Ophthalmology Residency Program
Message from the Program Director
|Timothy Martin, MD|
I’ll admit to being biased, but there are just not that many teaching programs that combine the personalized attention and depth of experience found at the Wake Forest program. There is no shortage of clinical and surgical opportunities for our residents. The faculty is full-time, on site, available, and dedicated to teaching residents. Residents and faculty work side-by-side within the same facilities. The teaching program is fortunate to have the full support of the chairman and faculty, as this truly is a "residency-driven" program. The program is stable, with very little turnover in faculty. Graduating residents universally comment that they were "ready and well-prepared" for private practice or fellowship. Most of all, we have cultivated a friendly atmosphere of mutual respect between faculty and residents, making this an enjoyable place to learn and work. We hope this website is helpful in answering questions about the residency training program at the Wake Forest University School of Medicine.
The ophthalmology residency training program at the Wake Forest University School of Medicine is a busy, high-volume clinical program known for its "hands on" approach and excellent preparation for the "real world". The program is a three-year residency, with three residents at each level, based primarily at Wake Forest University Baptist Medical Center in Winston Salem, with one third of the clinical training taking place at the Veterans Administration hospital in Salisbury, North Carolina. With a total resident cadre of nine, the WFU residency is among the smaller programs. However, it remains highly competitive for the best resident applicants for a number of reasons: the high full-time faculty to resident ratio, the location of faculty and residents together in a state-of-the-art facility, a busy medical and surgical resident experience, and the commitment of the faculty to resident education. About two-thirds of our graduates have gone on to pursue fellowship training at the most prestigious institutions in the nation.
Most of the training takes place at the Wake Forest University Eye Center, a modern facility located in the Janeway Tower in the heart of the hospital complex. The Wake Forest University Eye Center is a 28,000 square foot modern facility in which the outpatient activities of the department of ophthalmology are conducted. The eye center includes examination lanes used by both residents and faculty, and facilities for diagnostic procedures such as fluorescein angiography, OCT, automated perimetery, A-scan and B-scan ultrasonography, electrophysiological studies, and state-of-the art photographic equipment. Minor procedure rooms and therapeutic lasers (including an Allegretto Wavelight laser for LASIK) are also located on site. The Eye Center also includes the North Carolina Clinical Research Division, comprising about 1,000 square feet of dedicated clinical trial research space. With attending and resident clinics within the same facility, there is easy access to faculty by the residents. Interaction with other services, multiple disciplinary patients, and hospital consultations are facilitated by the strategic location of the Eye Center. An academic area in the Eye Center houses the faculty offices and the main conference room. The conference room contains a continually updated ophthalmology library, a convenient outpost of the exhaustive resources of the Coy C. Carpenter Medical Library also located on campus. Other on-site library resources include computers for use of internet, literature searches, and our educational CD-ROM library, and closed circuit television from the hospital operating suites. The conference room is also equipped for video, slide, and computer-based presentations and is the focal point of resident didactic instruction.
One-third of the residents' training is spent at the W. G. (Bill) Hefner Veterans Administration Medical Center in Salisbury, North Carolina, which is a 50-minute drive from the Wake Forest University Eye Center. This VA serves more than 280,000 veterans living in a 24-county area of the Central Piedmont Region of North Carolina. The residency training program at the VA has 4 full-time ophthalmologists with expertise in comprehensive ophthalmology and cataract surgery, and fellowship subspecialization in retina, glaucoma, and uveitis. The full-service ophthalmology clinic is undergoing expansion, currently with eight examination lanes and full ancillary testing. The residents have three OR days a week, supporting the busy surgical experience at the VA.
All major subspecialty areas of ophthalmology are represented by full-time, on-site faculty: retina and vitreous, uveitis, cornea/external disease, refractive surgery, glaucoma, ophthalmic plastic surgery, pediatric ophthalmology, neuro-ophthalmology, and comprehensive/cataract specialists. Ocular pathology instruction is provided by a pathologist with co-appointments in ophthalmology and neuro-pathology. The faculty members in the department of ophthalmology are distinguished experts in their fields, authoring many publications yearly. Faculty members are frequently involved in national clinical trials, and the North Carolina Lions Clinical Research Division has three full-time clinical research nurses/technicians. This dedicated clinical research entity may be utilized by residents who wish to participate in major clinical trials at the level of both performance and acquaintance with the methodologies of modern clinical research.
Wake Forest University Eye Center sees over 75,000 patient visits per year, providing an ideal substrate for resident clinical experience. The clinical portion of the teaching program is structured with subspecialty rotations in the mornings (where residents work side by side with attending subspecialists in all major areas), and the Comprehensive Eye Service in the afternoon. First-year residents have one-month subspecialty rotations, and then as second-years cycle back through the subspecialty rotations for a two-month block. This allows all major subspecialties to be visited during the first year, gaining familiarity with all areas of ophthalmology early in training. The two-month second-year rotations are more intense, and residents are expected to function with a higher level of expertise. The program's philosophy is that exposure to all subspecialty areas during the first year is important not only for patient care, but also as many post-residency fellowships require decisions early in residency training.
Comprehensive Eye Service (CES)
|Paul J. Dickinson, MD|
| Director, |
| Comprehensive |
| Eye Service |
One unique feature of the program is a continuous care clinic, the Comprehensive Eye Service (CES), in which residents care for their own population of patients for the entire three years of their training. This general outpatient service allows residents to manage patients much like a community ophthalmology practice, following their patients longitudinally for the duration of their training period. The CES provides an ideal format for clinical teaching and is supported by dedicated supervising faculty, staffing, and eye center facilities. Feedback from residents who have completed our program consistently place high value on their CES experience; often described as one of the "crown jewels" in our residency program. These residents note that it fosters development of the clinical skills needed to "hit the ground running" immediately after residency, whether for private practice or fellowship.
Residents learn the ocular manifestations of systemic disease first-hand as they participate in the busy inpatient consultation service, working with faculty in the evaluation of patients from the various medical and surgical services at Medical Center. Trauma experience is also exceptional, as Wake Forest Baptist Medical Center is a designated level I trauma center, and the Eye Center is a member of the National Eye Trauma System (NETS).
The training program is busy medically and surgically. More than 2,100 major ocular surgeries are performed by faculty and residents each year. These procedures include a full array of both outpatient and inpatient procedures performed in the operating rooms of North Carolina Baptist Hospital. Almost 800 additional procedures are performed yearly in the minor operating suites of the Eye Center itself. With this volume of surgical experience, residents have an opportunity to perform many surgical procedures, far exceeding recommended minimums by the ACGME. For instance, residents currently perform 200 or greater cataract procedures as primary surgeon in the scope of their training (with recommended minimum of 86 by ACGME).
As discussed above, one third of the residents’ training takes place at the W. G. (Bill) Hefner VA Medical Center in Salisbury, NC, a 50 minute drive from the Wake Forest Eye Center. Many residents live just south of town, shortening their commute. Most of the time the residents carpool, making access to the VA clinic more convenient. During our annual reviews the residents unanimously state that the drive to the VA is "worth the effort" given the high volume of surgical and medical experience at the VA hospital.
During the first year of training, residents spend four one-month rotations at the VA, and they spend two two-month rotations as a second-year resident. Senior residents rotate through a continuous cycle allowing each senior resident a full operating day each week at the VA. Resident clinics are busy at the VA, seeing many comprehensive and cataract patients, as well as glaucoma and retina subspecialty consultations. Junior residents perform many lasers, intraocular injection, and minor procedures. The Veterans Administration hospital has a full optometric service, which means that patients encountered at the VA clinics are essentially "prescreened" for pathology. This is especially true with patients having cataracts, with a high percentage of patients initially encountered at the ophthalmology clinic proceeding on with the resident for cataract surgery. About 70 percent of resident cataract surgery is performed at the VA, with 30 percent at the Wake Forest University Eye Center.
Lectures and conferences
The didactic schedule is designed to cover all of the material in the AAO Basic Clinical Science Course (BCSC) in a two-year cycle, allowing some flexibility for senior residents with their surgical schedule. More than 170 hours of didactic lectures are provided each year by the full-time faculty. Wednesdays are reserved for didactic lectures and clinical conferences, and all residents (including residents on VA rotations) are in attendance at the Wake Forest campus. Each Wednesday morning lecture day begins with a 7:15 clinical conference in which all attendings, residents and fellows participate, with residents presenting interesting, informative cases, or cases needing multidisciplinary consultation. Four to six hours of didactic lectures are scheduled on Wednesday, covering the subspecialty areas in a rotating fashion. Three hours on Wednesday afternoon are available for clinical time; this is primarily so residents rotating at the VA can follow some of their long-term patients while on off-campus rotations.
Visiting professors also bring their expertise to the Eye Center. The annual meeting is one such event with three invited lectures of national or international status. Grand Rounds are also held, typically three times a year, with visiting specialists participating in case conferences (usually with patient examination and discussion).
Each resident is required to pursue a clinical research project of his/her choice under the supervision of a faculty person and encouraged to publish at least one paper in a peer-reviewed academic journal before the training program can considered to have been successfully completed. Residents are given specific instruction in presenting case reports and scientific papers, and they benefit from superior audiovisual services for academic and scholarly pursuits. It is anticipated that residents will produce at least a case report during their first year, with rigorous research projects anticipated for the second and third year. Second and third-year residents are required to present the results of their research at the Wake Forest University Annual Eye Meeting as a scientific talk; this is expected to be a publication-worthy project. Residents who have papers or posters accepted at outside peer reviewed meetings will typically be sponsored by the Eye Center to attend, but this decision is made on a case by case basis.
All call is from home. The first and second-year residents take "first call", so on average call is every sixth night. However, call is more frequent on the Wake Forest rotations than when residents are on their VA rotations, so there is some variability throughout the year. Senior residents take "second call" and thus are on call on average of one out of every three nights for backup call. Senior residents are expected to come to the Eye Center after hours as needed (admissions, emergent procedures, or when the junior residents have clinical questions). Faculty coverage is available at all times, and faculty staff supervise all trips to the operating room, both scheduled and unscheduled.
The training program also supports fellows in retina, cornea, and oculoplastics. Having fellows in these three busy services has been a benefit to residency training, allowing more predictable educational structure for residents rotating through these subspecialties. Resident surgical volume has not been affected by the addition of fellows to our program.
Chairman: Craig M. Greven, MD
Residency Program Director: Timothy J. Martin, MD
Residency Program Coordinator: Mary Kirk Huske firstname.lastname@example.org