Aug 6, 2020
3
1
Status
Resident [Any Field]
Hi everyone,

I’m an ophthalmology resident at Yale. With the upcoming interview season likely to be virtual, I wanted to help people get to know our program. I recall being a med student and having trouble learning anything about the programs I was applying to in advance, so here’s an honest firsthand account. Several residents contributed to this together.

Teaching:
  • Having worked with the faculty here for several years, I can sincerely say that all my attendings are approachable and genuinely interested in our education. I regularly text message or email my attendings directly about patients I see on call without hesitation, even on patients that are not theirs (such as to request specialty advice). As I have been preparing for fellowship and job applications, speaking with these attendings has been incredibly helpful in planning and shaping my future career
  • This open, approachable, and teaching-oriented culture is not an accident. It is enforced. Our program leadership regularly asks people on a one-on-one basis in passing to see if attendings are approachable, available and take their roles as educators seriously.
  • Our Chair holds weekly research Chair Rounds with us as a way to get facetime with each of us. Topics of discussion usually include our various research projects or journal clubs on significant trials. This has been an amazing way to learn about what’s going on in the department, and to learn to think critically about the evidence that we use daily to shape our practice. It’s been awesome to have a Chair who is personally invested in our education and in getting to know us.
OR:
  • I’ve been quite happy with my surgical experience. We have plenty of volume for every resident to get 150-200 cataracts. The people I’ve spoken to in previous years seem to have landed around there; I’ve heard the limiting factor is resident motivation and organization (eg. Making sure patients show up to surgery through good followup). I’m on my first rotation of the year (out of four surgical rotations) and set to do fifty on my first block of four surgical blocks. In addition to cataracts, we do a variety of MIGS as third years with the glaucoma attendings, and graduating residents feel confident incorporating MIGS as part of their practice. Additionally, we can get certified on the Catalys femtosecond laser. Our attendings use ORA, so we get exposed to that technology as well. Many programs may have this, but for those interested in premium lenses there is also a program to implant free multifocals, and multifocal torics in our resident cases. The VA offers unlimited torics for free. I feel that our cataract training is comprehensive and prepares us well for a modern practice landscape.
  • We have an Eyesi simulator and a wet lab
  • We operate in a recently built ASC (about a year old) in Guilford (a stress and traffic-free fifteen minute drive) that for now is still mostly dedicated to eyes. Our patients gush over the ASC because the staff are just so nice, and it runs so efficiently. We also operate at the main hospital, in the pediatric ORs and the adult ORs.
  • We have regular cataract conferences that help hone our surgical skills
Fellowships:
  • Every year, we have people going to excellent academic fellowships in their competitive subspecialties of choice, or to local/private practice fellowships for those who want to stay local. What may not always be evident in the match list is that people have been very successful at doing whatever they want to do, and they have the support they need. Our letters of recommendation tend to be quite personalized as the department is small enough where attendings get to know residents well. I have found my attendings to be incredibly supportive advocates throughout the fellowship application process.
Clinics:
  • Clinically, we work in a variety of settings – the faculty practice (Yale Eye Center, which has our VIP patients), Dana Eye Center (hospital-based resident-run clinic), the VA (also a resident clinic), Cornell Scott Hill Health Center (which serves in endemic population in New Haven, mostly uninsured patients on a sliding fee scale, the poor, homeless and Medicaid patients). In addition to the obvious academic exposure, there is the opportunity to learn about private practice as well – we also work occasionally with practices in the area on our cornea rotation. The resident-run Dana Clinic helped me establish independence my first year. We get exposed to a variety of patient populations.
Yale:
  • Our program benefits from being at a top university. Research-wise, it is easy to set up collaborations with anybody on campus.
  • We are a tertiary referral center and the biggest trauma center in the state. Smilow Cancer Center brings in a variety of onc pathology. As a tertiary referral center, we have a vibrant neuro-ophthalmology department.
  • We are the only emergency room in the state with 24-hour ophthalmology in-house coverage, so we get interesting emergencies from a wide catchment area.
  • The medical school’s Yale System encourages collaboration among students, and this atmosphere extends to the hospital as well - there is a very real culture around and genuine emphasis on wellbeing extending from the university and medical school campus. I can’t even remember all the programs out there for resident wellbeing – there are plenty of formal resources for counseling (virtual and in-person), peer-to-peer counseling (having someone to talk to). More informally I feel that my attendings all genuinely want me to be happy. I can’t remember how many attendings have checked in with me to see how I was doing as a first year and offered me words of encouragement. There is an annual resident appreciation week. There is a free 24-hour gym across from the hospital. Residency, by its nature, is stressful no matter where you train. It’s nice to train in an environment that is articulate and well versed in topics of wellness, and that actually cares.
  • As I’ve been looking for jobs, I have found that my background has been welcomed by employers and respected. As I've applied to fellowships, I have not had any trouble getting plenty of interviews.

Covid:
  • Connecticut now leads the country in Covid disease control, despite being one of the hardest hit initially. In my opinion, this is the result at least in part of our amazing hospital leadership.
  • Contrary to media reports about provider pay cuts elsewhere in other states, all the housestaff got an $1800 bonus during Covid as a show of appreciation for our efforts, despite the hospital entering an enormous deficit as a result of the pandemic. This truly demonstrates how far the hospital leadership will go to prioritize staff wellbeing and morale, and the spirit of respect and professionalism at this hospital.
  • The Dean of GME was personally in touch daily via email about updates on the hospital census, PPE census, decisions and changes made to clinical care and protocols, throughout the pandemic.
  • Reassignment to the floors: We were allowed to volunteer in the inpatient units on a volunteer basis (and our attendings, PD and several of us jumped in)
  • PPE: Despite media reports about dire PPE shortages in other states, at Yale we always had enough PPE (the daily emails also included a PPE census). Researchers at the university quickly devised a way to repurpose N95 masks with aerosolized H2O2. The PPE sourcing team at Yale is physician-led and totally on top of things. Hand hygiene is culture. Telehealth in the MICU units was increased to reduce excessive PPE usage (like on rounds). There were countless other adjustments made to preserve PPE, reduce exposure while promoting patient safety and excellent care, and physicians led the response.
  • Infection rate: Not surprisingly as a result of these efforts, the infection rate of healthcare providers (based on random testing) was 0.2% (2.4 in 1000 people). Asymptomatic testing for healthcare workers was offered but the program was stopped because so few people tested positive. Until this September, I didn’t even know anyone who got Covid, and I’m a healthcare worker living in Connecticut.
  • For people who want testing, it’s still available the same day, with results the same day, all throughout the state.
  • Surgery is ramping back up, and all our patients are tested for COVID before surgery
  • Resident cataract surgeries have returned to normal volumes
  • At every moment during the crazy last few months, I always felt safe, and I always trusted our hospital leadership to do the right thing for staff as well as patients - and this was such a huge part of wellbeing during the crisis
  • The Yale New Haven hospital census is now around 20 inpatient Covid patients, down from 450 at the peak (~1k patients across all YNHH hospitals at the peak)
Call:
  • To be honest, it’s not that bad as far as call can go. First year, we start on buddy call so that we can learn from our seniors. Even after buddy call ends, seniors are expected and willing to discuss patients and come in to help examine if needed. The culture is supportive (again, this is enforced). We cover the main campus inpatient and ED consults. Call was q5, I averaged 5-10 calls a night.
  • Second year, we cover the Saint Raphael’s Campus emergency room, and the Yale Eye Center phone lines for a week at a time (q 5 weeks). There were no nights when I did not get at least 6 or 7 hours of sleep every night I was on call as a second year.
  • Third year, we are backup call for the first and second years and do all the open globe and surgical cases that come in on call. It gets busier than second year, but you get to do surgery and step into your role as a teacher.

Connecticut:
  • I personally lived in big coastal cities my whole life. I had no clue what Connecticut was until Yale drew me here for my training. I enjoy the good cost of living, easy access to beaches and nature (there are several beaches within a 20-min drive, state parks within an hour drive, hiking, biking and running trails a few miles from the Eye Center), variety of restaurants (to name a few, tapas, Korean fried chicken, multiple bubble tea shops, many sushi stores, Native American, Mesican, many Indian restaurants, some more creative than others, boutique and chain burgers stores, Halal, Turkish, pizza and countless bars), little traffic, and convenience.
  • Connecticut is a great place to raise a family due to the cost of living, plentiful family friendly activities and the excellent program orientation to wellbeing. I seriously feel like there is nothing I lack here in terms of nature, leisure and enjoyment of life.
  • The variety of residents varies. A few years ago, all the graduating seniors were single (one had recently gotten engaged by the end of the year). One year, almost all the residents had kids. It’s just luck of the draw. People are happy in general and live the life they want.
  • New Haven – I’ve never had safety issues on campus. The surrounding neighborhood is less ideal, but I never go there and have no reason to. Nearby towns are beautiful. Guilford is a preppier town with an outstanding school district and glistening beaches. Milford is a wonderful town with a Costco, Trader Joes and also walking distance to the beach (one of our residents lived there and planned a kayak outing for everyone)
These are my genuine thoughts. At a town hall meeting, someone brought up virtual interviews, and I offered to write this of my own accord. (My PD actually worried it would look staged). I am genuinely happy with my experience at this program. To summarize: If I were a medical student choosing my rank list, I would choose this program again for (in no particular order) its 1) excellent, well-rounded educational experiences 2) in a supportive, well-resourced environment 3) with great quality of life and concern for trainee wellbeing 4) successful fellowship matches (people get what they want) 5) at a top university with 6) low cost of living 7) a good place to live 8) reasonable call allowing for balanced quality of life as well as exposure to a wide variety of pathology 9) credentials that employers and patients will admire and respect 10) caring and concerned program leadership 11) a pandemic response that is second to none.
 
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Eye-eye

5+ Year Member
Jan 9, 2015
396
273
Western Washington State
Status
Medical Student
Thank you so much for all the information! A few quick questions, if you have the time:

1) How much clinical and surgical exposure do you get in retina? How much exposure to uveitis?

2) You mentioned call; just to clarify, is that call for one institution at a time, or do you cover multiple hospitals at once?

3) What's the average clinic day look like for a resident? When do you get in, when are didactics, when do you leave, etc?

4) How much autonomy do you feel you get? Do you have the chance to do patient encounters yourself a lot and then just run things by the attending, or are most encounters done simultaneously with the attending?

5) Is there a resident clinic or other avenue to allow for you to have your "own" patients, or to have longitudinal care with patients?

Thank you so much!
 
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Aug 6, 2020
3
1
Status
Resident [Any Field]
1) How much clinical and surgical exposure do you get in retina? How much exposure to uveitis?
Clinical exposure is plentiful - we get retina throughout all 3 years on the VA. Two of five days a week are retina, and we spend 30, 20 and 20 weeks each at the VA our first through third years. We have an additional 10 weeks of nothing but retina on our dedicated Yale Eye Center retina block, and about one day a week of retina in the resident-run Hill Health clinic. I think this is roughly equivalent to about 6 or 7 months of full time retina.

We have two full time uveitis attendings who are fantastic, and we work with them on our comprehensive rotation as third years. We also get a lot of uveitis during our retina rotations and all throughout, on call, and at the resident clinics.

As for surgery, I think we get a fair amount of retina surgery. Certainly a lot of injections - I'll have over 400 injections by the time I graduate. We get the chance to do some lasers too. I've had the chance to do anterior and core vitrectomies as primary surgeon.
All the retina microscopes have a third eyepiece so residents scrub into every retina case. The program has really made an effort to make sure that residents are present every day there is a retina case going on even though we have fellows, and we scrub for those.

2) You mentioned call; just to clarify, is that call for one institution at a time, or do you cover multiple hospitals at once?
Great question! First year, we cover the main hospital, Yale New Haven. This hospital is organized essentially as four separate hospitals all interconnected by an atrium. There's the Children's Hospital (West Pavilion, 11 floors), Smilow Cancer Center (North Pavilion, 14 floors), the inpatient units (East Pavillion, 10 floors), and South Pavilion (ED, additional inpatient floors, 10 floors). The nice thing is it's all in one building and you don't have to drive anywhere but that one location.

Second year, we cover Saint Raphael's campus and Yale Eye Center (faculty practice) phone calls. The two locations are half a mile apart.

Third year, we are backup for the above. Everything is located within a one-mile radius. Driving is minimal.

3) What's the average clinic day look like for a resident? When do you get in, when are didactics, when do you leave, etc?
Depends on the rotation. Most of the time, lecture at 7am (these days on Zoom), clinic at 8am, and I stay until 4-6pm depending on the rotation and how much I'm needed. Plus call. At the VA, we often have time to go out to town and get lunch.

4) How much autonomy do you feel you get? Do you have the chance to do patient encounters yourself a lot and then just run things by the attending, or are most encounters done simultaneously with the attending?
Almost all of the time, we get things started on our own and staff with an attending. If clinic is all caught up, the attending might join me before I'm done with a patient. Learning is emphasized. We always get the chance to come up with our own plan.

5) Is there a resident clinic or other avenue to allow for you to have your "own" patients, or to have longitudinal care with patients?
Yes, patients we see on call have longitudinal care at Dana Eye Center, the resident-run clinic. Hill Health and the VA are also resident-run clinics with attendings staffing. So I do feel there is an excellent amount of autonomy with oversight.

Good luck, and feel free to post or PM me with any more questions!
 
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