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 the majority 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 in order 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 have the opportunity to offer superlative medical care to a population in need.
Case Volume at a Glance (2017-2019)
We believe strongly in the benefits of early introduction to intraocular surgery, as it has benefits for both surgical competency as well as case volume. Our residents consistently perform well above the ACGME minimums for the different categories of subspecialty procedures and uniformly graduate as outstanding eye surgeons. Below are our average resident procedure volumes from 2017-2019.
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 of time. 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.
Residents are encouraged to collaborate with the Eye Institute’s clinical and research faculty on projects. Every resident is required to present a clinical or scientific paper at the annual Resident-Fellow Research meeting held every June. Funding is available to help support independent resident research. In addition, residents are encouraged to present their research at regional and national meetings and are funded to present first-author papers and/or posters. Senior residents are allowed to attend one scientific conference of their choice. The depth and diversity of research at Harkness enables residents to have tremendous opportunities that are truly unique.