PGY II / FIRST YEAR OPHTHALMOLOGY RESIDENTS
The first year residents are given a series of introductory lectures prior to commencing their clinical duties. A formal course in optics and refraction is given, followed by introductory lectures on detailed ocular history and examination, common ophthalmic disorders, management of ocular emergencies, ocular pharmacology, retinal function testing, ethics, policies and procedures of the eye clinic, hospital computer training, operating room procedures and taking call. The first year resident takes call every sixth night on a rotating basis.
The first year rotations at the Parent Institution are termed:
A. Acute Eye Care Clinic (AECC) (4 months)
B. Pediatrics (4 months)
C. Retina (4 months)
A. Acute Eye Care Clinic (AECC)
Patients with acute complaints/presentations, in-patient consultations and emergencies are seen within this service. The resident has the responsibility for obtaining a history and performing the initial examination and assessment pertinent to the acute event. An attending physician provides the necessary supervision and perspective. After initial management of the acute disorder, the AECC resident continues to follow patients with limited problems and refers other patients to appropriate subspecialty (after consultation with the attending physician) and general clinics as necessary. Each patient is seen by the attending physician in this clinic.
B. Pediatrics
The Pediatric Clinic duties include obtaining a detailed historyand performing a complete examination including tests of muscle balance and retinoscopy. Evaluation, assessment, and plan of treatment is made with guidance from the attending physician who directly supervises the resident. In Pediatric clinic you will work with 2 part-time ophthalmologists and one optometrist. The Pediatric Surgery experience is designed to allow the resident to view and assist on all types of pediatric surgery with emphasis on strabismus surgery and pediatric cataract.
C. Retina Clinic
The first year retina rotation is designed to master indirect ophthalmoscopy with scleral depression and introduce the resident to principles and interpretation of fluorescein angiograms. Complete retinal examination with retinal drawing and determination of need for fluorescein angiography are required.
PGY III/SECOND YEAR OPHTHALMOLOGY RESIDENTS
The second year resident spends four months in the following rotations at the Parent Institution:
A. Retina/Vitreous
B. Pediatric Ophthalmology/General Clinic
C. General Ophthalmology/Oculoplastics
A. Retina/Vitreous
Specific resident duties in this intensive rotation include mastering the technique of ophthalmoscopy with required detailed fundus drawings, learning the fundamentals of ultrasonography, formal interpretations of all fluorescein angiograms, pre- and post-operative management of surgical retina patients, performing focal, grid and panretinal photocoagulations, developing an in-depth practical understanding of major multicenter trials in connection with vitreoretinal disorders, i.e., ETDRS, DRS, DRVS, MPS, BVOS, etc., and learning the sensible application of diagnostic and therapeutic modalities involved in uveitic diseases. The rotation is directly supervised by the retina attending physician.
B. Pediatric Ophthalmology/General Ophthalmology
Specific duties in the Pediatric part of this rotation include performance of a detailed pediatric ocular examination, inclusive of various sensory tests and measurement of ocular misalignment. Typically, the resident masters the cover test, cover/uncover test, Hirschberg test, Worth four-dot test, measurement of stereopsis, Krimsky test, Maddox rod test, red filter test and tests utilizing dissimilar types of targets. He or she performs retinoscopy in the majority of patients and when necessary, calculates the AC/A ratio, performs Bagolini striated glass testing, Worth four-diopter base out prism testing, the red filter test and the after image test. Their surgical duties include pre- and post-operative management of all cases and performing surgery in cases of pediatric cataract, strabismus and lacrimal disorders. In addition, they screen premature neonates and low birth infants for retinopathy of prematurity and perform indirect laser ablation or peripheral panretinal cryotherapy when indicated. Inpatient pediatric consultations are seen by this resident. This rotation is under direct supervision of the pediatric ophthalmology attending physician. Specific resident duties in the General Ophthalmology Surgery part of this rotation concentrate more on pre-operative, intraoperative, and post-operative care of the ophthalmology patient. The resident is responsible for accurately performing the preoperative examination of all cataract patients and for gathering such data as preoperative refraction, keratometry, axial length, and for calculating intraocular lens powers. The resident is also responsible for learning the technique of phacoemulsification, and for being able to perform all parts of this surgery as the primary surgeon by the end of the rotation. The resident is responsible for post-operative management for each patient. All duties are performed under the direct supervision of the General Ophthalmology attending.
C. General Ophthalmology/Oculoplastics/Electrophysiology
By this rotation the resident is independently expected to interview, examine and evaluate each patient. The assessment and plan are then discussed with the General Clinic attending. The resident is expected to have a greater fund of knowledge and to be able to synthesize knowledge and procedural techniques learned on other rotations in this rotation. Specific duties of the resident include refraction, complete ophthalmologic history taking and examination and gathering of all preoperative data. The resident will also be responsible for all types of laser surgery performed on this rotation including Argon laser trabeculoplasty, peripheral iridotomy, YAG laser capsulotomy, focal laser treatment and panretinal photocoagulation. Also during this rotation the resident will spend one-half day per week for four months in the Oculoplastic Clinic. During this time he or she will be expected to perform a complete oculoplastic history taking and examination. He or she will also be expected to generate an appropriate assessment and plan under the guidance of the oculoplastics attending. Other duties include all necessary eyelid position measurements, Schirmer testing and Hertel measurements as required. Residents are responsible for incorporating the results of imaging studies in the differential diagnosis list. As required, the resident will perform biopsies of the eyelid and orbit. They will also participate in treatment including removal of eyelid and orbital tumors. Surgical duties also include learning the surgical management of eyelid malposition including ptosis, ectropian and entropion. Surgical management of disorders such as the lacrimal drainage system will also be the responsibility of this resident. In addition, any cases of eyelid and orbit reconstruction from trauma will be the responsibility of this resident. Two Friday mornings per month, this resident will participate in the Electrophysiology Clinic at the Illinois Eye Institute. During this time he or she will learn the principles of electrophysiological testing and its interpretation. A complete description of this portion of the rotation is given in Appendix D. All of these responsibilities will be performed under the guidance and direct supervision of the oculoplastics attending.
PGY IV/THIRD YEAR OPHTHALMOLOGY RESIDENTS
A. Glaucoma/Oculoplastics
B. Cornea and External Disease/Refractive Surgery
C. General Clinic and Surgery/Contact Lens/Refractive Surgery
A. Glaucoma/Oculoplastics
Specific resident duties include complete history taking and examination of the acute and chronic glaucoma patients. In addition, the resident will also be responsible for formal visual field interpretation. Preoperative, intraoperative and postoperative care of the acute and chronic glaucoma patient will be the responsibility of the resident. The vast majority of the surgeries will be performed by the resident as per surgeon. The resident will also be responsible for performing all glaucoma laser treatments on this service including Argon laser trabeculoplasty, peripheral iridotomy, and postoperative suture lysis. All of these duties will be performed under the direct supervision of the glaucoma attending. During this rotation the resident will also spend one-half day per week for four months assisting in oculoplastic surgical cases at Christ Hospital with our oculoplastics attending. The resident will again increase surgical exposure to cases of eyelid malposition repair, tumor excision and biopsy, as well as eyelid and orbit construction.
B. Cornea and External Disease/Refractive Surgery/Contact Lens
During this rotation the resident will be responsible for complete history and examination of the cornea and external disease patient. This will include refraction, anterior and posterior segment evaluation, preoperative measurements, assessment and therapeutic plan. The resident will be responsible for learning the following procedures: phacoemulsification, penetrating keratoplasty, pterygium excision, and secondary intraocular lens implantation. The bulk of class I surgery will occur on this rotation. The resident will also be responsible for performing YAG laser capsulotomy, Argon laser trabeculoplasty, and laser peripheral iridotomy as required. The performance of the residents duties will occur under the direct supervision of the cornea and external disease attending. This resident will also assist in preoperative and postoperative evaluation of the refractive surgery patient. In addition, the resident will also observe refractive surgery as performed by the attending. The resident will rotate through the Contact Lens Clinic and will perform complex contact lens fittings such as those patients with keratoconus, corneal scars, and post-penetrating keratoplasty patients. The activities of the resident will occur under the direct supervision of the contact lens attending.
C. General Clinic and Surgery/Contact Lens/Refractive Surgery
In this rotation the resident will spend more time in our General Ophthalmology Clinic and will continue to perform simple as well as advanced cataract surgery under the supervision and guidance of one of our General Clinic attendings. The resident will be expected to master the preoperative, postoperative and intraoperative evaluation of the surgical patient. In addition to this, the resident will be expected to perform with greater efficiency the comprehensive ophthalmologic examination on all chronic care General Clinic patients. Also during this rotation, the resident will rotate through our Contact Lens Service with an emphasis on mastering the difficult or complicated contact lens fit, as in patients with keratoconus, aphakia, or postoperative corneal transplant. The third portion of this rotation is management of the refractive surgery patient. The resident will have intensive experience in the preoperative and postoperative management of the refractive patient. In refractive surgical cases it is the pre and postoperative management that is of utmost importance in determining the ultimate outcome. It is our goal that the resident master the preoperative evaluation of the refractive patient as well as the postoperative management. In all of these facets of this rotation the resident will be directly supervised by the designated clinic attending.
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