What Will Ophthalmic Residency Training Look Like in the Future?

Think how much residency training has changed in recent years. From 3-D virtual surgical simulators to stem cell and genetic therapy to sessions in ethics and business, today’s programs are evolving quickly. Two of Cole Eye Institute’s leaders in education—Elias I. Traboulsi, MD, MEd, Vice Chairman for Education at the Cole Eye Institute, and Jeffrey Goshe, MD, Residency Program Director—share their vision about what the future holds.

Residency training programs, for the most part, have been building on what was determined to be a satisfactory “curriculum” decades ago. The responsibilities of a general ophthalmologist are very different now than they were 20 years ago and will likely be very different 20 years in the future. Medical knowledge and treatment modalities continue to grow exponentially while the overall duration of training programs has remained unchanged. Residency programs are tasked with delivering excellent clinical and surgical training without compromising the quality of patient care. In addition, physicians are expected to utilize information technology, navigate complex healthcare delivery systems and demonstrate ongoing improvement in quality and safety.

The result is that residency programs of the future will likely depend on increasing and earlier subspecialization, improved surgical training via advancements in surgical simulation, and increased integration of technology into medical training.

Three years are not enough

The traditional three-year ophthalmology residency program was designed to prepare the graduating resident to be a truly “comprehensive” ophthalmologist, with a broad knowledge of eye diseases and their treatments and capable of performing not just cataract surgery, but also glaucoma filtering surgery, simple eye muscle surgery, basic repair of retinal detachments and a variety of other procedures. As each of these subfields evolved, however, it became apparent that longer training was needed to achieve the proficiency to provide these treatments autonomously after residency.

As a result, at least 10 subspecialty fellowships now exist, and the majority of subspecialty care (especially surgical) has become the domain of fellowship-trained ophthalmologists. Although the Accreditation Council for Graduate Medical Education (ACGME) recommendations have been revised several times, residents are still expected to perform a minimum number of subspecialty procedures regardless of their ultimate career path.

Earlier subspecialization

Aside from lengthening the duration of training (which may ultimately be necessary from either the residency or fellowship perspective), programs may be able to better cater to the needs of a resident who has chosen a subspecialty path earlier in his or her training. Flexible curricula with earlier subspecialization would allow greater assimilation of career-specific medical knowledge and procedural training.

For someone who is committed to a career in oculoplastic surgery, for example, it might be prudent to spend more time during residency performing orbital and extraocular procedures rather than a high volume of intraocular surgery. Alternatively, we may witness the conversion of certain subspecialties to separate integrated residency programs, much like what has occurred in other surgical specialties. Similar to stand-alone residencies in vascular surgery, cardiothoracic surgery and plastic surgery, we may begin seeing dedicated residency programs for vitreoretinal surgery or oculoplastic surgery.

More simulation training

Resident surgical training will become progressively more reliant on, and benefit increasingly from, computer simulation and ophthalmic training devices. At the Cole Eye Institute, we have already implemented one of the most comprehensive surgical simulation training programs in the country (more than 100 hours of mentored microsurgical training during the first year of residency), with the potential to develop even better microsurgical proficiency. The future will undoubtedly bring an expanded role for virtual reality as well as engineered ocular analogues to increase the realism of surgery in the training environment.

The oft-repeated medical-training mantra of “See one, do one, teach one” is no longer compatible with high-quality patient-centered care. Adequate preparation prior to direct patient contact is the only answer. Abraham Lincoln perhaps provided a better analogy for modern medical training when he said: “Give me six hours to chop down a tree and I will spend the first four sharpening the axe.”

Technology to have a key role

Ophthalmic care will continue to become increasingly intertwined with technology as advances in laser and optical technology, biosynthetic materials, and stem cell and genetic therapy expand exponentially, opening opportunities for treatment of conditions that were heretofore untreatable. Furthermore, the availability and increasing quality of long-distance or “tele-” medical care will allow ophthalmologists to provide consultation for patients in remote areas.

Educational alliances between training programs around the globe can provide residents with opportunities to participate in the evaluation and treatment of patients with problems that may be underrepresented in their geographic area. Further integration of computers into medicine is inevitable, and academic training programs will be at the forefront of computer-assisted decision-making. Rapid, real-time computer analysis of exam findings and symptomatology will assist in generating differential diagnoses in complex or unusual cases and provide recommendations for management based on the most current evidence-based medicine. Residency programs will need to stay on the cutting edge of these improvements to ensure that trainees are exposed to all the tools they will likely encounter in their careers.

Commitment required

Ultimately, the mission of educating the next generation of ophthalmologists rests on a commitment to constantly re-evaluate curricula and education methods and to make sure that graduates are prepared for the real-world practice of ophthalmology. Simultaneously, residency programs must achieve these goals while continuing to provide high-quality and economical patient care in an increasingly cost-conscious environment. Successful residency programs of the future will need to be adaptable, efficient and aligned with like-minded hospital systems that place a high value on training their future colleagues and successors.