Moran Eye Center residents and faculty work together to enhance rigor in a longitudinal surgical curriculum.
One of former John A. Moran Eye Center resident Anthony Mai, MD’s favorite quotes is that “every system is perfectly designed to produce the results it does.”
Moran’s surgical curriculum was designed with a high degree of self-guided learning, wherein residents were responsible for scheduling 1:1 wet lab sessions with faculty to hone their skills before their first day in the operating room (OR). When Mai and then-fellow resident Mubarik Mohamed, MD, started discussing curriculum strengths and weaknesses in advance of their first live operation, the Longitudinal Integrated Surgical Experience (LIME) project was born.
“We know the surgical training at Moran is world-class, but residents were doing things on their own to make sure they met milestones and were doing what they needed to do in the wet lab to be prepared,” said Mohamed. “There were varying levels of success in that. From discussions among residents, we wanted to create something a bit more concrete and longitudinal.”
The idea was well received.
“Instead of focusing on resident responsibility,” said Mai, “we wanted to build the surgical curriculum into the existing flipped-classroom model, systemizing the learning so that no one fell through the cracks.”
LIME surveyed former residents to conduct a needs assessment that could evaluate strengths and gaps in surgical training. The resulting goal was to develop a longitudinal surgical and wet lab curriculum incorporating clearly defined milestones that would allow residents to be evaluated regularly, ensuring a logical development of surgical skills from PGY-2 to PGY-4.
A revamp started in 2023, and LIME rolled out a new, four-week structured cataract surgery training curriculum for PGY-3 and 4 in the 2024-2025 academic year. The effort featured:
- Just-in-time cataract surgery sessions targeted to PGY class year in a flipped-classroom style with a hands-on wet lab,
- a surgical mentorship program for chiefs with anterior segment experts,
- industry-sponsored wet labs throughout the year, and
- an annual cataract symposium.
“This is a continued evolution from a flipped-classroom model curriculum into more rigorous hands-on opportunities,” explained Moran Vice Chair of Education and glaucoma specialist Rachel G. Simpson, MD. “We believe residents are an integral part of the evolution, and it’s been rewarding to work with our chiefs and ensure we are truly creating the best clinical training possible. That only happens through constant evolution and self-evaluation.”
Next Level Courses
The first resident cataract surgery symposium day, held in 2024, combined didactic lectures with hands-on, proctored surgical practice and featured a keynote address from Barry Seibel, MD, pioneer of phacoemulsification (phaco).
Among the topics were how IOL choices affect surgery, from lens formulas and materials to premium lens consideration and counseling patients about them. Additional areas of study included intraocular lens loading, Malyugin and I-ring placement, and capsular tension ring placement. Trainees practiced on synthetic eyes and used the latest phaco technologies on animal eyes.
LIME conducted a resident survey following the symposium to assess pre- and post-workshop OR preparedness. The survey found residents felt more prepared to perform specific steps of cataract surgery, with the greatest improvement in paracentesis and main wound construction.
A new oculoplastic surgical curriculum is also underway.
“As part of their orientation, PGY-2 residents participated in a suturing workshop that gave them the training and confidence for their surgical experience on the rotation,” said oculoplastic specialist and LIME committee member H. Joon Kim, MD. “We also held the first soft tissue cadaver dissection lab, which was received with rave reviews from the residents. It allowed them to better understand the eyelid anatomy, as well as gain familiarity with common eyelid procedures.”
Additional workshops in the pipeline include a cadaver orbital dissection lab.
Surgical Video Review and Mentorship
The late Alan S. Crandall, MD, was known for his passion for teaching and the culture of continuous improvement he created at Moran.
A big-screen TV in his office showed surgeries in progress, and he often used a direct phone line to the OR to provide residents with real-time tips. He also invited trainees to his home to review surgical videos and share a meal.
Now the traditions he began are getting renewed emphasis. The residency program has welcomed nationally recognized adjunct faculty who are global thought leaders in surgical education. These adjuncts hold regular surgical video review nights, combined with intensive hands-on teaching sessions in person.
A recent night included complex cataract and renowned anterior segment surgeon Nicole Fram, MD, reviewing haptic removal at the home of resident Jordan Desautels, MD. Desautels said the nights are essential training in a time when a plethora of information online can be both a blessing and a curse.
"Sometimes you can get a little bit lost in the weeds because there is just so much information available," he said. "To have the ability to have your own surgical videos analyzed by world experts in the field is just the most incredible opportunity.”
Beyond video review, chief residents have engaged in a new surgical mentorship program in the past year. Anterior segment physicians Jeff Pettey, MD, MBA, Amy Lin, MD, Mark Mifflin, MD, and Craig Chaya, MD, served as surgical mentors. The mentorship included monthly meetings to discuss cases, coupled with a wet lab component.
“We will be working to match our incoming chiefs with a mentor this year,” said Simpson, “and we are working to make this into a two-year longitudinal program starting in PGY-3 that follows them into their final year.”