Rotating Residents through the VA
Kellogg residency program balances oversight and autonomy
Duna Raoof-Daneshvar, M.D.Residents at the University of Michigan Kellogg Eye Center give high marks to their experience at the Ann Arbor Veterans Affairs (VA) Medical Center. During each year of their residency, Kellogg's residents navigate through two, seven-week rotations at the VA. In the end, approximately one-quarter of their residency is spent there.
Second-year resident Duna Raoof-Daneshvar, M.D., feels it's time well spent. "We all love our time at the VA," she says. "It's the perfect balance between oversight and autonomy."
Oversight is of the utmost importance, says Denise A. John, M.D., who, as Chief of Ophthalmology at the VA, oversees the program. "At the VA, the residents get a balance of increasing autonomy while still maintaining the appropriate level of faculty supervision," she says.
Although there is no typical day at the VA, the clinic is fastpaced with different subspecialty clinics offered each day of the week. The entire clinic sees about 70 patients per day and, on this day, a Tuesday, Dr. Raoof-Daneshvar will see 15 patients—comprehensive cases in the morning and oculoplastics cases, accompanied by some minor clinical procedures, in the afternoon.
Dr. John, Chief of Ophthalmology at the VA, meets with Dr. Raoof-Daneshvar,a second-year resident.
"The technicians will have worked up the patients, and when we arrive, each resident takes a chart and gets to work," says Dr. Raoof-Daneshvar. "There are six of us together at the VA—two from each resident class—which really helps build a team approach to patient care."
As a second-year resident, Dr. Raoof-Daneshvar is expected to independently develop treatment plans for her patients under the guidance of the faculty supervisor. Second-year residents are also charged with keeping the clinic running efficiently. First-year residents are allotted more time to examine patients, while third-year residents spend more time in surgery.
Experience in the operating room is another highlight of the VA rotation. In addition to learning to perform retina and glaucoma laser treatments, retina injections, and minor oculoplastics procedures, the VA is where residents first learn to perform cataract surgery and then gain the bulk of their surgical experience. In fact, last year, residents participated in more than 1,130 cases at the VA.
"We have a step approach to surgery, and we learn a little each time we go into the operating room," says Dr. Raoof-Daneshvar. Firstyear residents assist in the OR with cataract surgeries and observe other types of procedures. The second-year residents begin to handle their own cataract surgeries with the goal of completing 10 on their own by year's end. The third-year residents serve as primary surgeon in cataract surgeries and also start taking on other types of surgeries—all with faculty supervision.
"We treat patients from all over Michigan and nearby states, and they are wonderful," says Dr. Raoof- Daneshvar. "They are always appreciative of the care they receive and their thankfulness makes you want to work that much harder for them. The experience we gain during rotations at the VA is invaluable."
