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Northwestern University, B.A., Economics
University of Michigan Medical School, M.D.
Oakwood Hospital, Dearborn, Michigan, internship
 When I was a medical student at Michigan I met several of the ophthalmology residents and attendings and couldn't help but notice how enthusiastic and happy they were. The overall environment was positive in every way. When I interviewed, the residents I met were pleased about their decision to come here, and every person was a proponent of the program. In fact, many residents seemed to be selling the program without really meaning to, and now I find myself doing the same thing. When you see residents and faculty who are happy and like what they do, you want to do it, too.
One of the best rotations for first-year, and maybe even third-year residents, is the Consult Service. It's unique to our program and is a terrific way to introduce a new resident to ophthalmology and to emergency and on-call situations. Guided by a faculty member, a first-year teams up with a third-year resident to staff the hospital for emergencies and to run all the inpatient consult cases during this two-month rotation.
The first-year has a great learning experience being with a third-year who is experienced, enthusiastic, and has a little more time to devote to teaching. You develop a strong bond with this senior resident throughout the year and he or she ends up being a friend and mentor. The direct supervision or immediate availability of the senior attending physician assures that the treatment plan is comprehensive.
Another advantage of this program is that first-year residents don't take call until the second half of the year. The Consult Service rotation is like being on call for two months, so it's amazing preparation. You've already been to the emergency room and have seen all kinds of trauma; when you take call by yourself you have a pretty good idea of what can occur.
Consult Service/Emergency at the University of Michigan Hospitals
We begin morning rounds at the main hospital, seeing patients who have been admitted for other conditions but may have some secondary ophthalmic problems. We generally expect to see 3 to 5 new patients and maybe 5 to 10 follow-ups. Those we see in the hospital become our patients until they are discharged or are stable ophthalmologically.
This morning we see a patient on the adult medical service who has had a stroke and has experienced sudden vision changes. Another patient has a rare connective tissue disease with vision changes, and the primary service has asked us to rule out ophthalmic manifestations.
We continue our rounds at Mott Children's Hospital. One child has undergone chemotherapy and we need to make sure that her vision is stable. For our next patient we are asked to examine a patient with graft vs. host disease and to look for ocular complications. Another child has double vision, and the attending asks us to figure out why.
We're called to the emergency room for a patient who has been in a motor vehicle accident. He has severe facial fractures and we are asked to rule out a ruptured globe. The patient may also have complicated lacerations of the eyelid that require the expertise of an oculoplastics specialist.
We have a few more consults this afternoon, including a patient who complains of sudden vision loss. This individual has a retinal detachment and we need to deal with it fairly quickly. We send her over to Kellogg for treatment in the Retina Clinic. A technician will be waiting for the patient, and the physician will see her right away.
We finish our calls and catch up on paper work. After 5:00 the emergency calls will go to the ophthalmology resident who is on call for that night.
Kellogg's Consult Service is unique for another reason. It has a fully equipped ophthalmology suite at the hospital, right next to the emergency room—a full clinic with four examination rooms. You won't find that at every hospital. Being onsite for this service is an advantage because we can take our questions to the primary service, show a slide to a pathologist, or review an MRI with a radiologist who is next door to our own clinic.
The location of the suite next to the emergency room is ideal. You don't want to be up eight floors in some eye exam room, or at another site, when your patient begins to have chest pains or respiratory complications.
Dr. Dhaliwal (residency 2005)
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Bristol University, England, B.Sc., Biochemistry
University of South Carolina, B.S., Biology
Medical University of South Carolina, M.D.
Duke University, internship
When I interviewed, the faculty was approachable and the people throughout were friendly. And every subspecialty is strong here. It's a very important point. Some programs might have only one person in cornea, for example. Here, there are several ophthalmologists in each subspecialty.
Because this is a major referral center, patients are drawn from a wide area. I knew I would see interesting pathology and learn to manage a wide variety of cases.
Another plus is that researchers and clinicians are all in one building. Kellogg has a strong research program, with clinical staff as well as basic scientists involved in research.
I also liked Ann Arbor's size. Larger cities tend to mean more expenses—apartments and parking. You might have to live some distance out to find reasonable housing. I like the convenience of living nearby.
By the second year we have completed all the rotations and have the basics down. We know the Department and the faculty, and the attending physicians count on us for our assessments of patients. During this year we spend two months on each service, and by the end we begin to feel part of the team.
For the first half of the year we're on call with the first-year residents. We teach them the ropes, demonstrate certain procedures, and call them in on interesting cases or emergencies. Then in January we no longer take first call. We come in when the first years need us or when surgery is indicated.
We also perform more surgeries and a greater variety of them during the second year. We'll perform more cataract surgery, for example, and more advanced lasers.
In the second year we are required to complete a research project—either in basic science or clinical research—and then present it at the Department's annual research day in mid-March.
Finally, this is the year we decide on future plans—whether to practice general ophthalmology or to apply for a fellowship.
For this month only, Dr. Houghton has a split rotation, glaucoma and neuro-ophthalmology.
I arrive for a scheduled but urgent procedure. It's my job to supervise the first-year resident who will perform a temporal artery biopsy. The neuro-ophthalmology fellow will be the attending physician.
I check in at the Glaucoma Clinic. Typically the glaucoma fellow and a first- and second-year resident will be on duty. Often we meet first with the patient—recording history and medications, checking vision, and taking eye and blood pressure. If the tech has already done this, I will come in to do the slit-lamp examination. Sometimes we perform a procedure, such as a YAG laser capsulotomy, or observe the attending if it's a complex procedure. At the end of clinic the attending reviews the patients we've seen, discusses any out-of-the ordinary cases, and answers our questions.
On this day I go to the main hospital (a 10-minute walk or a short shuttle ride from the Kellogg complex) for a conference with the neurology residents. A resident presents a case, we discuss it, and Dr. Trobe guides us through a diagnosis and treatment plan.
After the conference, we go on to see the patients. We learn from the direct experience and from interacting with the neurology residents who work out of the main hospital.
We begin consult rounds with neurology residents and the Kellogg residents who make up the consult team. We'll sit around a conference table and discuss the patients who are in-house and those who have entered through the emergency room. Again we follow up by seeing the patients.
We gather for the neuro-radiology conference. A neuro-radiologist from the hospital will read some interesting CT and MRI scans that relate to patients we've seen or who have been in clinic throughout the week. We present the patients' histories and our observations. The radiologist reads each scan and describes her plan, which may include further tests or surgery.
A first-year calls me. A patient has come in with a retinal detachment. When I arrive the first-year resident has already dilated the patient's eyes and has done a preliminary exam. I do my own examination and call in the retina fellow who will then evaluate the patient for surgery. This all takes place on the Kellogg surgical floor.
A first-year resident calls me. A patient has been in a multi-vehicle accident and has a large lid laceration. I come in for the exam and set up for surgery, which will take place at Mott Children's Hospital, part of the UM Health System. I will assist the plastics fellow and the attending in surgery.
Dr. Houghton (residency 2004)
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Purdue University, B.S., Accounting
Indiana University, Medical School, M.D.
Ball Memorial Hospital, Muncie, Indiana, internship
I had decided to stay in the Midwest, and out of all the institutions in this part of the country, Kellogg was the most prestigious. When I came here, I sensed overwhelmingly that the residents were extremely happy with their training and that you could have great relationships with faculty. There also seemed to be a lot of rapport among residents.
Certainly Dr. Roth was very much an instrumental factor—and so was Kathy Whitney, the residency program coordinator. They are the people you see more than anyone else during the interview process. First impressions go a long way.
Another consideration was that I hadn't decided whether to practice general ophthalmology or to continue with a fellowship after residency. I saw that Kellogg had a good healthy mix of residents choosing both options. And those who decided upon fellowships did not seem to have trouble acquiring them.
Residents often wonder how a program will affect their family members. I was very busy, but my family thrived while I was in residency. Kellogg allowed me to maintain a healthy family life, while seeing enough in clinics so that one goal did not preclude the other.
During second year you spend a lot of time in the subspecialty clinics. In the third year you have a chance to put it all together as a comprehensive ophthalmologist. Your entire third year is spent in the general clinic, on consults, and at the VA Hospital. There's an opportunity to put all that knowledge you've acquired over the past two years into clinical practice in a clinical setting where you are the decision-maker.
Another big difference is that you take on a much more active surgical role—especially for cataracts and intraocular surgery. There's a big learning curve at the beginning of the third year—and all the benefits of the surgery schedule are yours during that final year.
Because the third year involves a synthesis of ophthalmic knowledge, Dr. Bucher chose to describe the two primary rotations: four months in the General Ophthalmology Clinic at Kellogg and four months at the VA Hospital, just five minutes from the Kellogg Eye Center.
Typically the clinic starts at 8:00 a.m. and ends at 4:30 or 5:00 p.m. Because Kellogg is a major referral center, the clinic is especially busy. We see about 20-25 patients a day, and they represent a diverse population and all aspects of ophthalmology.
In this clinic we're the front door for the Eye Center, so we see plenty of everything—cataract, retinal disorders, anything and everything—not much strabismus, but everything else. Our role is to be the primary caregiver, the primary decision-maker; there's always an attending in clinic to answer questions and to confirm your treatment plan.
One day each week is set aside for operating, and the cases are divided between two residents. Over the four-month period we perform about 40 cataract surgeries. In addition, each resident does lasers on another half day—primarily for patients with diabetic retinopathy.
We start at 8:00 a.m. and end at 5:00 p.m. There are four residents: two third-years, a second-year, and a first-year. It is a resident-independent service. The attending is always available, but the residents are in charge. On an average day we'll see between 60 and 70 patients.
The VA is the major ophthalmic referral center for veterans in the state of Michigan. We see a large geriatric population, with some younger people coming in for glasses and that sort of thing.
During this rotation, which lasts four months, we're busy and, surgically, we're extremely busy. We're in the OR every day, and we will perform 70-80 cataract surgeries over the four-month period.
How do you feel when you face this increased level of surgery? A little nervous, coupled with a great sense of anticipation. You've spent the first two years preparing for surgical training and here is the payoff. You are not alone; you will always find plenty of support from faculty and from fellow residents.
Third-year residents continue to attend Grand Rounds and lectures back at the Kellogg facility.
As he embarked on this third year, Dr. Bucher decided to pursue a retina fellowship and was accepted into Kellogg's Retina, Uveitis, and Ocular Oncology Fellowship Program.
The opportunity to sub-specialize in retina and do it here at UM was very appealing. I had enough subspecialty time during my first two years to know what each was about; the experience certainly cultivated my interest in retina.
Part of the value of this residency program is that the third year gives us a realistic picture of comprehensive ophthalmology. You get a real understanding of what it's like to have a busy general practice. And while I liked that experience, it also confirmed my decision to specialize.
The system must work well. My class was equally divided in its choice—three went on to fellowships and three accepted positions in general practice.
Dr. Bucher (residency 2003; retina fellowship 2005)
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