Transcription:
The Importance of a Modern Ophthalmology Residency

Melanie Cole (Host):  Welcome. Today we’re talking about the importance of a modern ophthalmology residency program. Joining me in this panel discussion are Dr. Dmitry Pyatetsky. He’s an Associate Professor of Ophthalmology and Medical Education and the Program Director of the Ophthalmology Residency Program at Northwestern Medicine. And Dr. Anupama Anchala. She’s an Assistant Professor of Ophthalmology and Associate Program Director of the Integrated Internship in Ophthalmology at Northwestern Medicine. Dr. Pyatetsky, speak a little bit about how ophthalmology residency training has evolved in the past several decades. What is required of modern ophthalmology physicians?

Dmitry Pyatetsky, MD (Guest):  Ophthalmology residency training is a part of the greater system and as such, because our healthcare environment has changed dramatically with an explosion of information and knowledge that’s related to the field to eye disease and the treatment of eye disease; also keeping in mind that there has been a much higher patient volume with baby boomer generation approaching their retirement years, as well as expectations from the public changing expectations of really excellence in the care that they are receiving, expectations about transparency of outcomes of their care and accountability of physicians and organizations, while the number of providers not really changing over time; the residency programs have really had to adapt.

For modern residency training program, goal oriented residency structure is key. There really is no time to waste because there’s so much information and so many skills to gain. Attention needs to be paid to logic and efficiency of training of every single resident. In order to help with this process, we’ve integrated the internship which used to be a free standing entity that was separate but required for ophthalmology; we have integrated it into the ophthalmology residency training and Dr. Anchala is going to talk about this I believe down the road.

We’ve really shifted our focus to the balance of supervision and autonomy to make sure that not only are our residents learning but to make sure that the patients are receiving the best possible outcomes. There has been an emphasis placed on what lab courses and surgical simulation as well as early immersion into intraocular and other eye related surgery and step by step surgical training. We are really focused on efficiency and working as a team and part of a larger healthcare organization rather than training individuals, providers responsible for every aspect of patient’s care. And of course, as the demands on the physician workforce are increasing; we are understanding the potentially devastating impact of physician burnout and so our residency programs have had to prioritize resident wellbeing, wellness and making sure they are sticking to their duty hours.

Host:  What an interesting time to be in your profession and Dr. Pyatetsky, sticking with you for just a minute, as you tell us how Northwestern Medicine is poised to deliver as these new technologies come around; how has the curriculum changed with all of these new technologies and as it’s evolved?

Dr. Pyatetsky:  We’ve taken a deep dive so to say into what is it that we have to teach our residents. We came up with a list of priorities and goals. What are the most important things that we have to achieve? And we thought about what are the very best ways of teaching our residents these concepts. And as a result, we came up with a very logical clinical and didactic curriculum. The curriculum builds on prior knowledge, so we’ve put in the beginning information that’s kind of a little bit more straightforward and we’ve put our trainees in situations where they are closely paired with faculty members teaching them these basic concepts.

And as they progress through their training, further and further, we give them a little bit more and a little bit more autonomy and so, what we’ve done in addition to this is also instead of giving them opportunity to really immerse themselves to a particular subspecialty within ophthalmology and never have a chance to come back to it; we’ve broken it up so that they get particular focused training for a while. Afterwards, they move on to a different subspecialty area. Let all that knowledge sink in, let them incorporate this knowledge and see it from different perspectives and then to come back to it at a later stage in their training to the same subspecialty they’ve covered earlier. So, that has been a big advance.

The other thing that we’ve done is we’ve really made sure that we present the information in a focused fashion, meaning when residents receive lectures, or do didactic sessions; they do it for a stretch of several weeks with a focus on a single relatively speaking subject. For example, for six weeks they are going to be learning about neuro- ophthalmology. For six weeks they are going to be learning about ophthalmic plastics et cetera. Rather than having a random collection of lectures for example. So, those are some of the things that we’ve done.

Because the patient volumes are so high, in some ways we’ve had to really focus on surgical training and as such, we’ve made sure that we incorporated surgical experience throughout the entire residency and as the field has advanced with introduction of intraocular injections for macular degeneration and uveitis, introduction of minimally invasive glaucoma techniques, minimally invasive cataract surgery techniques, with specialized intraocular lens implants; we are making sure to incorporate all of those techniques into the residency training.

Host:  Well that’s a very comprehensive program Dr. Pyatetsky. So, Dr. Anchala, tell us about the integrated internship year at Northwestern recently incorporated. What makes it unique?

Anupama Anchala, MD (Guest):   I love to talk about the internship. We are very excited about our integrated internship. Last year was our first intern class that started with us after the initiation of this program and it was a great success. This year, we have our second class. I think what makes our internship unique is that we are some of the first early adopters of having these integrated internships in ophthalmology programs so it’s relatively new territory. I think what makes our specific program unique is we really are dedicated to the training of our interns. We have a very specialized didactic curriculum as well as clinical curriculum that we have developed for these interns to progress through their training to not only make them a good ophthalmologist but a good well rounded physician.

Within this internship, they get exposure to some of the broader fields of medicine that we believe all physicians should have exposure to before subsequently specializing. And that includes time with surgery department under which our interns are housed as well as internal medicine department and emergency medicine department. So, we really feel that our interns get a good exposure and breadth of knowledge from experience during all of these rotations. But in addition, given that we are really trying to produce high functioning, exceptional ophthalmologists; these interns get more exposure to ophthalmology than they would otherwise. Obviously, this is our end goal.

So I think that for all these reasons, it’s really nice that we’re able to do this for our residents. And what we can already see is now that we’ve completed one year of intern class, and we have these residents now as our second year residents; or our PGY2s, we can really see a big difference in their comfort in managing patients and in diagnosing patients and I really think this is going to catapult their learning and really we will end with residents and trainees that are even more capable than we already produce. So, I think we are really excited about this.

Another unique aspect to our program is given that we are allowing these residents additional time for ophthalmology during their internship; it does free up the schedule a little bit later in the curriculum later for the residents in their final years kind of as Dr. Pyatetsky mentioned. These residents get kind of a taste of a subspecialty and then they might return to that subspecialty and add onto their prior knowledge and with the advent of the internship, we may be able to give them even further subspecialty training without the necessity of pursuing fellowship training if that resident so chooses. So, I think for all these reasons, the internship is a really great addition to our program.

Host:  Dr. Pyatetsky residents have the opportunity to participate in an international surgical rotation in India. Can you speak about that for us please?

Dr. Pyatetsky:  It is an outstanding opportunity that we offer to our trainees to our residents. It is funded by the department and it’s in partnership with an ophthalmology center of excellence located in northern India. It exposes our residents to a healthcare model that is very different from that in the United States in which the patient volumes and surgical volumes are extremely high while at the same time the costs are very low, and the outcomes are outstanding. Our residents do take part in the care of individuals as part of this team approach there and they care for the most part for the underprivileged individuals. It’s an immersive two to three week long experience.

And so it allows them to deliver care to individuals who probably would otherwise not have any eye care as part of a team with an outstanding reputation under excellent supervision with the center’s reputation on the line. So, and the outcomes of this experience are tremendous both in terms of the experience that the residents get both surgically and medically and culturally as well as the actual outcomes of the surgery being performed under really good supervision in a state of the art center with so many people getting to see after not being able to.

This is an opportunity we’ve been offering to our residents for approximately a decade now. It’s been very positive, and we plan to continue it.

Host:  And Dr. Anchala why don’t you tell us about the Northwestern Medicine Ophthalmology team, what other providers that are referring to this department can expect.

Dr. Anchala:  Having come from other medical facilities I can very honestly say that I do love the Northwestern Medicine Ophthalmology team.  I think that it’s a very collegial team of physicians delivering the utmost highest care that is evidence based and current. I think providers that refer to us can really be sure that we will be treating the entire patient picture. If a patient gets referred to me specifically for glaucoma; but I may notice that perhaps there’s a component of uveitis, I can then work closely and send that patient to Dr. Pyatetsky to make sure that all facets of this patient’s care are appropriately and adequately treated and kind of use a team approach within our ophthalmology department to make sure that this patient gets the best care possible. And I really do see that day in and day out here at Northwestern Medicine.

In addition, we are very dedicated to providing the most technologically updated and advanced care as we all know there’s a lot of innovation within ophthalmology, a lot of new technological toys that we can have at our disposal and our department has been really great about making sure that any aspect of technology that we really feel is necessary or has been shown to benefit our patients, that we have access to that. In addition, I think that especially specifically in the field of ophthalmology that I practice in which is glaucoma; there is a lot of innovative surgical treatments that I think our physicians are well versed in and have been some of the earlier adopters potentially even in the Chicago area and really are comfortable performing these procedures. So, I think that’s just one example of how our team in general keeps up to date and wants to provide the most current and great medical care possible.

Dr. Pyatetsky:  I’d like to jump in and just mention that from the residency training standpoint; as part of the team of faculty physicians and resident physicians, we are able to offer 24/7 coverage for patient care through our clinic and our surgical center and the emergency department. And I would like to put a little plug in for the fact that the ophthalmology department for the last several years has been ranked the number one consult service by Northwestern’s Emergency Department and in fact, one of our residents this year Dr. Sudeep [00:14:04] has been given a recognition for professionalism in teaching medical students, a very prestigious award as part of this team based care model that we have here at Northwestern.

Host:  Well thank you for that. As we wrap up, Dr. Pyatetsky what other advice do you have for other residency program directors and physicians preparing the next generation of ophthalmologists?

Dr. Pyatetsky:  I really identify the departments and the programs number one or the biggest priorities and essentially write them down and having done that, it’s important to develop a committee of faculty and trainees motivated to go ahead and make the program better, to make the department outstanding. As part of this committee, the leader, the program director and the chair, should develop strategies for achieving the written goals over time and to really prioritize ethical patient care and resident and faculty wellness. Because without it, nothing can be achieved.

Host:  Thank you both so much for joining us today and telling us about the importance of a modern ophthalmology residency program. To refer your patient or for more information on the latest advances in medicine please visit our website at www.nm.org to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all of the other Northwestern Medicine podcasts. I’m Melanie Cole.