Ophthalmology Residency

Residency Coordinator

Dr. Brian Gilger
Phone: (919) 513-6239
Email: Brian_Gilger@ncsu.edu

Objectives

The primary objectives of this program are to prepare the resident for the successful completion of all steps of the certification process leading to diplomate status in the American College of Veterinary Ophthalmologists after 3 years. The program is designed to train veterinary ophthalmologists interested in pursuit of academic achievement and contribution, whether in an academic or private institution. This program is designed to expose the resident to the fundamentals of academic veterinary ophthalmology, including a balance of teaching, service, and clinical and basic research.

Program Coordinators

Program Design

The 3-year program is designed to provide in-depth training in the medical and surgical aspects of clinical veterinary ophthalmology. Approximately 2 years of the residency involve clinical training in the Veterinary Teaching Hospital. Non-clinical time is allotted for literature review, basic science training, publication preparation, and board exam (see clinic schedule).

The balance of the training involves research training in a research laboratory in the College of Veterinary Medicine , with one of several research mentors. Depending on the resident's background, they may be required to take a graduate level biotechnology course, statistics course, or an electron microscopy course.

The research experience and graduate courses inherent to the postdoctoral position may be applied to the pursuit of a PhD at the resident's option. In this case the resident must apply and be admitted to the graduate school during the postdoctoral program. Areas of concentration presently available in the graduate program are microbiology/immunology, pathology, pharmacology, morphology, cell biology, epidemiology, and population medicine.

 

Resident Selection

Resident selection is generally handled through the veterinary matching program. Depending on funding and other circumstances beyond the control of the mentors, residents may be selected out of the match program.

 

Program Structure

 

1. Clinical Training:

Case Load : The NCSU ophthalmology service examines approximately 60 patients weekly and performs surgery on from 10-15. Approximately 100 cataracts are extracted annually. The large animal caseload is primarily horses and consists of approximately 40 animals per month, and the exotic animal caseload is approximately 7-10 animals per month. NCSU has an approved laboratory animal facility and access to a variety of species, which the resident can examine to supplement training in this laboratory animal ophthalmology.

 

Clinic Schedule: The resident will be allowed 6-8 weeks off clinic duty during the first year of training. This time will be in the form of two, 2-week blocks, to be used at the resident's discretion for literature review, designing a clinical research project, or preparing for the postdoctorate research. Two weeks total vacation time is allowed each year, to be taken when the resident is off clinic duty. Other sporadic time off clinic to attend scientific meetings may be allowed. The resident's clinical training will be directly supervised by one of the mentors at all times during the program, except for 2 months during the third year, during which time the resident may function as chief clinician and run the service. One of the mentors will be available during this time for assistance and consultation.

During years 2 and 3 of the program, the resident will spend approximately 10 months off clinic duty, a block of time which includes approximately 4-6 months performing research, and the balance of the time devoted to extracurricular training (e.g., basic science courses), manuscript preparation, writing, and board exam study. The specific schedule will be determined during year 1 of the program and will depend on research funding for the postdoctorate and the background of the resident.

Emergency Duty: The resident will work with primary hospital emergency service to ensure that is all ophthalmology emergencies are effectively and efficiently managed. The resident will be responsible for all ophthalmology cases that are hospitalized over the weekends and holidays. Emergency duty includes weekday and weekend duty and all holidays. Arrangements to the contrary must be made with the faculty member on the service at the time of the holiday; however, priority will be given to the faculty, and residents should not expect to leave town during these times. No primary, non-ophthalmology emergency duty will be required. The resident will NOT be expected to cover emergency duty during scheduled off clinic time for manuscript and grant preparation, and board exam study. Specific emergency duty schedules will depend on the availability of other ophthalmology residents in which duty will be shared.

Surgical Training: Extraocular surgical experience will be gained primarily by working with animals presented for treatment to the teaching hospital. Intraocular surgical experience is gained through a graduated, step-by-step process that begins with reading assignments during the first month of the program. After discussion of the reading materials with the mentors, the resident then practices basic surgical techniques on enucleated eyes. The resident must practice each step of the common procedures until they can be completed, as judged by the mentors, in a competent fashion (see addendum). The resident will be supervised during all intraocular procedures until late in the second year of the program. It is anticipated that the resident will be performing lens extractions on clinical patients by the eighth to ninth month of the program. The resident is required to maintain a surgical log for the ACVO, documenting surgical experience. The surgical procedures performed with a operating microscope are routinely video-recorded and are used to critique and monitor the resident's progress in surgical training.

Responsibilities Of Ophthalmology Residents When On And Off Clinical Duty

Clinical Schedule

The senior clinicians / mentors will make the clinical schedule for faculty and residents. Minor changes can be made to this schedule by discussion with the senior clinician or the residents can trade clinical duty with senior clinician approval.

On Clinical Duty

  1. Residents will examine ALL clinical (in patient and out patient) animals
  2. Residents are responsible for ALL hospitalized patients and this includes:
    1. Treatment orders
    2. Daily examinations
    3. Keeping the student(s) and technician(s) up-to-date on the patient
    4. Medical records and discharge instructions
    5. Client communication
    6. RDVM communication
  3. Residents are responsible for planning and participating in all surgery of their patients

Off Clinical Duty

Amount of time: The resident will be allowed 6-8 weeks off clinic duty the first year, and approximately 10 months off clinic duty for the remainder of the two years.

Purpose of off-duty time:

A written plan must be given to the mentors prior to going off clinics describing work to be done during the off-clinic time (e.g., taking annual leave – 1 week; case reports – 2 weeks; retrospective study – 2 weeks; etc). Off-clinic time is NOT free time. The resident is expected to attend ALL resident rounds when they are off clinics (Exceptions – if they are on vacation; during the board exam study period).

2. NCSU Residency Publication Requirements: To successfully complete the NCSU Ophthalmology residency, 3 publications must be completed as described below:

a. Case report - Although case reports are not required for ACVO credentials process, 1 case report must be completed and submitted for publication by the end of the first year of the residency.

b. A retrospective or prospective clinical study / case series - preparation and submission of a manuscript to a referred journal is required. The resident will work with the mentors to identify an appropriate study during year 1 of the residency.

c. Research project - must be completed by the resident and the data submitted for publication by the end of the residency. If the study requires funding, the resident will be expected to prepare and submit a research grant to one of the following sources: Departmental Grants ($4,000), American Society of Veterinary Ophthalmology Grants ($2,000), NCSU College of Veterinary Medicine Grants (with a faculty mentor, up to $25,000), ACVO Grants ($4,000), or other outside funds.

3. Board Preparation:

Special sessions are held weekly to facilitate preparation for the board examination. Journal review is held twice monthly, with pathology review, grand rounds, and slide examination taking place on the alternating weeks.

Journal Review: Journals are reviewed in 2 groups, each on alternating sessions. In the first group are 26 veterinary journals, and in the second group are human and basic science journals. All papers in the veterinary literature that pertain to ophthalmology are reviewed. The mentors select the pertinent articles from the human and basic science literature for review. At each session there are from 3 to 10 manuscripts discussed. The resident is expected to have critically reviewed each manuscript and to have critiqued, in writing, the scientific methods used. The responsibility for library work is shared equally between the resident and mentors.

Pathology Review: The resident has at their disposal an ophthalmic pathology slide file containing all histologic specimens processed over the previous 12 years, each accompanied by a written report. Ophthalmic specimens processed by the histopathology laboratory during the previous month are reviewed. The resident is expected, prior to coming to the review session, to have studied the slide and written a comprehensive histopathologic description of their findings. After the clinical details of the case are presented, the residents present their findings to the group (which include pathologists and pathology residents) with the slide being jointly viewed through a multiobserver scope. Mentors and residents share equally the responsibility of identifying slides for review.

Grand Rounds: The resident has the responsibility of preparing a case for presentation. All aspects of the case management are then critically assessed in group discussion format. Case presentation and discussion are limited to 60 minutes.

Slide / Image Exam Training: This exercise is designed to help the resident learn to objectively and thoroughly assess clinical photographs (gross adnexal, globe, or fundus lesions, or diagnostic procedures) and prioritized differential diagnoses.

Study Review Sessions: During the first month of the program, the resident is required, with guidance from the mentors, to schedule their reading of manuscripts and textbooks for the coming 3 years. Review sessions are then scheduled to take place on a quarterly basis. Each review session lasts approximately 60-90 minutes, during which time the mentors ask the resident questions pertaining to the assigned material. During each session, pertinent texts and manuscripts are covered. The purpose of this exercise is to ensure that the resident's board study progresses on a timely basis.

Surgical exam practice: Practice of extraocular or intraocular surgery on cadaver pig tissue will be done monthly to prepare for the ACVO examination.

4. Research Training:

The resident is required to participate in a postdoctorate research program of 6-8 months in duration. This may be in one of several laboratories in the College, including, but not limited to, the ophthalmology laboratory, the pharmacology lab, or immunology/retrovirology lab, depending on funding availability and the background of the resident. The nature and scope of the postdoctorate program will be dictated by the background experiences and interests of the resident, in additional to funding. Ophthalmology research efforts at the College currently include investigation of animal models of recurrent uveitis, ocular immunology particularly as it relates to recurrent uveitis, sustained ocular drug delivery and infectious keratitis. Research grant preparation and submission by the resident will be a component of this aspect of the program and may be directed at a variety of funding sources, including those listed under part 3 above.

The NCSU ophthalmology section has a 500 square foot laboratory and a full-time research technician. In addition to a wide variety of research equipment, this laboratory houses computers with a wide variety of software programs (graphics, data analysis, word processing, image scanning, slide generation, E-mail, internet access) for the resident's use.

6. Resident Travel:

The resident is currently allowed $400.00 to $1000 per year for travel. The ophthalmology will attempt to supplement this amount of money when possible. This amount, and the money described under 7 below sometimes varies from year to year at the discretion of the department head depending upon the economic climate. The expenditure of this money is at the discretion of the resident. The resident is encourage to attend the ACVO annual meeting (first and third years) and is encouraged to attend at least one of the annual meetings of the Association for Research in Vision and Ophthalmology (second year). The resident is required to cover the clinic during the ACVO meeting during their second year of the residency.

7. Biomedical and Resources:

The NCSU College of Veterinary Medicine houses a biomedical resource facility that provides all types of graphic art, photography, and video services. The resident has complete access to the exceptional Veterinary Medical library at NCSU library for literature searches, reviews, and study. Two other world class medical libraries (UNC-Chapel Hill and Duke University ) are nearby and also have a convenient interlibrary loan system with the College of Veterinary Medicine

8. Presentations:

The resident is required to present a clinical or research paper at the annual meeting of the ACVO during the third year of the program. Additionally, the resident is required to participate in a departmental house officer seminar series where the resident will present 2 one-hour seminars (House Officer Seminars) to faculty, interns, and fellow residents.

9. Teaching Experiences:

The resident will be expected to be an active and vital member of the teaching team in ophthalmology. They will have the opportunity to assist with and, in some cases, lead the discussion in several teaching laboratories for veterinary students. These will include assisting with junior surgery laboratories in ophthalmology, case study laboratories in the clinic, and didactic course (years 1-3) case study laboratories. The resident will also be expected to lead discussions, direct learning, and assess the performance of the senior veterinary students and interns during their clinical rotations. The resident is also encouraged to give at least one continuing education seminar at the North Carolina Veterinary Conference.

10. Extracurricular Training:

The resident is required to attend a Basic Science Course in Ophthalmology. This may include either the ACVO Basic Science Course, the Stanford University Course in Palo Alto, California or another similar course (with approval by the mentors). The resident is allowed time off clinic for this training as described above. The Ophthalmology Section will make every effort to support the costs of tuition; however, remuneration for the costs of tuition for the course will depend on available funding from the College, and tuition will be the ultimate responsibility of the resident. Travel and housing must be provided by the resident; however, the resident's travel budget may be used for this purpose.

Opportunities are also provided for the resident to participate in examination of laboratory animals (Glaxo/Wellcome Co.) and observation of human ocular surgery ( Duke University ). Residents are also encouraged to attend the Ophthalmology Seminar Series the at the Duke University Eye Center . Visits to regional specialty practices may also be arranged during off clinic time. The resident is also encouraged to participate in CERF clinics.

11. Program Reviews:

At the beginning of the program the resident is assigned a committee to oversee the training program and to handle any problems that may arise. The committee is comprised of the program mentors and 1 neutral member. The resident is evaluated informally by the mentors quarterly and formally by the entire committee each 6 months, with copies of a written review sent to the office of the Associate Dean for Clinical Services and to the chairman of the ACVO Residency Committee. Progression to the second and third year of the program is dependent upon favorable progress reports.

Addendum: Resident Intraocular Surgery Training Guidelines

The following is a suggested schedule to assist the resident in the timely development of intraocular surgery skills. The goal is to attain the minimum level of competency necessary to perform lens extractions by the ninth month of the program. It is the resident's responsibility to keep current on the schedule and obtain mentor approval prior to progressing to the next step.

July - Familiarization with intraocular instruments; study standard surgical texts including Eisner's Principles of Surgery, Jaffe's Cataract Surgery and Its Complications, and Troutman's text on Anterior Segment Surgery.

August - Assist faculty with intraocular surgery, set up for intraocular surgical procedures, review phacoemulsification tapes.

September - Perform open-sky extracapsular lens extraction on enucleated eyes until proficient with the basic components of the surgery, e.g., corneal incision, closure, etc. The resident should arrange for the faculty member to review their technique prior to progressing to clinical patients.

October - Videotape open-sky technique and review with senior clinician on service. Continue assisting in intraocular surgery. Following videotaping procedure, begin incision and entry on clinical cases. Perform phacoemulsification on enucleated eyes.

November - Review phacoemulsification tapes. Set up for procedure. Videotape small incision procedure on enucleated eyes with needle capsulotomy and phacoemulsification on Wednesday afternoons following the day's surgery and review with faculty member. Tape closure of wound for faculty to review. Continue performing incision and entry on clinical patients. Begin closure on clinical patients after closure is satisfactorily mastered on enucleated eyes.

December - Begin incision, entry and capsulotomy on clinical cases. Continue closure in clinical cases. Videotape procedure and review with faculty.

January - Begin partial phacoemulsification on clinical cases. Begin irrigation-aspiration technique on clinical cases. Videotape procedure for review with faculty.

February - Begin complete phacoemulsification on clinical cases, including capsulorhexis. Begin implanting IOL's. Videotape procedure for faculty review.

March - Resident should be capable of completing procedure from start to finish.

 

Ophthalmology Rounds

Description of Rounds

Responsibility of Scheduled Person

Journal 1

(Once a month)

Review of ophthalmology-related articles in veterinary journals

•  Review the previous month's veterinary journals and retrieve all ophthalmology related articles

•  Mark off which journals were reviewed in the journal club folder

•  Place 1 copy of the articles in the ophthalmology cubicle at least 1 week prior to the scheduled journal club

•  Send out a reminder email of the journal club at least 1 week prior to the schedule meeting date.

(Residents, graduate students, regular visitors to be assigned)

Journal 2

(Once a month)

Review of veterinary-related, or current research interests- articles in research and human ophthalmology journals

•  Review the previous month's research and human journals and retrieve all veterinary or reseach-interest related articles

•  Place 1 copy of the articles in the ophthalmology cubicle least 1 week prior to the scheduled journal club

•  Send out a reminder email of the journal club at least 1 week prior to the schedule meeting date.

(Faculty members, researchers to be assigned)

Pathology

(Once a month)

Review of the previous month's histopathology slides and/or selected histopathology cases/slides with the pathology faculty

•  Pick up saved slides from the histopathology lab

•  Create work sheet with case number, signalment of animals with path slides

•  Send out a reminder email to ophthalmologists and pathologists of the path rounds at least 1 week prior to the schedule meeting date.

•  Review all slides (everyone)

(Residents, faculty members be assigned)

Section meeting

(Once a month)

General business meeting of the ophthalmology section with the clinical technicians.

No specific assignments – all members of the ophthalmology section are to attend this meeting (Residents, faculty, clinical technicians) regardless of being on or off clinics. This meeting is to review schedules, discuss issues and problems, and to bring up new ideas.

G rand Rounds (Once a month)

•  To review manuscripts, clinical studies, research

•  Review difficult cases, or case series

•  Write up and present case or study– signalment, history, differential diagnosis, result, discussion etc (provide handouts to group, or PPT presentation.

•  Show existing photos, histopath etc

•  Discuss “holes” and needed additions or subtractions

( Residents to present – all invited)

Slide Rounds (Once a month)

Review images and questions to prepare for ACVO examination

1. Faculty will send out images and questions a week prior to the practice exam

2. Residents to review the slides and answer the questions prior to rounds

Review Session (0nce a quarter – Thursday morning prior to VERC)

Individual oral examination of resident on subject dictated by study schedule

Residents should have reviewed literature as described in study schedule. Faculty will ask questions (detail and difficulty as resident would expect on the ACVO examination) on the selected subject.

( Residents only )

Resident Review (Every 6 months)

Individual formal resident review

Review of resident over the past 6 months. Fill out review sheet

(Residents and Faculty)