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).
All ophthalmology rotations in in the PGY2 and PGY3 years are two months in duration. The subspecialty rotations in the PGY4 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).
VAMC (Four Months) - The PGY1 VAMC resident participates in the evaluation and management of clinical patients at the MED VAMC. Residents work in the general clinic, evaluating routine ophthalmology patients, as well as in specialty clinics such as glaucoma. They spend their first two weeks learning how to operate diagnostic equipment and perform the basic eye exam. Their clinical load is reduced to reflect their level of experience.
Oculoplastics (Two Months) - The PGY2 Oculoplastics resident has the opportunity to work in a variety of clinical sites, including BCM/Cullen Eye Institute, the Michael E. DeBakey Veterans Affairs Medical Center (MED VAMC), and Texas Children’s Hospital (TCH). Residents also receive training in ocular pathology on this rotation with Dr. Debra Shetlar.
Neuro Ophthalmology/Ocular Pathology (Two Months) - The PGY2 Neuro/Path resident works in the clinics at Houston Methodist Hospital (HMH), 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 Neuro-Radiology Rounds. Residents also work in Ocular Pathology on this rotation at HMH.
Pediatrics (Two Months) - The PGY2 Pediatrics resident participates in both pediatric oculoplastics and strabismus cases on this rotation, in addition to learning in clinic. The resident on this service has the opportunity to first assist on, as well as perform extraocular muscle surgery with attending supervision.
VAMC (Two Months) - The PGY2 VAMC resident participates in the surgical curriculum for cataract surgery and the evaluation of clinical patients at the MED VAMC. Residents work in the general clinic, evaluating routine ophthalmology patients, as well as in specialty clinics such as glaucoma.
Ben Taub (Four Months) - The PGY2 Ben Taub resident participates in the surgical curriculum for cataract surgery and the evaluation of clinical patients at Ben Taub Hospital. Residents participate in specialty clinics, including Retina, Oculoplastics, Glaucoma, and Cornea. First year ophthalmology residents also perform primary cases in Oculoplastics on this rotation.
Glaucoma (Two Months) - The PGY3 Glaucoma 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.
Medical Retina (Two Months) - The PGY3 Medical Retina rotation includes clinical and surgical experience at Ben Taub, the VA and BCM/Cullen Eye Institute. The rotation focuses on the fundamentals of medical and surgical management of vitreoretinal disease, with an active role in retinal injections at the VA and Ben Taub. The Medical Retina resident spends one half day at TCH in the pediatric retina clinic.
Cornea/Anterior Segment (Two Months)- The PGY3 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.
Pediatrics (Two Months) - The PGY3 Pediatrics rotation includes clinics and surgical cases at Texas Children’s Hospital (Main Campus) and Texas Children’s Hospital (West Campus). Residents evaluate patients with strabismus, as well as general pediatrics conditions. Minimums on strabismus cases routinely exceed ACGME requirements. Residents are exposed to pediatric sub-specialty care in oculoplastics, retina, neuro-ophthalmology, ocular oncology, and glaucoma. 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.
VAMC (Two Months) - The PGY3 at the MED VAMC is responsible for evaluating and managing all triage patients, as well as participating in specialty clinics with Oculoplastics. The 2Y resident at the VA also takes on their own patients for cataract surgery and evaluation, with minimum two independent cataract surgeries per week on this rotation.
Ben Taub (Two Months) - The PGY3 Ben Taub serves both in clinic and the OR at Ben Taub; the 2Y is also responsible for triage, evaluation and care of all inpatient and outpatient ophthalmology consults. The 2Y at Ben Taub also takes on independent cataract surgeries in the OR, with an average of one-two per week.
Surgical Retina (Two Months) - The PGY4 Surgical Retina resident evaluates patients at Ben Taub and the MED VAMC, participating in evaluation, treatment, and surgery for complex surgical patients. The 3Y Surgical Retina resident has both their own injection and laser clinics at Ben Taub, in addition to evaluating complex retinal pathology. The 3Y resident participates in surgery on this rotation at BCM/Cullen Eye Institute, Ben Taub, and the MED VAMC, and has the opportunity for primary vitrectomies. Two months are spent on this rotation in the third year.
Anterior Segment/Cornea (Two Months) - The PGY4 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.
VAMC (Four Months) - The PGY4 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, LensX training, and MIGS certification are all available during the PGY4 VAMC rotations, which are completed over four months during the third year.
Ben Taub (Four Months) - The PGY4 Ben Taub rotation is surgically focused, while still benefitting 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.