Each of the 3 years of residency is divided into 4 rotations each lasting 3 months. Details for each year are given below.
The First Year
The first year focuses on attaining the basic clinical skills and fund of knowledge needed to properly evaluate and manage the majority of ophthalmic pathology encountered. Lectures, clinical conferences and wetlabs combine with extensive guided clinical experience to achieve this goal. Six months are spent at the Rocky Mountain Lions Eye Institute (RMLEI) and 3 months each are spent at the VA Hospital and at Denver Health Medical Center (Denver’s county hospital).
RMLEI A: This rotation is spent mainly working with the glaucoma faculty at RMLEI. Residents learn the interpretation of visual field testing, nerve fiber layer analyses and gonioscopy. The busy clinics allow them to examine and review the medical and surgical management of the many varieties of glaucoma with guidance from leading experts in the field.
RMLEI B: This rotation gives extensive exposure to neuro-ophthalmology, with 4 mornings per week spent working in the neuro-ophthalmology clinic. The volume of patients is less than in other clinics, but the extra time spent with each patient and in discussion with the attending is invaluable. Time is also spent working in the retina, cornea and oculoplastics clinics. This rotation, combined with the other RMLEI rotation, gives the first year resident good exposure and experience in all the core sections of ophthalmology.
VA: At the VA the resident is the patient’s doctor. There is an attending present in the clinic at all times for consultation, but the resident is expected to perform the exam and think through differential diagnoses and management options prior to any consultation with the attending. The attendings in charge of the resident general clinics do not have clinics of their own during this time. Therefore they are available to offer as much guidance as the resident deems necessary. This allows the resident to work with appropriate independence, given their own comfort level with each patient situation.
In addition to the general clinics, there are weekly subspecialty clinics in glaucoma, retina, and cornea. These are staffed by both full-time faculty and volunteer faculty from the community, exposing the resident to a variety of perspectives. There are also monthly clinics in neuro-ophthalmology and oculoplastics. In addition to performing a variety of laser treatments in the subspecialty clinics, there are a few clinics per month devoted solely to laser procedures. All of the slitlamps and lasers have teaching sidescopes so residents can observe the procedures and then be mentored as they perform the procedures themselves.
Denver Health: Similar to the VA, the resident at Denver Health is the patient’s doctor, with an attending available in clinic at all times for consultation. The variety of pathology and patient demographics, however, are more varied than at the VA. Trauma and pediatric patients are common and many common diseases present in advanced stages. There are weekly clinics in all the major subspecialties, once again staffed by both full-time and community-based faculty. The first year residents perform a variety of laser and other minor surgical procedures during their time at Denver Health. As a Level 1 regional trauma center, Denver Health provides a wealth of experience in the evaluation and treatment of injuries involving the face and eyes.
The Second Year
Having developed their clinical skills in the first year, the second year residents begin a year which includes a high volume of procedures in the fields of strabismus, oculoplastics, and retina. Additionally they perform about 20 cataract procedures as the primary surgeon.
Plastics: The resident surgical volume on the oculoplastics service consistently exceeds 200 procedures, making it one of the most productive in the country. Based at RMLEI, the resident works daily with Dr. Vikram Durairaj, a leading expert in the management of orbital tumors. The procedures performed, however, range from common blepharoplasties to complex orbital and eyelid reconstruction. After 3 months on this service the resident will be skilled at both the evaluation and management of eyelid and orbit pathologies, including the interpretation of the various imaging modalities performed on these patients.
During this rotation the resident also meets weekly with our ocular pathologist to review a series of teaching slides displaying histopathologic sections of common and rare eye diseases.
Children’s: The 3 months at Children’s Hospital Colorado (CHC) are very busy, both clinically and surgically. Residents consistently perform over 50 strabismus procedures as the primary surgeon during this rotation. As a regional referral center, the clinics are also very busy. This allows the residents to develop the special techniques, such as retinoscopy, needed to evaluate children. The inpatient consult service also exposes the resident to a variety of common and rare eye pathologies that occur in children. The resident is the "point person" for all the consults, but always has attending oversight as backup.
Denver Health: As a second year at Denver Health the resident has dedicated O.R. time one half day per week, performing 15-20 cataract procedures as the primary surgeon during this rotation. A number of other minor procedures and laser treatments are performed in the clinic. In addition to their general clinics, the residents also work in glaucoma, pediatric and cornea subspecialty clinics with a variety of community-based faculty, giving them a variety of perspectives on disease management. The second year is also in charge of all the inpatient consultations at this large level 1 trauma center, with one afternoon per week dedicated strictly to this work.
Retina: The retina rotation is based at RMLEI. The resident assists in clinics and surgeries with each of the 3 full-time vitreoretinal surgeons at RMLEI. A monthly Tumor Clinic is held in which they work with our ocular oncologist. Many of the cases seen are discussed at our quarterly Tumor Board meeting, which is a multidisciplinary conference focused on the overall evaluation and treatment of ocular malignancies.
The Third Year
The third year is an intense year of surgery, focusing mainly on cataract procedures. In addition to approximately 150 cataract surgeries as the primary surgeon, the senior resident is a consultant for the junior residents, both in the clinics and on call. They have a high level of responsibility in both the care of patients and the organization of their surgery schedule. Though functioning with greater independence, they still have an attending available at all times for any questions. As the year progresses, the residents’ surgical skills and decision-making mature so that upon completion of residency they should feel comfortable addressing any ophthalmologic situation that arises.
VA 1: This resident is in charge of all the retina and oculoplastics cases performed. There is a weekly retina clinic and dedicated retina surgery time 1 full day per month. Additionally a significant number of urgent retina procedures are performed each month. Oculoplastics also has one full day of surgery each month, during which a variety of eyelid, orbital, and lacrimal drainage system procedures are performed. In addition to the retinal and oculoplastics cases, the resident has 1 day per week of dedicated O.R. time and averages 40-50 cataract cases during this rotation.
VA 2: This rotation focuses on the management of glaucoma and cataracts, with one and a half days per week dedicated to this resident’s cases. A glaucoma surgery is performed each week and an average of 50-60 cataract cases are completed during this rotation. The resident works relatively autonomously, but always has attending support in the clinic and operating room. The resident also participates in weekly retina and cornea clinics.
Denver Health: The 3 months at Denver Health are focused on surgery. The resident spends two and a half days per week in the operating room and performs 30-50 cataract procedures. The residents’ clinics are focused largely on surgical cases, but also include a variety of other types of pathology, including trauma and vitreoretinal diseases.
RMLEI: The 3 months at RMLEI in the senior year focus on cataract and anterior segment surgeries, including the many current varieties of corneal transplantation. An average of 20-30 cataract procedures are performed on this rotation. The residents work with the anterior segment surgeons in their clinics, and also have weekly clinics of their own, which generate a significant number of cataract surgeries. They also spend time observing Lasik and other excimer laser procedures. Through these experiences the resident gains skills in the evaluation of a variety of corneal and cataract situations, such as management of the post-refractive surgery cataract patient and the use of premium intraocular lenses.