Life as Chief Resident at Bascom Palmer

By John Kitchens, MD

Dr. Ed Norton, the founding father of Bascom Palmer, was quoted as saying that a great residency program required three things: patients to see, a library to read about those things you see, and a faculty to help you interpret what you read. The Bascom Palmer Eye Institute has all of these things in abundance. I had the opportunity to experience Bascom Palmer as both a vitreoretinal fellow and as a chief resident.

I was not the typical Bascom Palmer chief resident. Most of the “chiefs”, as they are referred, are former Bascom residents who want to pursue a career in retina and realize that there may be no better training available than that found in south Florida. A tribute to how great the chief residency is the fact that it becomes available to an “outsider” (or resident who has trained elsewhere) only about once every ten years. My becoming chief was a matter of getting great residency training (at the University of Iowa), having good letters of recommendation from my Iowa mentors, and luck. I was very fortunate as the year I interviewed for the Bascom Palmer vitreoretinal fellowship spot, there was only one resident interested in doing the chief residency from Bascom Palmer (Dr. Luma Al-Attar). Since there are two chief residents each year, I was offered the position and accepted it readily.

The first year of training involves a surgical vitreoretinal fellowship. The primary goal of this year is to train you in vitreoretinal surgery. The year is divided into 6 “blocks” or rotations. Two blocks each are spent with Dr. Tim Murray, Dr. Harry Flynn, and a combination of Drs. Ingrid Scott, Janet Davis, and William Smiddy. I also had a chance to work with Drs. Nina Berrocal, Sander Dubovy, Phil Rosenfeld, and Carmen Puliafito. Between all of these faculty members, I had a chance to see a wide variety of disorders and their diagnosis and management. There were also grand rounds to prepare and present (3-4 per year), fluorescein angiography conferences (6-10 per year), tumor conferences (1 per year), and a research presentation (at the annual Resident’s Day Conference).

The surgical experience during the first year was definitely more than adequate to prepare you for the chief resident year. I had the opportunity to participate in over 750 surgical cases. I would estimate that I did a significant amount (more than 50% of the case) in about half of these surgeries. This was more than enough surgery and enough variety of cases to feel very comfortable operating on my own. The staff physicians were dedicated to getting me ready for the chief year.

The second year consisted of the chief residency. I truly enjoyed my residency and the first year of fellowship, but without question this is the best year of my entire training process. There are many opportunities during this year (surgical and professional). With these great opportunities came great responsibility. As chief residents, myself and my co-chief, were responsible for the repair of all ruptured globes that presented to Bascom Palmer, staffing the consult service for Jackson Memorial Hospital, providing vitreoretinal care for the Public Health Trust patients, staffing the Bascom Palmer Emergency Room, training residents in vitreoretinal diseases and surgery, organizing and implementing an OKAPS review course for the residents, as well as “helping out” with the residency training program. It was a very busy year in the clinic, the operating room (OR), and in an administrative role.

The surgical volume of this year is really tremendous. I expected a lot of trauma (as a former chief resident told me: “Miami is a very violent place”) and was not “let down”. I staffed 70-80 ruptured globes during the year. I was very fortunate to have very good training during residency that prepared me for this. In addition, the residents at Bascom Palmer are exposed to a tremendous amount of trauma and are very skilled at working up patients and operating on these tough cases. Most of the ruptured globes were repaired at Bascom Palmer with a rare case occurring at Jackson Memorial Hospital, which was like operating in a third-world environment. I performed just over 450 surgical retina cases (true surgeries, not lasers or tap and injects, etc.) with the most common cases including: rhegmatogenous retinal detachments, diabetic cases consisting of tractional detachments and vitreous hemorrhages, pars plana lensectomies, and proliferative vitreoretinopathy cases. These cases were generated from the resident clinics were supported by the Miami-Dade Public Health Trust. Many of these cases were “the worst of the worst”. As my predecessor, Dr. Jeff Moore, had told me: “it would take you ten years in a general retina practice to see this many severe diabetic cases”. I had OR time three days a week and the operating room staff and anesthesiology faculty, who were dedicated to ophthalmic anesthesia and were amazing, were easy and enjoyable to work with. The Bascom Palmer retina faculty were always available for advice or to “help out” with tough cases. There were two days per week dedicated to clinic. Having the opportunity to operate on such challenging patients on my own gave me a great deal of experience and confidence. My transition to my practice in Lexington was very easy due this year.

One of the most enjoyable aspects of the chief year were the interactions with the residents. The chief service, referred to as “the vitreous service”, had one third-year resident. This resident would see patients in clinic and assist in the operating room. Residents who were interested in retina would typically learn to “do” a core vitrectomy, perform endolaser, place a scleral buckle, and in many instances would get a chance to peel the ILM or epiretinal membranes. One of the strengths of Bascom Palmer’s residency is the tremendous surgical opportunities for residents. It is not uncommon for a resident to graduate having performed a significant amount of 50 or 60 pars plana vitrectomies. The residents would also have the chance to schedule difficult or high-risk cataracts to be performed when they were on the chief resident service. I also had a chance to help staff the emergency room, train first year residents during their orientation, and organize social events for the residents. I was able to get to know and train a great group of people who will be future leaders in ophthalmology.

In summary, Bascom Palmer is a unique place. Just as Dr. Norton had envisioned, there are remarkable patients to see, a fantastic and extensive library to read about those patients, and a world-renowned faculty to help you interpret what you have learned. When you combine that with the opportunities available as Chief Resident, you have an amazing training experience.