I wanted to dispel any myths about the residency and hopefully give a balanced overview of the program to prospective residents from the perspective of a current resident.
Residents: 7 per year. A highlight of the program. The residents are a select group: smart, great people who care deeply about their patients and work well as a team and very nice. I think they also feel confident in what they know, and also know when they need to ask for help. They are also great teachers. There is not a competitive feeling among residents as there are so many opportunities for everyone. I think the selection committee does a great job of identifying individuals who will thrive in this training environment and will work well with others. You are treated well as colleagues here, as faculty take great pride in the residency program and the residents. For whatever reason lately, the residents who have matched have been predominantly male (currently 20/21 residents are male!) This is unusual, normally it is pretty balanced in years past. The incoming class has 4 females she it should start to get more balanced. There are many female fellows as well as attendings.
Graduation: almost all residents pursue fellowship. Recently, a majority of residents have chosen to go into retina. I think this is because we manage and see a lot of retinal pathologies from day 1 (diabetic retinopathy, RDs, etc.) Following fellowship, about 50/50 academics vs. private practice.
Philosophy: This program is known for its high volume, learn by doing philosophy. The see one, do one teach one philosophy does aptly summarize the method of training.However, this does not mean you are left alone without any support. Before coming here, I was a bit apprehensive about this type of learning philosophy because I generally learn best by having some didactics and then having an experienced teacher show me how to do it, and give continual feedback as I learn to master a procedure.
However, I have really come to love the method of training here. I realized half way through internship, that I learned the most by taking a leap and making an independent clinical decision without having an attending or resident supervision all the time. I then was more invested in that patient in that decision, and thus learned much more. I started to hate having to run every single decision by an attending. At Bascom, you have your own clinic from day one. One unique thing is that there are essentially two clinical services at Bascom, the attending service, and the resident service. All pts who come through the ER and dont have private insurance generally end up on the resident service. You as the resident are the primary provider for this patient. There is incredible pathology and you as the resident manage all of it. Pts that come with AMD, BRVO, diabetes, that you see in the ER become your pt for residency and you are the primary provider and are responsible for their medical decisions. They are always senior residents and attendings to help you out, but they are your patients. You are essentially an attending from day 1 as you are primarily responsible for the patients. You are not expected to know any ophthalmology before coming, so of course at the beginning, you are asking your third years about everything. However, as you get more comfortable, you need them less and less. You are thrown into the fire at the beginning, but there is a lot of backup, and I think everyone has made the transition well. You have 7 weeks of buddy call with your seniors which give you a good foundation, and it is amazing how quickly you pick things up. You have a lot of back up thoughout the year, senior residents and attendings are always available for consultation. It is daunting at first, but also very rewarding. I can understand why graduates feel very comfortable post residency as you are thinking like an attending from day 1.
Atmosphere: The environment here is very fast paced due to the high volume of patients, but I have found it to be a very supportive, collegial and friendly place. This again is a highlight of the program. While it is definitely very fast paced, the espirit de corps among residents is great. We are all here to support each other and there is a work hard/play hard atmosphere. Also, you are highly dependent on your other co-residents, especially a 1st years, as you are responsible for the ER. If someone is slacking off, it makes life more difficult for the other residents. Attending are great and friendly, many invite us over to their houses for dinners etc. There is definitely no hierarchy and attendings are very approachable, even those that are world-renown ( which are quite a few) if you have a question about patients, or want to work with them for research. There is an attitude that there is no stupid question and I never feel intimidated to ask a question. There is no competition for cases between fellows and residents because there is more than enough pathology to go around. The support staff, nurses, ophthalmic techs are awesome, many have been working here for 10+ years and know what you need even before you do. I have found it be a pretty happy place, people really enjoy coming to work here, from attendings down to techs,take great pride in the institute and love what they do. Fellows are great, where you mainly interact with them in the ER, also great to hear about how other programs do things.
As 1st years, you mainly learn from your 3rd year residents how to manage patients as you do buddy call with them and are with them in the ER. At first, I thought this would be a con, as I would have thought I would have learned better from an attending. However, I have really liked it, 3rd years are awesome as they have seen so much through their 2 years of residency, and you dont feel bad asking silly basic questions as they are your peers. They are also very patient and supportive, as they were in your shoes only 2 years ago, and know what it is like to be a first year and not know anything.
Faculty: great, and very strong in all departments. Many faculty in each department (many retina, large glaucoma, 6-7 oculoplastics, many cornea 3 neuro oph, in house ocular pathology and lab), with many leaders in their respective fields. Dr. Gedde the program director is awesome, also people are very responsive to improving the program if there are things that are not working.
Lectures: We have lectures every 7am each day as well as an imaging conference from 5:30-7pm (OCT, VF, etc.). Most of these are excellent and geared toward residency education (e.g. not geared at too high a level and not focused on persons research). Didactics actually quite good and more than adequate.
Facilities: the vast majority of your time is spent at the Bascom Palmer Eye Institute. ¼ is also spend at the VA, which is a 5 min walk and on the same campus. Jackson Memorial, where you do consults, is a 2 min walk. That means no driving to off campus sites and that all the subspecialty services are very close as well. It is an interesting juxtaposition as the 2nd floor of Bascom is essentially a county hospital (ER, resident clinic), while the rest of the floors are the attendings subspecialty clinics. This is good for you as a resident as all attendings, imaging services etc. are all accessible. At the VA, there is a little more supervision, whereas at Bascom you are more autonomous.
Surgeries: outstanding surgical experience with both cataracts as well as subspecialty services. I think it is generally considered one of the best surgical experiences in the country because of the breadth and depth of surgeries. You dont go into the OR in the 1st year, as there is so much to do elsewhere. Lots of cataracts, but also lots of glaucoma, cornea, and retina cases where you do a lot of the cases in your 2nd or 3rd year.
Call: This is a very front loaded program with in house call in the ER taken by the first years. There is a night float system where you actually spend 2 out of your 7 blocks in the first year on. This is composed of working two days and then 3 nights in a row (e.g. Mon, Tues day, Wed, Thurs, Fri night). The rest of the residents split weekend call (either a 24 hr overnight call on Saturday or a 12 hour call on Sunday). This averages out to being on call once every 2nd to 3rd weekend on one of the weekend days. When you are not on call, you are free that weekend. The ER is always busy but you are usually able to get at least1-3 hrs of sleep on call. This is probably on the heavier spectrum of ophthalmology programs, but compared to internship, the call schedule is not too bad.
2nd year: very light, you work 4-5 Saturday day shifts in the ER (about 8-5pm) the whole year. Otherwise all other weekends off. Cant get much better than that at any program.
3rd year: you take a week block of back up call q 7 weeks(not in house,; but are available to answer questions from 1st years, come in for surgeries etc.) You also work 3-4 Saturdays during the day or so during the day during the year in the ER. Again, not bad at all.
Clinical experience: incredible. The Bascom Palmer Eye ER is very busy and all types of pathology come through the door. It is said that after the 1st year there, you will have seen almost everything in the Wills manual. Once you see a patient in the ER, they are your patient for the residency. Any procedures (lasers, injections etc.) that need to be done, you are the primary person to do it. As first years, we are doing lasers/injections and other procedures from day 1. After 3 months of residency, I would say all the 1st years are pretty comfortable with lasers (PRP, focal) and intravitreal injections, AC taps, YAGs, PIs, and most office procedures on their own. There is as much supervision as you would like. If you would a senior resident to supervise and help you out with every laser/injection, it is possible, but of course everyone is busy. If things get complicated you can always ask anyone to help you out. A great thing is I never feel intimidated to ask my senior restaurants or attendings any questions or to help supervise me for something I dont feel comfortable with, no matter how basic. I think it is because they realize that you are managing the ER with a high volume of patients with serious eye problems, and want to make sure no one falls through the cracks or suffers bad clinical care. Also one thing that is unique is that we learn our clinical information from managing patients rather than reading from the book. For instance, forCMV retinitis we dont know how to manage this condition because we read it from the book, but it is because we have had 10 patients with CMV retinitis which we have managed from start to finish and have seen how these patients have responded. We see a lot of exotic cases so the clinical experiences of the residents are unparalleled.
Research: There are a lot of opportunities for research for clinical trials/chart review to basic sciences. There has been a large expansion of the research enterprise in recent years which have led to a lot of new cutting edge research. As a resident, especially 1st year, there is very little time to do serious research as you are so busy clinically. However, for those that are seriously committed/interested in academics, amazing opportunities are available and research is strongly encouraged. There is a required research presentation that is given at residents day every year.
Location: Miami is a mixed bag for people. For those that are single, love the party scene on South beach, it is heaven. For the majority of people, Miami is plus.minus, most of the residents are not from Miami and think the city is livable, but not their ideal place to live. However, they love the residency. Residents are from all over the country. There is a very latin American centric culture here, and it is probably the most unique place to live in the United States. I think all of the 1st years had culture shock when they first started, but after a month you acclimate. You do use a lot of Spanish here. However, it is completely doable. Many of the residents had zero Spanish experience before starting, and most pick up enough in the first few months to get by as long as you are willing to try. You dont need that much Spanish to do an ophthalmic exam. Miami is actually not bad for families, many things to do for kids, latin culture is very family friendly. The majority of residents are single, but there are a fair amount now with kids.
In summary, I think there is someone for everyone here.
Orientation: There is a two week orientation at the beginning of residency where they orient you to medical records etc., as well as teach you basic exam principles, basic anatomy etc. You then start rotations and take buddy call q7 overnight with your 3rd year resident for 7 weeks. At the end of the 7 weeks, you then switch over to the night float system and the 3rd year no longer stays in house at night.
Potential cons:
1. Little time to read during your first year: You are very busy clinically and generally quite tired following your day to be able to do significant reading. That being said, it is possible to do it. I have found it is generally better to get that extra half hour of sleep so you have enough energy for the next day. Also, because you are having so much clinical exposure, you are learning all the clinically relevant material because you are using it on a daily basis. You just dont know so much of the basic science theoretical things. Because of this first years do average on the OKAPs. I imagine this might be similar at other high volume front loaded programs. However, 2nd and 3rd year there is plenty of time to read. 100% of residents have passed their boards. OKAPs are not emphasized here, dont think anyone cares about your scores as long as you will pass your boards.
2. The first year is tiring and is an intense clinical experience because 1st years manage the ER. It is probably both the best and worst year of residency. Realistically, you will have little time for your family and other interests this year. However, I feel I have more time than internship. There is a steep learning curve for ophthalmology. It is tough because in addition to your regular rotation, which is usually 8-5, there is something called the sweep where 1st year residents come back to the ER to clear out patients for the night float. Usually this takes until around 7pm, but some days later because if you have a complicated patient, you should manage it yourself instead of giving it to your night float. Therefore your days are long (usually 7am-7pm during the week). 2nd and 3rd year is nice, usually 7am-5-6pm. However, the 1st year is tough at all residencies, I think ours is probably a little more tough. Are there other residencies that work harder? Probably. One thing I like though is that you have a very supportive environment and get a lot of technical support (e.g. nurses tech patients in the ER so you spend your time examining and diagnosing pts vs. getting VA etc.). Most fellows who have seen the system seem to really like and admire it. At the end of the first year, you will feel comfortable managing anything that comes through the clinic on your own. You are then rewarded with very light call in your 2nd and 3rd year as well as amazing surgical opportunities. And you still get at least every other weekend completely off, and most residents are able to enjoy Miami in their free time. I think the 1st year is so much better than internship ( in both hours as well as type of work), and I went to a reasonable and desired TY year. Also compared to other residencies, (IM, surgery etc.), the 1st year is easier. I think all my co-residents are really enjoying the year, despite the heavy workload, because they are doing what they love. For me, I wanted to go to a front loaded program, work really hard first year and sacrifice a bit, and then have some more free time later on. 2nd and 3rd years definitely have time to pursue outside pursuits, family life, etc. As I said before, the 1st year still is easier compared to an IM, surgical, or other inpatient heavy residency.
3. Those that will do well here and would really enjoy the residency are
a. Strong work ethic
b. A self directed learner, you learn best by managing patients vs. reading from the book. You cannot be passive and expect people to teach you things just by showing up. Cant be shy, need to ask for help when you need it.
c. A Team player
d. A desire to get the best ophthalmic education they can and willing to work for it
e. Good clinical judgement about what they feel comfortable managing, and what they dont feel comfortable doing
f. Being willing to ask for help and not let your ego get in the way of doing what is in the best interests of the patient.
Overall: An incredible training experience in a high volume but benign, friendly environment that will make you well prepared for anything you wish to do post graduation. I think the most unique thing about the residency is taking ownership of patients from day 1 and being the primary doctor for them. Residents are highly sought after for all types of fellowships and all the doors are open to you, both academic and private practice. It is a busy place, and 1st year is particularly busy, but I think all the residents are all pretty happy and love what they do here. Graduates of the program are extremely well trained and I find that its reputation as one of the top residency programs is well deserved. I am very happy and fortunate to be training here for residency.
