Oculofacial Plastic Surgery 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.

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.

• Accreditation: The fellowship is sponsored by the Krieger Eye Institute and Sinai Hospital of Baltimore. The fellowship is approved and strictly monitored by the American Society of Ophthalmic Plastic and Reconstructive Surgery.
• 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 ACHME-accredited ophthalmology residency programs. Applications will be handled through a national matching program with all other approved ASOPRS programs (approximately 15-17 programs per year).
• 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.

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. 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

• Biopsy
• Orbitotomy (all approaches)
• Tumor removal
• Orbital decompression
• Trauma repair

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.

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:
Marc J. Hirschbein, M.D., F.A.C.S.
Fellowship Coordinator
Phone: 410-601-8283
Fax: 410-601-8273
mhirschb@lifebridgehealth.org