Residency Training Program
Jean E. Ramsey, MD
Boston Medical Center
On July 1, 1996, Boston University Medical Center and the Boston City Hospital merged to create the Boston Medical Center, thus enabling us to both provide high quality care and reduce the inefficiencies inherent in duplicated services at two adjacent, previously-competing academic hospitals. The merger of a private, university-based academic medical center and a public, municipal hospital into a single private institution has been eminently successful and has created a new health care presence in Boston.
Boston Medical Center carries with it a history as the major provider in Massachusetts of health services to the disadvantaged. It continues as the epicenter of public and private initiatives to improve the delivery of excellent health care for all. It draws from the fine traditions of its predecessor institutions and maintains their missions: a) providing high-quality tertiary care patient services and unparalleled primary medical care; b) providing excellent supervised training opportunities for future physicians; c) adding to medical knowledge through advances in medical research; and d) safeguarding the unique ability of this institution to provide needed medical services for underprivileged patients of the Greater Boston area.
Boston Medical Center (BMC) is more than one of the premier teaching hospitals in New England. It is also the keystone of the Boston HealthNet, a citywide system of Neighborhood Health Centers. The Health Centers, enthusiastically supported by the City of Boston, provide routine care for thousands of Bostonians, with rapid referral to BMC of patients requiring advanced medical or surgical care. The successful launch of a Boston Medical Center-based health plan also has contributed to a marked growth in outpatient visits.
Boston Medical Center continues the strong bond of Boston University School of Medicine with the Boston Veterans Administration Healthcare System (Boston VA). The Boston VA provides comprehensive medical care to the veterans of New England and is a major site for the residency and fellowship training programs of BMC.
Ophthalmology at Boston Medical Center
The Department of Ophthalmology at Boston Medical Center provides a full range of eye care services. On site at BMC, the Department of Ophthalmology runs two full-time out-patient facilities (The Trygve Gundersen Eye Center located in the Doctors Office Building, and The Eye Center in the Ambulatory Care Center of the Yawkey Pavilion), providing general and urgent eye care services, as well as specialty services for cornea and external ocular diseases, surgical correction of refractive errors, cataract, glaucoma, oculoplastics and orbital surgery, retinal and vitreous diseases, pediatric ocular disorders, and neuro-ophthalmic diseases. The consultation service provides evaluation of hospitalized patients. Comprehensive optometric services, contact lenses and low-vision examinations are offered. Special diagnostic procedures of ocular photography, corneal topography, specular microscopy, visual field perimetry, fluorescein and ICG angiography, A and B scan ultrasonography, and electrophysiological testing of the eyes are all available.
Ophthalmic surgery provided at the Boston Medical Center includes the full range of cataract, cornea, glaucoma, oculoplastic, retina, and pediatric procedures. Minor procedures and laser surgery are done at The Trygve Gundersen Eye Center; major surgical cases are scheduled either in the Eye Surgical Unit of the Ambulatory Surgicenter at BMC or in the main operating rooms.
Twenty-four hour, seven-day per week emergency ophthalmology evaluation and treatment are maintained at the Level I Trauma Center of Boston Medical Center. This commitment allows our medical and surgical patients the peace of mind that comes with the certainty of dependable, available eye care any time of the day or night.
The Boston University School of Medicine, the primary academic affiliate of the Boston Medical Center, also is the primary academic affiliate of the Boston Veterans Administration Healthcare System (Boston VA). The BMC Department of Ophthalmology has administrative responsibility for the ophthalmologic services at the Boston VA, the tertiary care facility for VA ophthalmology in New England, and for the training and supervision of ophthalmology residents there. The Boston VA provides general ophthalmology care, as well as care in all subspecialty areas, ancillary ophthalmic diagnostics, minor procedures, ophthalmic laser surgery, and major ocular surgery under the direct supervision of cataract, cornea, glaucoma, retina, and oculoplastic specialists. Three residents from the Massachusetts Eye and Ear Infirmary/Harvard Medical School residency program join our own three residents there.
The Residency Training Program
The Residency Training Program in Ophthalmology at the Boston Medical Center has been designed with the goal of producing comprehensive clinical ophthalmologists who possess not only clinical knowledge and surgical skills, but also the judgement, confidence, and independence to succeed in a variety of career choices. Graduates have been successful in obtaining coveted clinical fellowship and research training positions. They have become expert clinicians in all areas of the country. Many have achieved recognition in academic ophthalmology, and several have become department chairmen. We strive for the breadth and depth of experience necessary to prepare our graduates for whatever future they may choose.
The Residency Training Program in Ophthalmology at Boston Medical Center is ideal for the energetic, highly motivated, self-propelled and inquisitive physician who wishes to gain wide experience and clinical expertise in ophthalmology. The resident assumes responsibility for the care of patients with a wide spectrum of ophthalmic disease, mastering the skills required for ophthalmologic diagnosis and treatment, and performing laser and surgical procedures under the tutelage of a committed faculty in a wide variety of settings.
- BMC-Ambulatory Care Center Eye Clinic – 9 months
- Boston Veterans Administration Healthcare System – 3 months
- BMC-Ambulatory Care Center Eye Clinic – 6 months
- Boston Children’s Hospital (pediatric ophthalmology) – 3 months
- Boston Veterans Administration Healthcare System – 3 months
- BMC Ambulatory Care Center Eye Clinic - 9 months
- Boston Veterans Administration Healthcare System – 3 months
Prior to entering the initial (PGY-II) year of the Boston Medical Center Residency Training Program in Ophthalmology, all residents must satisfactorily complete a post-graduate clinical year of training (PGY-I) in a program approved and accredited by the ACGME or by the Royal College of Physicians and Surgeons of Canada. During the first weeks of training, residents are introduced to their clinical activities with close supervision. The introductory lecture series and tutorial program in the first weeks eases the transition of new residents into their role as ophthalmic specialists. After this initial period, the balance between supervision and resident independence is gradually modified to encourage the residents’ self-sufficiency and confidence and to keep pace with their increasing ability and responsibilities.
The first year of training centers around the evaluation of ambulatory patients in varied settings. Each new resident is guided into the nuances of ocular diagnosis and the medical and surgical treatment of ocular diseases and ophthalmic emergencies. During each first-year rotation, the resident serves on a variety of general and subspecialty services in order to gain broad exposure to the entire spectrum of eye disease. Each resident spends 9 months at the Ambulatory Care Center Eye Clinic of the Boston Medical Center. Theclinics are fully supervised by the Boston Medical Center Ophthalmology faculty. The remaining three months are spent at the Boston Veterans Administration Healthcare System. All Boston VA clinics are staffed by faculty from Boston University and the VA, providing general eye, cataract, cornea, retina, glaucoma, ophthalmic laser, oculoplastics, neuro-ophthalmology, and in-patient consultation services.
The second (PGY-III) year is devoted to further training in the ophthalmological subspecialties. Residents spend six months at the Boston Medical Center concentrating on the clinical aspects of glaucoma, neuro-ophthalmology, pediatric ophthalmology and strabismus, ophthalmic pathology, contact lens fitting, and vision rehabilitation. Each resident serves as the primary consulting ophthalmologist for BMC. The pediatric experience is bolstered by three months at the Children’s Hospital in Boston, where each resident receives intensive training in the diagnosis and medical and surgical management of childhood ocular disease under the supervision of the full-time pediatric ophthalmologists from the Harvard faculty based at that institution. As at the VA, this rotation is shared with Massachusetts Eye and Ear Infirmary residents. The year is rounded out by a rotation at the Boston Veterans Administration Healthcare System, providing additional training in intraocular surgery, laser surgery, retinology, neuro-ophthalmology, glaucoma, corneal and external disease, and ophthalmic consultation.
The senior (PGY-IV) year provides the bulk of the residents’ surgical experience. Six months are spent at Boston Medical Center, where the resident receives further training in cataract surgery; cornea and external disease, and diseases of the retina and vitreous, glaucoma, and oculoplastic and orbital surgery. Three months as senior resident at the Ambulatory Care Center provides additional experience in these skills and in pediatric ophthalmic surgery. Each senior resident carries primary responsibility for all ophthalmic surgical services during the rotation at the Boston Veterans Administration Healthcare System.
Facilities and Resources
The residents are provided with excellent facilities in which to acquire and develop professional skills. The Trygve Gundersen Eye Center’s 13 examination rooms are equipped with Haag-Streit slit lamps, Goldmann tonometers, and phoropters. The Gundersen also contains a minor surgery suite and a laser facility with argon, krypton, and Nd-YAG lasers. Our staffed ophthalmic photography unit has capabilities for digital fluorescein and indocyanine-green angiography; fundus, slit lamp and external photography; specular microscopy; and media facilities for presentations. An ultrasonography unit and electrodiagnostic (visual evoked potentials, electroretinography) facility complement the automated and manual perimetry unit to complete the Center’s diagnostic capabilities.
All major ophthalmic surgery (ambulatory and inpatient) for cases originating at Boston Medical Center is performed in fully updated eye operating rooms at Boston Medical Center in the recently opened Moakley Building. Closed circuit television for viewing and recording the on-going ophthalmic microsurgical procedures provides an invaluable educational tool for residents wishing to review their own techniques and document their advancements and proficiency. The Eye Clinic in the Ambulatory Care Center of the Yawkey Pavilion boasts not only its own comparably equipped examination rooms, but also independent ophthalmic photography and perimetric capabilities.
Emergency cases are seen in the Emergency Rooms at Boston Medical Center, Children’s Hospital and the Boston Veterans Administration Healthcare System. Call is taken from home, but there are on-call rooms at BMC for residents who find it convenient to stay in-house after being called in.
The Department of Ophthalmology maintains an extensive laboratory research program in the Massachusetts Lions Eye Research Laboratory, the Harold S. Larkin Eye Research Laboratory and The Larkin Family Eye Research Laboratory of the Boston University School of Medicine. Scheduled teaching conferences for residents are held several days per week and follow the American Academy of Ophthalmology’s Basic and Clinical Science Course. Conference formats include patient presentations, formal lectures, and journal article reviews, as well as video and interactive computer tutorial programs. A complete in-house course in ophthalmic pathology is given. Grand Rounds are held weekly. A monthly Surgical Complications Conference allows discussion of difficult cases and non-optimal outcomes as a way of introducing the new ophthalmic surgeon to surgical decision-making and the life-long task of improving surgical skills via honest self-assessment.
Residents attend the regular meetings of the New England Ophthalmological Society; these full-day seminars bring nationally recognized educators and researchers to Boston to discuss current advances in many areas within ophthalmology.
We believe that an environment emphasizing the transfer of clinical knowledge and skills, utilizing abundant clinical cases and dedicated, proficient staff best serves the interests of our residents. We attempt to strike an appropriate balance between supervised preceptorship and individual initiative. Resident input is encouraged at all times. This feedback allows appropriate, timely updating of the didactic portion of the residency training program.
There are multiple computers, including one in each examining room with word processor, spreadhseet, and presentation media capabilities and literature searches with access to the many educational sites on the Internet. The Department of Ophthalmology also maintains dedicated computers for residents in the department conference room. Copies of the latest issues of more than 30 ophthalmology journals are also available in the conference room.
Library resources are provided in the Boston University School of Medicine. These include a wide selection of journals in ophthalmology and related fields, an extensive collection of ophthalmology reference books and atlases, updated yearly, and computer access with fully computerized searches of the library’s collection and of the Medline database. Computer facilities continue to expand: an interactive computer module for ocular pathology already is well established, and future uses are being explored.
Ophthalmology Research at Boston Medical Center and Boston University School of Medicine
The Massachusetts Lions Eye Research Laboratory, the Harold S. Larkin Eye Research Laboratory, and The Larkin Family Eye Research Laboratory in the Boston University School of Medicine is the center of basic ophthalmology research. The full-time research faculty currently numbers seven members plus several post-doctoral fellows and Ph.D. candidates and continues to grow. These researchers and the members of their laboratory staff actively pursue ongoing basic laboratory research projects utilizing specialized equipment including electron microscopy and confocal thick-section microscopy.
In addition, the clinical faculty pursue their particular research interests, with current clinical studies underway searching for improved methods of diagnosing, monitoring, and treating ophthalmic disease. Opportunities for resident participation in basic or clinical research are always available, and many of our residents present their work at regional and national meetings such as ARVO and the American Academy of Ophthalmology. Since this work must be carried out in addition to clinical duties, participation in research activities remains voluntary.
The past decade has produced remarkable growth of the Department of Ophthalmology at the Boston University Medical Center. A consolidation of the two Boston Medical Center clinics on the second floor of the Yawkey Pavilion is underway, along with renovations of the clinics at the VA. The residency is a core mission of the department and continues to attract excellent young physicians for training.