Residency Clinical Training

The residency training program begins each July with a two-week introductory course to ophthalmology. This course consists of a series of lectures, workshops, and skills-transfer sessions designed to assist the resident with the transition into ophthalmology training. During this course, didactic lectures emphasize common and emergent conditions in the areas of cornea and external disease, pediatric ophthalmology, retina and vitreous, glaucoma, neuro-ophthalmology, orbit, and oculoplastics. 

Workshops combine didactic lectures with clinical experience and include trauma evaluation and management with interpretation of imaging studies; automated visual field principles and interpretation; introduction to fluorescein angiography and interpretation techniques; and A- and B-scan ultrasonography. Skills transfer modules are conducted by at least one full time faculty member, and include the following subjects: basic history and examination techniques, refraction, keratometry, slit lamp examination of the anterior and posterior segments, applanation tonometry, and indirect ophthalmoscopy. At the completion of this course, the first year residents begin full time clinical duties at the Veterans Affairs Medical Center or the Regional Medical Center.

First-Year Residency (PGY-2)

The major emphasis of the first year of ophthalmology training is to develop an understanding of the pathophysiology of ocular diseases and development of skills in the diagnosis and management of these diseases. The first year of training consists of three 4-month rotations, one at the VAMC Veterans Affairs Medical Center and two at the MedPlex Clinic of the Regional Medical Center. The first-year resident assists with cataract, glaucoma, and oculoplastics procedures with the senior residents and full-time faculty. First-year residents also perform minor oculoplastics procedures, enucleations, and repair of corneoscleral lacerations under the supervision of a faculty member. 

Residents are required to provide their own Indirect Ophthalmoscope and lenses, as well as Direct Ophthalmoscope with Transilluminator.

Each first-year resident is on call an average of once every sixth night. First call is shared by the first- and second-year residents while senior residents serve as backup for consultation and assistance.

Second-Year Residency (PGY-3)

The second year of residency training is divided into three rotations of four months, and focuses on subspecialties (cornea, cataract, and glaucoma), pediatric ophthalmology and strabismus, and ophthalmic pathology. Second- year residents spend four months at the VAMC where they can expect to perform over 30 cataract extractions as the primary surgeon. Additionally, residents perform basic oculoplastic surgery including tarsorrhaphy, blepharoplasty, ectropion, entropion, and ptosis procedures. Second-year residents gain extensive experience in argon and YAG laser procedures including panretinal photocoagulation, grid photocoagulation, trabeculoplasty, iridotomy, and capsulotomy. 

The rotation in pediatric ophthalmology and strabismus is spent primarily at Le Bonheur Children's Hospital. Residents gain extensive experience in the diagnosis and management of pediatric patients. Residents perform a variety of strabismus procedures. During this rotation, residents also have the opportunity to see patients at St. Jude Children's Research Hospital including children with retinoblastoma, rhabdomyosarcoma, ocular complications of bone marrow transplantation, and ocular complications of brain neoplasms. 

The remaining four months are with Cornea, Glaucoma, and Retina faculty where the resident is able to participate in the initial evaluation and management of patients with complex corneal disorders, glaucoma, and retinal disease. Residents may perform and assist cataract extractions, penetrating keratoplasty, refractive surgery, glaucoma surgery, and retinal surgery. One morning a week, residents are assigned to the Ophthalmic Pathology service where they participate in gross and microscopic examination of tissues. Pathologic specimens from all the affiliated hospitals are processed and analyzed by the resident under the direction of full time faculty during this rotation. In addition, residents are assigned unknown cases for review at weekly pathology rounds conducted by the full-time faculty.

Third- Year Residency (PGY-4)

The third year of residency training consists of three rotations of four months each at the VAMC, Regional One Health (formerly The Med), and Methodist University Hospital. The senior resident assumes increasing responsibility for the medical and surgical management of patients. Third-year residents serve as Chief Residents during their rotations at Methodist University Hospital. Additionally, each third-year resident attends the Annual Meeting of the American Academy of Ophthalmology. Senior residents are urged to submit abstracts to the Association for Research in Vision and Ophthalmology (ARVO) under the sponsorship of a full-time faculty member. 

Surgical experience at the VAMC routinely includes over 150 major anterior segment procedures including phacoemulsification, penetrating keratoplasty, glaucoma surgical procedures including trabeculectomy, combined phacoemulsification and trabeculectomy, and glaucoma drainage implants. Complex oculoplastic procedures are also performed during this rotation, including complicated entropion and ectropion repair, enucleation, evisceration, orbital fracture repair, and blepharoplasty. Vitreoretinal procedures including pars plana vitrectomy, scleral buckle, epiretinal membrane removal, and endolaser are also performed during this rotation, as well as focal/grid photocoagulation procedures. 

The third-year rotation at Regional One Health (formerly The Med) offers an extensive experience in craniofacial trauma and reconstruction. Residents gain extensive experience in repair of corneoscleral lacerations, complex orbital and maxillofacial trauma, and traumatic cataracts. Additionally, senior residents perform phacoemulsifications, trabeculectomies, and penetrating keratoplasties. Laser procedures include argon laser grid/focal photocoagulation, panretinal photocoagulation, trabeculoplasty, YAG capsulotomy, and iridotomy. 

The rotation at Methodist University Hospital provides residents with the opportunity to provide comprehensive ophthalmology services to a wide variety of patients. Adult and pediatric patients are seen at this facility and the outpatient clinic. Senior residents perform phacoemulsifications, glaucoma procedures, penetrating keratoplasties, and strabismus procedures during this rotation. Additionally, a variety of argon-laser procedures are performed at this facility.