Starting in 2021, the Columbia Ophthalmology residency program will be welcoming its first class of interns in an integrated internship set at the Columbia University Irving Medical Center. This internship has been thoughtfully designed with input from present and past ophthalmology residents at Columbia as well as residents around the country to maximize experiences in specialties that overlap well with ophthalmology. Interns will spend 8 months rotating in medicine, emergency room (pediatric and adult), ENT, plastic surgery, neurology, neuroradiology, neurosurgery, rheumatology, endocrinology, dermatology, and the neurological ICU. 3 months will be spent in the Ophthalmology department, with special attention paid to foundational skills, triage, and the ambulatory surgical clinic. There will be 4 weeks of vacation to round out the year.
First-year residents spend most of their time in comprehensive ophthalmology clinic mastering the ophthalmic exam, seeing walk-in emergencies as well as scheduled patients. ER and triage patient encounters introduce residents to the identification and effective management of diverse pathology and trauma. These supervised responsibilities allow for efficient development of examination skills and complement the clinical curriculum.
First-year residents also regularly staff the glaucoma, pediatric, neuro-ophthalmology, uveitis, and oculoplastic and orbital surgery clinics. During the first year, each resident has one half-day assigned to the operating room, where they assist on a wide variety of ophthalmic cases and perform pterygium surgery and oculoplastic procedures as primary surgeons. They also perform steps of more advanced procedures, such as phacoemulsification and trabeculectomies. In addition, they perform minor ophthalmic procedures (e.g., chalazion excision) in the clinic under attending physician supervision. First-year residents are also exposed to ocular oncology, neuro-ophthalmology, pediatric cornea, and glaucoma in the clinics of Dr. Brian Marr, Dr. Jeff Odel, Dr. Danielle Trief, and Dr. Steven Kane.
In January, first-year residents attend the four-week Columbia Basic Science Course, now in its 80th year, taught by an internationally renowned panel of more than 80 clinicians and scientists from the Harkness Eye Institute as well as other institutions worldwide. Residents from New York, as well as international attendees from Europe, Asia, and the Americas make up the diverse student body. Topics include the anatomy, histology, embryology and development of the orbit and globe, pathophysiology and treatment of ophthalmic disease across various subspecialties, molecular physiology, and avenues of basic science inquiry in ophthalmology. The course also includes a two-day guided orbital and facial workshop, phacoemulsification wet lab, refraction and retinoscopy workshops, and full-day clinical optics and pathology sessions.
During the second year of the residency curriculum, residents sharpen their clinical acumen with four major rotations: adult consult, pediatric consult, subspecialty clinic, and Harlem Hospital. Adult and pediatric consult residents follow inpatients and emergency room patients with active ophthalmic disease at the CUIMC campus. The adult consult residents rotate through the Lighthouse Guild -- augmenting low vision service training-- as well as through the contact lens clinic. A weekly rotation in Dr. Michael Kazim’s private oculoplastics and orbital surgery practice complements the ample orbital pathology seen on the inpatient service. Oculoplastic surgical skills are further honed during the resident oculoplastic and orbital surgery clinic, and while assisting on cases in the surgical suite and operating room.
During the pediatric consult rotation, the residents assist and perform primary strabismus surgery, as well as pediatric cataract extractions. Consistent exposure to pediatric glaucoma, cornea and retina surgery adds to the pediatric consult experience. The pediatric consult resident is the senior resident in neuro-ophthalmology clinic, which complements the first-year private and resident-clinic neuro-ophthalmic curriculum.
The subspecialty clinic rotation exposes the second-year residents to a wealth of ophthalmic pathology, with the opportunity to perform many anterior and posterior segment laser procedures and intravitreal injections. Subspecialty education is supplemented by regular rotations in pediatrics with Dr. Steve Brooks, glaucoma with Dr. Jeffrey Liebmann, and retina with Dr. Stanley Chang.
During the second year, residents begin to perform phacoemulsification surgery in their weekly, dedicated surgical block times. Each second-year resident is expected to complete approximately 30-50 primary phacoemulsification procedures with a core group of surgical faculty before entering the final year of training. At the end of the second year, residents participate in the Massachusetts Eye and Ear Infirmary’s Cataract Surgery Course to refine their surgical skills before entering the third year.
In the third year of residency, residents hone their skills in the operating room, performing primary cornea, glaucoma, plastics, retina, and trauma surgeries with two full days per week in the operating room. They perform cataract extraction with clear cornea incision and phacoemulsification, and, as the senior in each specialty clinic, they operate on specialty cases. Senior residents also enhance their medical decision-making process through supervision of junior residents in clinic and on back-up call.
Rotations with Dr. George Cioffi and Dr. Royce Chen help residents refine their skills in glaucoma and retina and serve as mini fellowships before residents embark on the next stage of their careers.
In addition to rotations at the Harkness Eye Institute, Columbia residents spend 3 months in each PGY-year at Harlem Hospital Center, a public, municipally owned teaching hospital affiliated with Columbia University. Harlem Hospital Center provides a tremendous breadth of pathology that fully complements the experience at the Eye Institute. Patients are seen daily in the ambulatory clinic, and surgical procedures including cataracts, glaucoma, cornea, plastics, and strabismus cases are performed on site in state-of-the-art operating rooms. In this rotation, residents are immersed in a diverse patient care environment and can offer superlative medical care to a population in need.
Primary call responsibilities are divided between first year and second year residents, with most primary call taken by the first-year residents. Third year residents provide back-up call and assist in the management of complicated medical and emergency surgical cases. All call is taken from home, although there is an on-call room available to the residents in case they need to stay onsite for an extended period. The residency program is in full compliance with ACGME work-hour regulations.
The adult and pediatric emergency rooms are equipped with slit lamps, and the on-call resident has a full palette of hand-held instruments and lenses to bring to consults, including wireless indirect ophthalmoscopy, portable slit lamp, and portable ultrasound. Adult emergency surgeries are performed at the Eye Institute, and pediatric emergency surgeries take place in the Children’s Hospital.
Medical education is not static, and neither are our learners. In response to the COVID-19 pandemic, we have shifted to teleconferencing for lectures, and we have closely re-examined the way we teach. The New York area ophthalmology program directors have come together to develop a core citywide curriculum for education that is based on the AAO BCSC series. This core curriculum features the collective expertise of physicians in New York City and New Jersey with pre-recorded lectures available to residents at all New York area institutions. To interact with these fundamental subspecialty lectures, we have developed a Columbia “Eye-Talks” series that flips the classroom and focuses on case-based discussions with our world-renowned faculty. Our residents’ response to this new educational model has been overwhelmingly positive.
Each morning via teleconferencing, residents review challenging overnight call cases and inpatient consults with a rotating schedule of our outstanding faculty members. Morning report is a fantastic opportunity for learning and is also a critical part of sign-out and continuity of care.
Surgical Curriculum and Labs
With Dr. Steve Brooks (aka Tiger Dad) and our dedicated faculty, we have developed a robust surgical curriculum that begins with suturing skills education in July, followed by a suturing olympics obstacle course in the fall. In addition, we have an annual cataract symposium with all anterior segment faculty each summer, and dedicated specialty-specific dry and wet labs that occur throughout the year. Residents practice microscope centration, tissue handling, wound construction, and specific surgical techniques with a combination of virtual simulation, porcine and model eyes. Each first-year resident is paired with a third-year buddy and a faculty mentor to develop fundamental surgical skills before performing the first primary case. Surgical procedures are introduced early in residency training to build skills over a longer period – for example, residents start performing cataract surgery in the first year of training and typically perform 30-50 primary cases by the end of the second year of training.
Columbia Basic Science Course in Ophthalmology
Since 1941, the Columbia BSCO has been educating attendees from around the world on the fundamentals and cutting-edge topics of vision science. Each January, the first-year residents are excused from clinical activities to attend this fantastic course.
COACH is our web-based educational system featuring surgical videos, lectures, and presentations by our own distinguished faculty. How does the world’s greatest retinal surgeon, Dr. Stanley Chang, repair a complex retinal detachment? How does President of the World Glaucoma Association, Dr. Jeff Liebmann, perform a trabeculectomy? Our trainees access these resources to be better prepared when it is time to operate with our faculty.
In addition to OKAP review lectures each February and March, our faculty administer Mock Oral examinations annually to better prepare them for the Oral Board examination. Second year residents attend the Wills Eye Review Course each year, and each resident is provided a subscription to an online question bank. Our residents have consistently performed better than the national averages for both the written and oral board examinations.
Upon graduating from the program, our highly skilled residents typically complete ophthalmic subspecialty training at the most prestigious clinical and research fellowships in the country. Many of our graduates have gone on to faculty and leadership positions at top academic institutions, including UCSF, Wills Eye Hospital, Columbia, Wilmer, and UCLA. Others have served as successful leaders of their communities and their private practices.
Preeminent Educational Resources
Our trainees have access to robust instructional resources, including our new surgical wet lab and simulation suite with the HelpMeSee haptic-based eye surgery simulator. Trainees also have access to COACH, our web-based educational system featuring surgical videos, lectures, and presentations by our own distinguished faculty. These resources prepare our trainees for when the time comes to assist or operate alongside our faculty.
Senior Enrichment Elective (SEE)
Seniors participate in a 1–2-week elective of their choosing to develop interests and experiences that may not occur during the normal scope of training. Recent electives have ranged from global trips to Guatemala, to an elective with an ocular geneticist at another institution, to an elective mini-internship at the Bausch and Lomb Headquarters.
A Brand-New Eye Institute
In 2022-2023, the Harkness Eye Institute will begin a new chapter in its storied history. A brand-new Eye Institute will be rebuilt from the ground up to accommodate our expanding department and to anticipate the needs of 21st century cutting-edge care. Most day-to-day operations for the department will be relocated to a new temporary space located on the CUIMC campus and will offer the same state-of-the-art equipment and environment that our faculty, trainees, and patients associate with Columbia. Extensive planning is already underway to assure continuity and minimize disruption across our teaching, research, and patient care enterprises. Rotation experiences at our faculty practice satellite offices and Harlem Hospital will remain unchanged.