Mission

The mission of the Madigan Ophthalmology Program is to educate and train highly competent military ophthalmologists to serve the national defense, with graduates uniquely qualified to provide ophthalmic care in any environment. Our graduates are equally capable of practicing comprehensive ophthalmology or proceeding to subspecialty fellowship training. We, the faculty, are dedicated to seeing residents through to the completion of the training program, and beyond, ensuring the readiness of the Army's ophthalmologists and thereby the readiness of America's fighting force.

Vision

Our program provides the fundamental medical knowledge necessary for graduates to function as independent ophthalmologists, completing board certification, and pursuing a lifetime of learning and growth as surgeons, officers, and academics. Graduates understand the importance of military readiness, vision readiness, and the unique aspects of military medicine.

Aims

• Produce competent and compassionate physicians who will be leaders in Ophthalmology.
• Educate residents on providing ophthalmic care globally, including austere environments.
• Promote excellence in the delivery of safe, equitable, affordable, and quality care.
• Serve as role models to the community for the promotion of wellness and lifelong learning.

Residents participate in daily peer-taught “home study” sessions based on the Basic and Clinical Science Course. Weekly, residents participate in Morbidity and Mortality conference, which includes pre-operative planning for the ensuing week. Fridays are set aside for resident clinics and academic sessions with staff lectures. Academic sessions include monthly wellness discussions and workshops as part of our mental skills & wellness curriculum. Also monthly, residents present Grand Rounds topics. Quarterly, we hold wet lab sessions to build surgical skills and sponsor wellness activities like team sports, hiking, skiing, or pumpkin carving.

Comprehensive Ophthalmology includes 1 week of dedicated low vision care.

There are no elective rotations in our residency. During the transitional internship, you will have three months of Ophthalmology training and two elective months. Common elective choices include Neuroradiology, Radiology, ENT, and Dermatology.

PGY-2 and PGY-3 residents are on home call every 4th week, with supervision from a PGY-4 chief resident. By mid-year, most PGY-3s are able to do home call independently, reporting directly to staff on call.

Madigan graduates are uniquely equipped to serve as military surgeons. We are the only program co-located with operational units, including one of the Army’s three Head & Neck Augmentation Teams. Two of our faculty are assigned to this team and deploy regularly, bringing their experience back to the clinic. Our Capstone training event is more immersive due to the involvement of Special Forces, Rangers, Army Aviation, Navy, and USAF assets. Our vision readiness mission involves refractive surgery, and our graduates lead the nation in case number and certifications in PRK, LASIK, ICL, and SMILE—taught over a 2-year period to ensure a solid foundation.

Madigan is a regional trauma Center of Excellence, one of two facilities capable of taking civilian eye trauma, and it shares coverage of Western Washington with the University of Washington. Lectures cover military topics such as deployment ophthalmology, leadership, how to run a clinic, humanitarian missions, military finances, and off duty employment. Our senior residents attend a surgical readiness mission, where they hone their surgical skills while providing a service to the host nation. Previous mission locations include Panama, Haiti, Honduras, Guatemala, and the Dominican Republic. Our junior residents participate in the Seattle Free Clinic and in the Range Health Eye Van—both providing care in austere, underserved environments, one to an urban setting and the other to indigenous populations.

The curriculum is structured around six surgical disciplines, with six months of training in: glaucoma, cornea & refractive surgery, retina, pediatrics & strabismus, oculoplastics, and comprehensive ophthalmology & cataract. Residents also have a 1-week course in Refractive Surgery at the end of PGY2, a 1-week Ocular Trauma course near the end of PGY3, and a 1-week field training exercise (Capstone) at the end of PGY4. The Capstone involves caring for simulated casualties from point of injury, through MEDEVAC (ambulance, helicopter, and fixed-wing aircraft). At the completion, residents are TCCC certified in trauma and critical care. There is a 1-month academic review (Lancaster or Bay Area Course) and a 1-month trauma rotation at University of Washington in Seattle.

Cataract Simulation

• Eyesi Ocular Surgical Trainer – residents must complete the entire training program prior to starting cataract surgery.
• Katena Sim Eyes – used to practice various techniques such as incision, capsulorhexis, hydro dissection, lens removal, lens placement, and suturing.

Oculoplastic Surgery Simulation

• Cadaver Tissue at Orbital Dissection Course (ODC) – annual course held in August. This course has a combination of didactic training with afternoon wet labs on cadaveric tissue. Residents get the opportunity to review anatomy and practice skills such as suturing, flap creation, dissection, enucleation, evisceration, laceration repair, and fracture management
• Lateral canthotomy/cantholysis (LCC) Training System – models used to simulate retrobulbar hemorrhage requiring LCC

Open Globe Injury

• LCC Training System – as above

Ophthalmology Skills

• Eyesi Ocular Surgical Trainer – as above

Orbital Hematoma/Hemorrhage

• LCC Training System, Cadaver Tissue at ODC- as above

Perform Tarsorrhaphy, enucleation, evisceration, canthotomy/cantholysis

• Actual practice: Ocular Trauma Course – annual course held at USUHS in Bethesda that our 2nd year residents attend. This is a week-long course that is similar to the annual ODC. This is a Tri-service course where the residents receive lectures from all the ophthalmology subspecialties and perform wet labs on simulators in the afternoons. This course is also attended by ophthalmology staff that are preparing for deployment, and by other residency programs in the Bethesda area
• Cadaver training at ODC, LCC training systems – as above

Perform LASIK, PRK, and SMILE refractive Surgery

• Laser Suite with Vendor eye simulator – residents train for refractive surgery.

Perform Manual Small Incision Cataract Surgery and Minimally Invasive Glaucoma Surgery

• Katena Anterior chamber simulators – as above

Repair Eyelid Laceration

• Actual practice; animal lab at Ocular Trauma Course; cadaver tissue at ODC – as above

Leadership is an important quality in our graduating residents, and is thus discussed and emphasized throughout residency. Leadership concepts are taught specifically during our military unique curriculum, and optional leadership reading materials are available to our residents. There are opportunities for residents to hold leadership positions within our program (chief resident), as well as within MAMC GME (house staff officer, resident membership on all GME subcommittees, etc...). Our program has also been successful in sponsoring and supporting our residents in national leadership positions to include American Academy of Ophthalmology (AAO) and American Board of Ophthalmology (ABO) resident leadership positions.

Our residents have access to ample research opportunities and funding. Residents are required to complete two research projects during residency. One must be a publication / poster presentation and the other is a process improvement/quality improvement project. Residents present at Madigan Research Day, the Military Refractive Surgery Safety Symposium, and teach classes in our Washington Association of Eye Professionals (WAEPS) Regional meeting. Residents are supported to attend two national conferences per year to which they are invited or are presenting / speaking.

Residents participate in helping to improve the healthcare system for our patients. Residents are educated in quality improvement and patient safety (QIPS) principles through the completion of the MAMC Core Curriculum, through weekly Morbidity and Mortality Conference (M&M), and involvement In patient safety Investigations.

Madigan Ophthalmology Residency focuses on developing future military leaders through mentoring and modeling. Funding is available for residents to attend at two professional conferences per year during residency when presenting a scholarly activity. Residents have given national lectures, research podium presentations, held national leadership board positions, and taught procedural courses at AAO, ASOPRS, ASCRS, AAPOS, AUPO and ARVO.

• Madigan Army Medical Center
• Harborview Hospital, University of Washington
• American Lake VA Center
• Spokane VA Hospital

Our program offers rotations to third-year and fourth-year medical students. Rotations are typically four weeks (one block) long and include exposure to acute care, trauma, subspecialty clinics, and in the operating room. Students also participate with the residents in academics, labs, and simulation time. Students interested in rotating with our program should contact our program, dha.jblm.madigan-amc.list.mamc-ophthal@health.mil, and follow guidance through Madigan Graduate Medical Education Office regarding rotation logistics.

If you would like to schedule an interview with our program, please contact the Program Director, Associate Program Director, or Program Coordinator, dha.jblm.madigan-amc.list.mamc-ophthal@health.mil.

Our program hosts rotators from medical schools, physician assistant schools, interns, residents from other services, and enlisted medics. Residents are the primary teachers for these rotators.

Residents are offered the opportunity to teach courses at local, regional, national, and international conferences including ophthalmic trauma, emergency eye care, ophthalmic procedures, grand rounds case presentations, and unique case reports.

• Ophthalmic Plastic and Reconstructive Surgery
• Vitreo-Retinal Surgery
• Cornea/Refractive
• Pediatric
• Neuro-Ophthalmology
• Glaucoma
• Pathology
• Global

Residents are assigned or can choose a staff mentor. This mentorship lasts throughout the entire residency. Mentors and mentees meet quarterly, or more often if needed. Topics of discussion include academic and surgical progress, personal and career goals, and research.

Resident well-being is a high priority in our department. Well-being activities include:

• Annual resident retreat & Quarterly “5th Friday” wellness events
• 5th Friday Resident Wellness Days (team building activities)
• Annual Face Race (5k/10k/half marathon) for Ophtho, ENT, and OMF departments
• Optional participation in the MAMC Wellness Committee, as well as the Resident Council’s Wellness Group, both are geared at optimizing program wellness and support or prevent physician moral/mental injury
• Frequent off duty social gatherings and celebrations