Elevating Surgical Training
JOHN A. MORAN EYE CENTER / UNIVERSITY OF UTAH HEALTH / 2025
2024-2025 Best Hospitals for Ophthalmology No.10 NATIONWIDE Learn More Scan for more information about our education program.
2024-2025 Residency Navigator No. 6 NATIONWIDE No. 1 IN THE WEST
Providing an Exceptional Education
HIGH SURGICAL VOLUMES
On average, one Moran resident performs nearly 700 surgeries and procedures in a typical threeyear period. Nearly 300 are cataract surgeries—86 is the national requirement. A wet lab and surgical simulators give residents additional opportunities for hands-on experience.
RESIDENT CONTINUITY CLINIC
From day one, interns manage a patient’s eye care throughout their ophthalmology rotation under the supervision of a board-certified ophthalmologist.
INNOVATIVE CURRICULUM
Moran goes beyond the traditional, didactic teaching model to foster a dynamic, interactive ophthalmology curriculum, including a wellness program with protected academic time.
ONLINE PUBLISHING—MORAN CORE
Residents publish on Moran’s multimedia, peer-reviewed educational website, the Clinical Ophthalmology Resource for Education at morancore. utah.edu.
QUALITY IMPROVEMENT
Residents design quality improvement projects as part of value training to provide the best patient outcomes at the lowest possible cost.
SNAPSHOT: CLINICAL CARE AND EDUCATION FISCAL YEAR 2024
DEDICATED RESEARCH TIME
Moran residents may receive up to one-half day of dedicated weekly research time for projects. Moran also provides funding opportunities like the Achievement Rewards for College Scientists (ARCS) Foundation’s scholars program.
ELECTIVE TIME
Third-year residents can tailor three months of elective time to their interests and participate in local and international outreach work with Moran’s Global Outreach Division.
PROGRAM GROWTH
With interns, Moran is training 16 residents and 14 fellows in specialties that include cornea and refractive surgery, glaucoma, neuro-ophthalmology, oculoplastics, retina and vitreous surgery, uveitis, and global outreach this year.
182,600+ PATIENT VISITS
9,200+ SURGERIES
685
RESIDENT APPLICATIONS FOR 4 SPOTS IN 2024
350+
MORAN-TRAINED OPHTHALMOLOGISTS PRACTICING IN 45 U.S. STATES AND WORLDWIDE
Innovation Rooted in Tradition
An institution takes on the qualities of its leader. As educators, it’s easy to say we prioritize critical thinking, new ideas, and innovation. However, creating an institutional environment where faculty and trainees feel free to embody these principles is a different challenge altogether.
As our department prepares to bid farewell to Randall J Olson, MD, I can unequivocally say he has established a culture where educational excellence and continuous improvement are the ultimate goals, free from ego or fear of change.
Recently, Dr. Olson served as the keynote speaker at our Resident Research Day, reflecting on his remarkable 46-year career. It was a talk filled with pearls of hard-won wisdom, but among them was one I found particularly poignant, both for its relevance and simplicity: Encourage questioning of accepted wisdom.
Our educational program has long boasted engaged faculty, unique learning opportunities, high resident surgical volumes, and trainees committed to maximizing their growth. I am proud to say that we are also well equipped to follow Dr. Olson’s advice.
This edition of Education FOCUS highlights a resident-driven effort to elevate the rigor of our surgical curriculum. In many ways, this effort is a natural outgrowth of our Moran culture, where residents already conduct quality improvement research related to patient care. Now, they are applying these principles to the training process itself.
I believe encouraging resident curriculum engagement, coupled with a renewed emphasis on wellness, is working. Our recent residency program survey results from the Accreditation Council for Graduate Medical Education hit a new high as 100% of residents reported they would “definitely choose” Moran for their training again and gave a “very positive” rating evaluation of the program/experience.
As I enter my second year as vice chair, I feel even more motivated to support continued innovation in our proud tradition of excellence. The next generation of clinicians will face exciting new opportunities in the field alongside new challenges. My colleagues and I look forward to helping them rise to both.
Rachel G. Simpson, MD Vice Chair for Education, John A. Moran Eye Center Associate Professor, Department of Ophthalmology and Visual Sciences, University of Utah
I believe encouraging resident curriculum engagement, coupled with a renewed emphasis on wellness, is working.
Surgery, 3.0
Moran Eye Center residents and faculty work together to enhance rigor in a longitudinal surgical curriculum.
One of former Moran 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 20242025 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
We believe residents are an integral part of our evolution, and it’s been rewarding to work with our chiefs and ensure we are truly creating the best clinical training possible.
— Rachel G. Simpson, MD, Vice Chair of Education
Resident Ayesha Patil, MD, MPH, practices a skill during the inaugural cataract day symposium.
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.
VIDEOS 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.”
• • •
Resident Mubarik Mohamed, MD, above, practices a skill during the inaugural cataract day symposium. Residents and faculty, left, watch a surgical video during a review night event.
To get input from five or six anterior segment experts, you realize there are so many ways to do things. That helps you hone what you think is the best way as you go out and become an independent surgeon.
—Resident
Jordan
Desautels, MD
The Voice of Experience
Nick Mamalis, MD, has spent more than 40 years as an ophthalmologist, intraocular lens researcher, and medical educator. We asked Mamalis, who recently retired from surgery, to share perspectives from 38 years of teaching residents in the operating room.
1. Residents can be very nervous, and it’s important for attendings to do whatever they can to calm them down. I would always try to speak in a very even, monotone way, what is described as my “HAL” voice (referring to the HAL 9000 computer in the movie “2001: A Space Odyssey”). If a resident is getting too deep in the eye, you can’t say, “OH, don’t go so deep!!!” Instead, you calmly say, “OK, we’re not going to go quite so deep, we’re going to go a little more superficial.”
2. Consider the inside-out cataract teaching method.
Residents start with the parts they can do most easily that won’t affect the other parts of the surgery. For example, in a cataract surgery, I would make the incision, and I would make the capsulotomy (capsulorhexis). Then, I would have the resident start the procedure where they remove the hard part of the cataract, and the softer parts, and put in the lens implant. We started from the inside first and added more pieces to the surgery as they became more confident.
3. It’s important to let more senior residents with many cases under their belt work through the problem. I talked to them a lot and told them, “OK, you need to do this technique, or that technique,” and worked with them to rescue what was happening. There were times when they got into trouble and they weren’t going to get out, so in that case, you would have to trade places with them.
• • •
Dr. Mamalis is a clinicianscientist who directs Moran’s Ophthalmic Pathology Laboratory and is co-director of the Intermountain Ocular Research Center. He holds the Calvin S. and JeNeal N. Hatch Presidential Endowed Chair.
More Online
Scan for more teaching advice from Dr. Mamalis.
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Global Outreach Fellow in Nepal, Tanzania, Guatemala
The John A. Moran Eye Center’s Global Outreach Division provides unique opportunities for trainees to hone their skills as part of its mission to expandaccess to eye care where it is needed most.
With continued support from The Alcon Foundation, the division welcomed Belinda Ikpoh, MD, as a global ophthalmology fellow in Salt Lake City on July 1, 2024. Throughout her international travels, she worked in three low-resource settings, assisting more than 1,245 patients and training more than 30 physicians, nurses, and technicians.
In Nepal, Ikpoh split her time between the Tilganga Institute of Ophthalmology and the Hetuda Community Hospital, performing surgeries, including manual small incision cataract surgery (MSICS). In Tanzania at Bugando Medical Center and Benjamin Mkapa Hospital, she focused on teaching phacoemulsification surgery and implementing a daily operating room protocol. There, she also participated in “glaucoma week” events that evaluated a large number of pre-scheduled glaucoma exams for patients with complex conditions. In Guatemala, Ikpoh trained at Vizualiza - Hospital of Oftalmologica and participated in a surgical outreach camp.
“I now feel more confident with doing MSICS independently,” Ikpoh reported after her time in Nepal. “It was also a great experience to participate in the surgical camps and community screenings—to see how the camps are set up, what is assessed, how the day is formatted, and how post-op care is handled”
In monthly reports, Dr. Ikpoh also thoughtfully suggested ways future fellows can use simple preemptive practices to avoid confusion, delays, and frustrations.
Belinda Ikpoh, MD, spent part of her global ophthalmology fellowship in Tanzania.
