Timeline for learning surgeries in residency

[kwel]

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Mostly a curious question, but what's the general timeline for learning surgeries in ophtho residency? In other words, by the end of first year or second year what procedures do residents generally feel comfortable doing independently?

I've heard that you usually don't do a lot of cataracts until 3rd/final year. Since that's the bread-and-butter procedure I'm wondering when you actually learn to do all the more complicated surgeries

 

[MstaKing10]

I would argue that all surgery in ophthalmology has its own degree of complexity. Cataract surgery is no different but there are nuances to plastics and glaucoma procedures for example that rival those of phaco.

In general, most first years learn external procedures (extra-ocular) such as plastics, glaucoma, cornea and others. There may be some early introduction to phaco like wound construction and the like. I think I did my first extracap procedure at the end of my first year. Second year in many programs you may perform your first few phaco, usually towards the end of the year. Certainly third year is the primary cataract/phaco year as well as time to fine tune other surgical skills.

 

[ophthope]

I would argue that all surgery in ophthalmology has its own degree of complexity. Cataract surgery is no different but there are nuances to plastics and glaucoma procedures for example that rival those of phaco.

In general, most first years learn external procedures (extra-ocular) such as plastics, glaucoma, cornea and others. There may be some early introduction to phaco like wound construction and the like. I think I did my first extracap procedure at the end of my first year. Second year in many programs you may perform your first few phaco, usually towards the end of the year. Certainly third year is the primary cataract/phaco year as well as time to fine tune other surgical skills.

In pretty much every program I interviewed you were introduced to doing each part of surgery towards the end of your first year after learning external procedures, really learned the basics of full cataract surgery in your second year, and fine tuned it your third year. That's pretty much how where I matched does training, too.

 

[hurdlepup]

The program where I matched has you do your first cataract within the fall of your first year. Didnt interview anywhere else where the first years got to do this. You get more out of seeing them if you have actually done one yourself. Then again, I matched at what I feel is a clinically driven, surgically stout program.

 

[JMK2005]

My residency stopped doing extracap surgeries. Did any programs mentioned it during interviews?

 

[guttata]

My residency stopped doing extracap surgeries. Did any programs mentioned it during interviews?

What do they do with dense lens that are difficult to phaco? Combined PKP/phaco or couching? 🙂

 

[JMK2005]

We phaco'ed it all.

In practice now, i've come across a few dense lenses that may be better suited for extracap or sics. I phaco'ed though it. Cornea recovered well.

 

[kwel]

I would argue that all surgery in ophthalmology has its own degree of complexity. Cataract surgery is no different but there are nuances to plastics and glaucoma procedures for example that rival those of phaco.

In general, most first years learn external procedures (extra-ocular) such as plastics, glaucoma, cornea and others. There may be some early introduction to phaco like wound construction and the like. I think I did my first extracap procedure at the end of my first year. Second year in many programs you may perform your first few phaco, usually towards the end of the year. Certainly third year is the primary cataract/phaco year as well as time to fine tune other surgical skills.

oh I see, so I guess cataract surgery is actually more complicated than a lot of other surgeries in ophtho, huh

 

[ophthope]

The program where I matched has you do your first cataract within the fall of your first year. Didnt interview anywhere else where the first years got to do this. You get more out of seeing them if you have actually done one yourself. Then again, I matched at what I feel is a clinically driven, surgically stout program.

Texas Tech does this too I think.

My residency stopped doing extracap surgeries. Did any programs mentioned it during interviews?

Yeah some did - although I asked about it specifically.

 

[MstaKing10]

I hunted down patients and a faculty member that did small incision extracap and did a handful of them. Some attendings refused to do them. I'm glad I got to do it though, as it's a handy skill to have.

In terms of introduction to cataract surgery, most do start first year but the degree of involvement really varies. Like I said before, wound construction, maybe parts of I and A or inserting the lens, maybe suturing a wound or two. Not sure there is a program out there where you do a complete, start to finish, phaco during your first year, but I might be wrong. Second year I probably did a dozen or so start to finish cases without any interruption by my attending. Third year was the real cataract year though.

 

[kwel]

I hunted down patients and a faculty member that did small incision extracap and did a handful of them. Some attendings refused to do them. I'm glad I got to do it though, as it's a handy skill to have.

In terms of introduction to cataract surgery, most do start first year but the degree of involvement really varies. Like I said before, wound construction, maybe parts of I and A or inserting the lens, maybe suturing a wound or two. Not sure there is a program out there where you do a complete, start to finish, phaco during your first year, but I might be wrong. Second year I probably did a dozen or so start to finish cases without any interruption by my attending. Third year was the real cataract year though.

When are residents usually able to do laser surgeries w/out interruption by attendings? What about retinal surgeries? Do you have to do a retina fellowship to really get experience in that area? It seems like a world of its own, and if you don't master cataracts till 3rd year I can't imagine when you'd find the opportunity to do retinal surgeries..

Edit: while I'm asking all these n00b questions, does anyone have a list of the surgeries you're supposed to be able to do by the end of residency (for certification purposes)?

 

[DrZeke]

I think this might help. It's the ACGME requirements for Ophthalmology residency.

http://www.acgme.org/acgmeweb/Progr...ines/SurgicalAccreditation/Ophthalmology.aspx