Sinai Hospital Ophthalmology Oculofacial Fellowship
The Krieger Eye
Institute is privileged to offer one of only 36 approved American Society of
Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) Oculofacial Fellowships
in the United States. This intensive two-year training program is designed to
provide an intense and comprehensive exposure to all aspects of oculofacial
surgery. The fellow will work closely with the residents to heighten their
educational experience
Purpose
The Oculofacial Fellowship Program of the Krieger Eye Institute and Sinai
Hospital provides post-graduate medical education in a unique ophthalmic
subspecialty that includes the in-depth study, diagnosis and treatment of a full
spectrum of oculoplastic and facial diseases. This includes eyelid malpositions,
lacrimal disease, orbital disease, trauma (eyelid, orbital and facial),
neoplasms (eyelid, orbital and facial), Graves’ disease, aesthetic surgery and
lasers. The fellow will be trained in a variety of diagnostic, medical and
surgical techniques.
Program Description
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Accreditation
The fellowship is sponsored by the
Krieger Eye Institute and Sinai Hospital of Baltimore. The fellowship is
approved by and strictly monitored by the American Society of Ophthalmic Plastic
and Reconstructive Surgery.
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Application and Tenure
The fellowship is offered
for 24 months, with only one fellow for each two-year period. Positions will be
available on even numbered years. This extremely competitive fellowship is
offered to graduates of ACGME-accredited ophthalmology residency programs.
Application will be handled through a national matching program with all other
approved ASOPRS programs (approximately 15-17 programs per year).
Each applicant to the fellowship will submit all required information through the
standardized matching program. This will generally include the following:
curriculum vitae, three letters of reference and a personal statement.
Interviews will be offered based on initial review of these documents by the
fellowship co-directors. Once the applicant formally accepts the fellowship
position, medical credentialing documents and applications for medical
privileges are required. Each fellowship applicant must pass the current medical
credentialing standards set forth by the Department of Medical Education of
Sinai Hospital. After acceptance of the fellowship position, a contract, which
must be signed and returned, is sent to the applicant.
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Clinical Assignments
The oculofacial fellow will
work side-by-side with the the physicians and staff of the Krieger Eye Institute
(KEI) and its affiliated sites. Fellows will work primarily with the fellowship
co-directors. They will also work with a select group of associate preceptors –
both within the ASOPRS community as well as with preceptors in other
subspecialties. They will interact with ophthalmology residents in the course of
their training. Service commitment will be primarily with patients under the
care of the oculofacial service at the Krieger Eye Institute, Sinai Hospital and
its affiliate sites. Fellows are not assigned responsibilities outside the scope
of practice or outside the direct supervision of program faculty as described in
these guidelines. Fellows and residents will occasionally overlap in the care of
patients – with neither educational experience being diluted at the expense of
the other.
Locations
The Oculofacial Fellowship Program is centered at the Krieger Eye Institute
at Sinai Hospital of Baltimore. The KEI has numerous affiliate offices,
including but not limited to, The Baltimore Eye Center (Glen Burnie, MD), Apple
Hill Eye Center (York, PA), Center for Total Eye Care (Westminster and
Eldersburg, MD), and Eye Doctors of Lancaster (Lancaster, PA). Associate
preceptors maintain offices in Baltimore, Annapolis and Bethesda (see below).
Surgical sites include, but are not limited to, the ambulatory and general
operating rooms at Sinai Hospital of Baltimore, SurgiCenter of Baltimore, BWEye
Surgicenter, Plastic Surgery Center of Baltimore, Apple Hill Surgery Center,
Lancaster General Hospital and Lancaster Regional Medical Center.
Clinical Volumes
The Krieger Eye Institute is a high-volume, tertiary referral ophthalmology
practice with 10 full-time physicians. Clinical volume for the fellow will be
as follows:
| New Patients: |
20-40/week |
| Follow-up Patients: |
75-100/week |
| Surgical Cases: |
10-25/week |
| Minor Procedures: |
10-20/week |
| Aesthetic Laser Procedures |
5-10/week
|
The patient mix ensures a substantial educational experience for both the
fellows and the residents
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Clinical Subspecialty Support
Broad support for this program is available from other clinical specialties
at Sinai Hospital of Baltimore including general medicine, pediatrics,
general/plastic surgery, otolaryngology, maxillofacial surgery, radiology,
pathology, rheumatology, endocrinology, radiation oncology, oncology and
laboratory medicine.
Educational Directions
The program directors, associate preceptors and support staff are committed
to bringing all resources to bear to ensure a worthwhile educational experience.
This commitment is evident by the direct, continual supervision of clinical and
surgical activities of the oculofacial fellow by the faculty. Fellows are
expected to participate in all clinical, surgical and research activities of the
KEI alongside the faculty. There is adequate volume to ensure an exceptional
educational experience for both residents and the fellow. The program directors
directly monitor and supervise the interaction between the fellow and the
residents.
Program Personnel
Program Directors
The co-directors of the Oculofacial
Fellowship Program are James
W. Karesh, M.D., F.A.C.S., and Marc
J. Hirschbein, M.D., F.A.C.S., Oculoplastic Service KEI. Both are
board-certified by the American Board of Ophthalmology. Both have completed
ASOPRS-approved fellowships in oculoplastic surgery and are ASOPRS members in
good standing. Both are members of numerous other medical societies; have
published in peer-reviewed journals; and lecture locally, nationally and
internationally.
Associate Preceptors
The
associate preceptors can be divided into two main groups. The first group
consists of ASOPRS surgeons not affiliated with the KEI. At present, these
surgeons include Marcos Doxanas, M.D. (Towson, MD), Orin Zwick, M.D. (Annapolis,
MD), Albert Cytryn, M.D., and Kevin Perman, M.D. (both in Bethesda, MD). The
value in these distinguished preceptors will be in exposing the fellow to a
variety of surgical approaches and patient populations.
The second group
of preceptors will include physicians in other related subspecialties. To date,
this group consists of Adam Bassner, M.D. (director of Plastic Surgery, Sinai
Hospital of Baltimore), Ira Papel, M.D. (Facial Plastic Surgery –Baltimore, MD).
Preceptors in maxillofacial surgery and other subspecialties are in
consideration.
Support Staff
The KEI maintains a
large support staff to assist in patient care, including secretaries,
administrative and billing personnel, certified ophthalmic technicians, and an
ophthalmic photographer.
Educational Program
The KEI Oculofacial Fellowship will provide a diverse and high- volume
clinical experience in all aspects of oculofacial surgery. This will include
exposure to eyelid malpositions, lacrimal disease, orbital disease, trauma
(eyelid, orbital and facial), neoplasms (eyelid, orbital and facial), Graves’
disease, aesthetic surgery and lasers. The fellow’s time will be divided between
clinic and surgical duties. The fellow will have wide exposure to all aspects of
oculofacial diseases and surgeries. Emphasis will be placed on developing
advanced medical diagnostic and problem-solving skills, combined with an
individualized approach to surgery. The fellow will be trained in multiple
surgical approaches to each individual condition – understanding that no one
surgical technique can be applied to all patients with a given problem. In
addition, the fellow will have the unique opportunity to train in orbital
applications of the Cyberknife®
stereotactic radiosurgical system for non-invasive treatment of orbital
malignancies and other conditions. The fellow will have a broad exposure to a
range of facial aesthetic procedures including, but not limited to,
blepharoplasty, endoscopic forehead surgery, mid-face lifts, face lifts, Botox
and cosmetic fillers, and ablative and non-ablative laser
procedures.
There are academic and technical skills that the oculofacial
fellow must acquire. The academic component emphasizes the scholarly approach to
clinical problem solving, analysis of disease conditions, self-directed study,
teaching and research. The technical component includes the ability to
competently perform the variety of surgical procedures required of an
oculofacial surgeon. The fellow will also acquire an understanding of the
indications, risks, alternatives and limitations of these procedures. The fellow
will prepare operative plans prior to each new procedure.
Based on
experience and competency as judged by the co-directors and associate
preceptors, the fellow will assume a progressively greater role in the surgical
caseload and non-surgical patient management. The fellow will complete a
standardized written record of all surgical cases performed.
Specific operative skills that the fellow will be expected to master will
include, but are not limited to, the following:
- Eyelid surgery
- Ptosis repair (all types)
- Eyelid malpositions (ectropion, entropion, etc.)
- Upper and lower blepharoplasty
- Tumor excision and reconstruction
- Trauma repair
- Retraction repair
- Skin and tissue grafts
- Congenital conditions
- Lacrimal surgery
- Probe and irrigate
- Silicone stents
- Balloon dacryocystoplasty
- Dacryocystorhinostomy (external and endoscopic)
- Conjunctival dacryocystorhinostomy
- Trauma
- Orbital surgery
- Anophthalmos
- Enucleation
- Evisceration
- Exenteration
- Fornix reconstruction
- Socket expansion
- Aesthetic procedures
- Botox and fillers
- Ablative and non-ablative lasers
- Blepharoplasty
- Fat-transfer
- Brow lifts (all types)
- Endoscopic approaches
- Mid-face lift
- Face lifts (multiple approaches)
The year one schedule will be centered around the co-directors main practice,
with a mix of clinical and surgical exposure. The Fellow will rotate with the
outside ASOPRS preceptors at least once a month. There will be at least one
half-day a month for preliminary research activities.
The second year
will mirror the first year schedule with the following changes: The fellow will
partake in 2-r rotations in related subspecialties (i.e., facial plastic
surgery, plastic surgery, maxillofacial surgery, etc.). During these rotations,
the fellow will still spend one to two days per week on the main oculofacial
service – to maintain continuity of care. The fellow will have additional
research time during the second year – approaching one half-day per
week.
At the end of the training period, the fellow will have acquired
the skill, knowledge and judgment with which to establish an oculofacial program
similar in capability to the one at the KEI.
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Program Research and Scholarly Activities
- Clinical discussion before, during and after patient interactions in both
the clinic and operating room.
- Review of relevant journal articles – both in the current literature and
from the ASOPRS list of relevant articles.
- The fellow is required to complete a scholarly thesis to gain entrance as an
ASOPRS member. This may take a variety of forms (i.e., bench research, new
surgical technique, clinical studies, etc.). The co-directors will work closely
with the fellow to develop the fellow’s individual research project, establish a
timetable, and make every attempt to complete the project within the two-year
fellowship period.
- Numerous opportunities will occur for the fellow to be involved in other
research projects within the department, and to take part in authoring chapters
in scientific texts with the co-directors.
- The fellow will be provided with a travel stipend to attend the annual fall
ASOPRS scientific symposium.
- Anatomic dissection time will be available to the fellow.
Library
The Krieger Eye Institute houses an extensive ophthalmology collection. The
Sinai Hospital Library contains additional subspecialty journals and texts. All
Medline texts may be obtained through inter-library loans as needed.
Evaluation
Program
The fellowship program will undergo an internal
review on a yearly basis. This will consist of feedback from the fellow, the
co-directors, the associate preceptors, and other physicians and support staff
of the KEI. The program is formally evaluated every two years by the ASOPRS
fellowship review committee.
Fellows
The fellows will
be evaluated informally in an ongoing manner by the co-directors and associate
preceptors. This will focus on diagnostic, clinical and surgical skills, as well
as knowledge. To become an ASOPRS member, the fellow will need to pass a
written and oral exam administered under the auspices of the
ASOPRS.
Clinical Fellowship
Requirements:
- Current USMLE certification
- Approval of co-directors (after evaluation of curriculum vitae, reference
checks and interview).
- Must be approved for appointment by Sinai Hospital’s Medical Education
Office.
- Must be approved for medical staff privileges at Sinai Hospital and all
off-site surgical locations.
- Must obtain Maryland and Pennsylvania medical licenses.
- Stipend of approximately $40,000 per year. Benefits include standard
hospital physician-in-training benefit package (health insurance options, life
insurance options, disability insurance options, etc.). Medical malpractice
insurance covered by the hospital. Fellow is responsible for all meals, off-site
lodging and travel.
Additional Information
For additional information on the Oculofacial Fellowship Program, please
contact:
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