Supervision vs. Autonomy
Resident supervision evolves as training progresses, with a clear goal of graduating with the skills and experience needed to function independently in a busy clinical practice. Residents directly manage their own patient clinics in the public hospitals (Ben Taub and the MED VAMC) under the direction of their upper-level residents and attending faculty. Supervision is always provided; autonomy is graded as residents progress through their training toward independence. All clinics are staffed by faculty, but direct faculty input is not necessarily required on all patients. In cases where residents manage patients independently, faculty members review their notes to gauge the appropriateness of their assessment and management plan. Upper-level residents are actively involved in the management and training of their junior residents. In the private subspecialty clinics, residents typically work up both new and established patients and devise their own management plans. Depending on the clinic, the resident may shadow the attending physician or work independently (or more likely, a combination of the two).
Rotations
All ophthalmology rotations in the PGY-2 and PGY-3 years are two months in duration. The subspecialty rotations in the PGY-4 year are one month in duration. Depending on the rotation, residents may work at a single hospital or may spend their time in several different training environments (most commonly on subspecialty rotations).
PGY-1
All ophthalmology rotations in the PGY1 year occur at the VAMC. Here, our interns start with a two-week orientation period where they have the opportunity to work with multiple providers and staff. Afterward, the resident will work in comprehensive and subspecialty clinics.
PGY-2
The PGY-2 Oculoplastics resident has the opportunity to work in a variety of clinical sites, including BCM/Cullen Eye Institute, Ben Taub, the Michael E. DeBakey Veterans Affairs Medical Center, and Texas Children’s Hospital. Residents also receive training in ocular pathology on this rotation with Dr. Debra Shetlar.
The PGY-2 Neuro/Path resident works in the clinics at Houston Methodist Hospital, BCM/Cullen Eye Institute, Ben Taub Hospital, and the MED VAMC. Residents participate in didactics several times per week at HMH and in conference with Neuroradiology Rounds. Residents work in clinic alongside Dr. Rod Foroozan, Dr. Andrew Lee, and Dr. Sushma Yalamanchili. Residents also work in Ocular Pathology on this rotation at HMH with Dr. Chevez-Barrios.
The PGY-2 Pediatrics resident rotates at Texas Children’s Hospital, spending time seeing inpatient consults as well as in the clinic and operating room. There are days when the resident may travel to a satellite site to spend time with faculty there.
The PGY-2 VAMC resident participates in the surgical curriculum for cataract surgery, getting started early with the surgical portion of their training. Residents work in the general clinic, evaluating routine ophthalmology patients, as well as in subspecialty clinics such as glaucoma, cornea and retina.
The PGY-2 Ben Taub resident participates in the surgical curriculum for cataract surgery and the evaluation of clinical patients at Ben Taub Hospital. Residents participate in subspecialty clinics, including retina, oculoplastics, glaucoma, and cornea. First-year ophthalmology residents also perform primary cases in oculoplastics on this rotation.
PGY-3
The PGY-3 Glaucoma rotation includes clinics and surgery at Ben Taub, the VA and Baylor/Cullen Eye. The resident assists in attending clinics with evaluation and management of new glaucoma and post-operative patients. The resident performs outpatient anterior segment laser procedures including selective laser trabeculoplasty, Nd:YAG capsulotomy, and laser peripheral iridotomy. They also perform primary incisional glaucoma procedures, such as tube shunts and trabeculectomy, and manage complex glaucoma patients.
The PGY-3 Retina rotation includes clinical and surgical experience at Ben Taub, the VA, and BCM/Alkek Eye Center. The rotation focuses on the fundamentals of medical and surgical management of vitreoretinal disease, with an active role in retinal laser and injection clinics at the VA and Ben Taub. The resident also participates in pars plana vitrectomy procedures. There is allotted time spent at a private retina practice as well on this rotation.
The PGY-3 Cornea rotation includes evaluation and management of complex anterior segment pathology, refractive surgery, and complex cataract surgery. The rotation includes clinics at both Ben Taub and Baylor/Cullen Eye. The resident participates in surgery at Ben Taub and Baylor/Cullen Eye, including complex cataract surgery, iris reconstruction, corneal transplantation, anterior segment reconstruction, and refractive surgery.
The PGY-3 Pediatrics rotation includes clinics and surgical cases at Texas Children’s Hospital. Residents evaluate patients with strabismus, as well as general pediatrics conditions. Residents are exposed to pediatric sub-specialty care in oculoplastics, cornea, retina, glaucoma, neuro-ophthalmology, and ocular oncology. Residents also participate in the evaluation of pediatric patients on the consult service and have the opportunity to evaluate many of the rare conditions for which patients are treated within the Texas Children’s system.
The PGY-3 at the MED VAMC is responsible for evaluating and managing all triage patients, as well as participating in specialty clinics with Oculoplastics. The PGY3 resident at the VA also takes on their own patients for cataract surgery and evaluation, with a minimum of three independent cataract surgeries per week on this rotation.
The PGY-3 Ben Taub serves both in the clinic and the OR at Ben Taub; the PGY-3 is also responsible for triage, evaluation and care of all inpatient and outpatient ophthalmology consults. The PGY-3 at Ben Taub also takes on independent cataract surgeries in the OR, with an average of one to two per week.
PGY-4
The PGY-4 Retina resident evaluates patients at Ben Taub, MED VAMC, and the BCM/Alkek Eye Center, participating in evaluation, treatment, and surgery for complex retina patients. The PGY-4 resident participates in surgery on this rotation at all 3 locations and has the opportunity for primary vitrectomies. Two months are spent on this rotation in the third year.
The PGY-4 Anterior Segment/Cornea resident works at both BCM/Cullen Eye Institute, Ben Taub, and the MED VAMC, evaluating complex cataract patients, complex refractive cases, and additional anterior segment pathology. Two months are spent on this rotation in the third year.
The PGY-4 VAMC rotation is surgically focused. Residents spend two full days per week in the OR performing surgery and manage pre-operative and post-operative patients on the other clinic days. Residents on this rotation also assist in clinic, as needed, and have the opportunity to perform cases in subspecialties such as Oculoplastics and Glaucoma. Multifocal IOL training and MIGS certification are all available during the PGY-4 VAMC rotations, which are completed over four months during the third year.
The PGY-4 Ben Taub rotation is surgically focused, while still benefiting from complex pathology seen in subspecialty clinics. The residents spend an average of two days in the OR, and cases include complex cataracts, glaucoma surgery, and oculoplastics. A total of four months is spent on this rotation in the third year.