Ophthalmology Residency: Beholders of the Eye

The Best Ophthalmology Residency Programs in the US

1. Harvard Medical School
2. University of Miami School of Medicine
3. Johns Hopkins University Medical School
4. Duke University School of Medicine
5. Emory Medical School

Find out the top 8 books residency applicants need to read:

The Best Ophthalmology Residency Programs in Canada

1. University of Alberta Faculty of Medicine & Dentistry
2. University of British Columba Faculty of Medicine
3. University of Ottawa Faculty of Medicine
4. University of Toronto Faculty of Medicine
5. McGill Medical School

What is an Ophthalmology Residency?

An ophthalmology residency is a chance for you to explore the healthy and diseased states of one of one the body’s most important organs – the eye. The speciality is also a surgical subspecialty and you will be trained on how to perform precise surgical procedures within the eye, such as removing cataracts and glaucoma surgery. Ophthalmology residencies are highly competitive and there are only a few hundred spots available each year for both the best residency programs in the US and the best residency programs in Canada.

Even though ophthalmology is not usually taught in medical schools, most ophthalmology residency programs only last four years in the US. This despite the fact that almost 70% of medical school graduates were unable to use an ophthalmoscope correctly when asked to use one. But more medical schools are including ophthalmology training or some clinical ophthalmology skills in their regular, pre-clinical curricula, which is why the discipline is becoming more competitive.

Despite its short length for a surgical subspecialty, you can also do a medical fellowship afterward in a particular subspecialty germane to vision and eye health including:

• Oculoplastic and orbit surgery
• Cornea, ocular surface
• External eye diseases
• Glaucoma
• Neuro-ophthalmology
• Ocular oncology
• Pediatric ophthalmology/strabismus (cross-eyes)
• Refractive surgery
• Medical retina
• Anterior segment surgery
• Ophthalmic pathology

The surgical aspect of the program does not require you to have any previous experience in surgery, and you’ll mostly learn the surgical techniques and practices from observing ophthalmologists at work in the operating room. You will also learn about how to help people restore their vision and a part of your didactic training will be seeing vision-impaired patients who are afflicted by various ailments that either require surgery or not.

What’s Involved in an Ophthalmology Residency (US)  

In the US, most ophthalmology residency programs last for four years, but a majority of residents opt to take additional fellowship training afterward. The application process and residency match for ophthalmology is different than other specialties that use the ERAS and NRMP match services, but we’ve already mentioned that. Even though, most ophthalmology residency programs use the SF Match service, it should not affect how many residency programs to apply to, since you should apply to those that you are most interested in.

The four years of your ophthalmology residency is usually divided between an internal medicine residency or general surgery year, depending on your program, with the other three years dedicated mostly to eye health and disease. There are independent programs as well that make you take a transitional year residency beforehand and then apply.

But the Accreditation Council for Graduate Medical Education (ACGME) has pushed for ophthalmology residency programs to start offering more categorial residencies to save you the hassle of applying twice to two different programs using two different match services. You must still register with the SF match and submit important application documents such as:

• Official transcripts
• Letters of recommendation
• Medical student performance evaluation (MSPE)
• Residency CV
• Ophthalmology residency personal statement

You will also spend a lot of time seeing patients in various settings (inpatient and outpatient) and have a chance to participate in free vision clinics, which are often a service offered by the teaching hospital or hospital system you train at. But you can also have a research role in your later years, or, in your fellowship, since the majority of your ophthalmology residency will involve you mastering the skills of an ophthalmological surgeon.

Applying to an Ophthalmology Residency (US)  

The number of ophthalmology residency positions in the US has increased over the last three years, as more graduates are discovering the field. As we mentioned, 75% of US medical students matched into the 516 positions available, with the rest being PGY-1 applicants, international medical graduates and osteopathic school graduates. While it may be easy to match to an ophthalmology residency program for US graduates, IMGs face an uphill battle, as they usually do when they are not applying to IMG friendly residency programs.

But there are ways to make sure that you stand out among ophthalmology residency directors. Most directors want to see a genuine interest in eye health and a service-oriented experiences where you have done work helping others. You can also join an Ophthalmology Residency Interest Group in medical school that will give you a lot of benefits.

You’ll show that you have a deep commitment to the field, but you can also get help from your fellow members to prepare for applying. You can also spend time shadowing an ophthalmologist, especially during surgical rounds, to get an idea of how delicate and precise many eye surgeries are, including when they are minimally invasive. Since the field can be competitive, the American Academy of Ophthalmology recommends you apply to a least 40 programs to increase your chances of being invited for an interview.

How are Ophthalmology Residency Programs Structured (US)

We talked about how change is coming to the way ophthalmology residency programs are structured in the US, but the didactic and clinical training inherent to any residency program will remain. The various programs around the US mostly offer the same kind of educational content as the others in that they help students first absorb the fundamentals of the eye and vision science and then puts them through various rotations to apply that knowledge.

Hitting key benchmarks (number of cataract, retina, and glaucoma surgeries performed, number of cataract extractions performed) are important to proving your competency and ease with these procedures. By your senior resident years, you’ll be performing more surgeries, but also have time for lectures from visiting ophthalmologists, presenting cases at conferences, and having Grand Rounds with faculty to discuss subjects varying from medical ethics to oculoplastic surgery techniques.

However, in your first few years, depending on the program you are in, you’ll rotate through various departments related to general medicine, similar to doing a one-year emergency medicine residency or a family medicine residency, but compressed into only a few weeks each. From then on, you’ll be trained on the most common surgical procedures that ophthalmologist typically perform, while also splitting time between didactic classes, seminars and journal clubs where you discuss specific journal articles related to your field.

Some programs, like the one at the University of Michigan have a required research rotation of seven-weeks, but other programs may leave out the research section and focus more on bolstering your skills in the operating room or doing patient examinations. But electives and free-time to explore other medical and non-medical interests vary at each program.

What’s Involved in an Ophthalmology Residency (Canada)

In Canada, you can apply to an ophthalmology residency directly after medical school, as the majority of programs in Canada are categorical, and encompass several years of training in various fields and subspecialties. Even though an ophthalmology residency is offered at all medical schools in Canada, you’ll face more competition, as the number of positions has not increased by more than 1 in five years.

The number of applicants to the 40 positions available in Canada fluctuates every year and it is unclear why there is so much inconsistency. One reason being that learning about the eye is as difficult or more difficult than learning about other systems and organs of the body. Only 20% of medical schools in the US have a required ophthalmology rotation, but in Canada, some medical schools have tried to require students to take an ophthalmology rotation, mostly because Canada will need highly-skilled, well-trained eye doctors for a rapidly aging population.

You’ll probably know by now that a majority of all residency programs in Canada are phasing in the Competence by Design model, and the same will happen to all ophthalmology programs. This model will assess your competency by making you perform certain professional activities, like you would in the real world with a real patient, to make sure you can be trusted to do it on your own. Other than this change, most ophthalmology programs in the Canada last for five years, and also emphasize surgical training, didactic knowledge and a set of required rotations.

Applying to an Ophthalmology Residency Program (Canada)

There was a perfect, 100% match rate for all applicants for last year's 1^st-iteration for Canadian medical graduates, even though there were more applicants in the last year than in previous years. The number of applicants has risen and fallen over the last few years, as more graduates become attracted to the typical factors of work-life balance and potential earnings (one source puts the average yearly salary for an ophthalmologist at $809,557) but are still put off by the niche quality of eye health.

You have to apply to all residency programs in Canada through CaRMS and you need to submit a standard set of application documents to these programs including:

• 3 or 4 letters of recommendation
• Official transcripts
• Medical student performance record
• CaRMS personal letter
• Research resume
• Altus Suite test scores

But these are only general requirements. Some programs, such as Queen’s University, have their own application requirements including answering a personal questionnaire and submitting an ophthalmological report by an eye doctor to confirm your visual acuity and readiness for the program. Other programs also require you to have passed the MCCQE Part I and MCCQE Part II or, at least, be in the process of taking the exams and receiving your medical license. 

How Ophthalmology Residency Programs are Structured (Canada)

The way ophthalmology residency programs in Canada are structured is typical and you have to cover basics in your first years while learning enough to pass your Entrustable Professional Activities and progressing to the other stages of the CBD model. You may have to do a few rounds in general medicine, and take required rotations in at least one off-service rotation, such as pediatrics, geriatric medicine or dermatology.

It’s in the second and third year of your residency when you begin to get into core ophthalmology residency rotations and do your rounds across the various training sites and locations tied to your program. You will also learn how to perform procedures central to an ophthalmologists training such as refractive surgery, cataract removal, and glaucoma surgery. You will also get more exposure to the subspecialties involved in ophthalmology but incrementally.

In your final two years of residency, you’ll be given more responsibility over patients and have to properly assess and diagnose patients you see during your rotations, while also balancing your other duties, such as attending Grand Rounds, conferences, and journal clubs. You’ll also attend academic half-days and spend time with other residents in faculty colloquiums that revolve around relevant topics to eye healthcare.

By this stage, you’ll be adept at performing a wide range of eye-related surgeries and other clinical procedures in various formats, and you’ll also help teach and instruct more junior residents once you have achieved chief resident status. In the final years, you’ll be freer to pursue a specialty in ophthalmology and apply for fellowship programs related to the specialty.

How to Get into an Ophthalmology Residency

Have a Genuine Interest in Ophthalmology

Given the fact that many medical schools in the US and Canada do not make eye health and vision a central part of their curriculum means it's hard to get students interested in the field. Many students do not apply because of interest, but because they are casting a wide net by listing as many disciplines as they can on their rank order list. But if you have your heart set on being an ophthalmologist, one of the ways you can show your interest is by having direct patient experience with the visually-impaired, taking medical school electives in ophthalmology and joining student-run or national ophthalmology societies.

Ace the USMLE, COMLEX or MCCQE

Whatever board-exams you take, make sure that you do your best and score as high as possible to make yourself a competitive candidate. Ophthalmology emphasizes cognitive skills and your foundational knowledge of medicine will be a deciding factor for many residency directors who also favor candidates with competitive board scores. Most programs do not have required scores to apply or to make it to the interview stage but you should still put in the effort to get as high a score as possible. You should even retake the exam if you have the time and resources, especially if you scored low the first time.

Do Public Service Works

The loss or degeneration of a person’s sight can be life-changing and you need to know how to communicate with patients about their conditions, possible therapies and whether they will need more serious treatments, like surgery. Doing rotations in free vision clinics where you attend to low-income patients is standard for most curricula so you should go beyond that and find extracurricular activities that expose you to people with sight problems where you can help them in other ways, and not simply as a medical doctor.

Do Mock Interviews to Prepare 

Acing your ophthalmology residency interview questions is an essential step to getting in, and many residency program directors admit that your interview performance is often a deciding factor for them, so, no pressure! In the US, your interview may be virtual and a traditional one-on-one or panel interview, but in Canada, you may have to do MMI or a hybrid. If you have to do a traditional interview, you can read over common residency interview questions to strategize what you would say and improve your answers over time. In Canada, if you are doing an MMI, you might have to address various aspects of your application, but also your knowledge of healthcare policy, health advocacy and what about ophthalmology interests you the most.

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Your friends at BeMo

BeMo Academic Consulting

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