing for family or spouses to join them if desired.
Attendings: Evangelos Gragoudas, MD, Ivana Kim, MD, John I. Loewenstein, MD, Joan W. Miller, MD, Shizuo Mukai, MD, Lucia Sobrin, MD, Demetrios Vavvas, MD, PhD, Lucy H. Young, MD, PhD, and Dean Eliott, MD
Senior residents on the retina service gain experience in the surgical management of retinal disease. Residents also spend two half days per week in Dr. Gragoudas’ tumor clinic and one half-day per week in Dr. Gragoudas’ OR learning about ocular tumor management.
International Elective Rotation/Aravind Eye Hospital, India
Third-year residents have an elective rotation. Most residents choose to do an international elective at the Aravind Eye Hospital in India that broadens their clinical and surgical experience. However, residents interested in spending more time on research may opt to stay in Boston to participate in a research project.
At the Aravind Eye Hospital, residents witness an impressive international health care system that is able to deliver high quality eye care to a large volume of patients in a cost-effective manner. Residents have the opportunity to participate in the cornea, glaucoma and uveitis clinics with exposure to end stage inflammatory and infectious diseases uncommon in the United States. The residents also spend one half of each day in the operating room and serve as primary surgeons for cataract surgeries (extra-capsular, small incision cataract surgery and phaco-emulsification).
Page updated November 10, 2011