Vitreoretinal surgery is among the most technically demanding disciplines in all of ophthalmology. Operating on the retina, the paper-thin layer of light-sensitive tissue lining the back of the eye, requires surgeons to manipulate instruments within a space smaller than a ping-pong ball, often working at magnifications of twenty-five times or more under an operating microscope. Procedures such as vitrectomy, membrane peeling, and the repair of retinal detachments demand millimeter-precision movements, where a tremor of even a fraction of a millimeter can mean the difference between restored vision and permanent damage. Because of this unforgiving learning curve, surgical educators have traditionally leaned toward observation-based models, particularly in programs that employ dedicated retina fellows who take priority in the operating room.

The new research, led by Jin Kyun Oh and Tarun Sharma of the Harkness S. Eye Institute at Columbia, was conducted at NYC Health + Hospitals/Harlem between April 15, 2024, and March 30, 2025. The team carried out a single-center retrospective observational study in which eight ophthalmology residents participated in thirty retinal surgeries under direct faculty supervision. Rather than standing at the edge of the operating theater as passive observers, the residents were placed in the surgeon’s seat for defined portions of each case, with attending surgeons guiding every step. A structured questionnaire then captured which surgical steps each resident performed, how much they felt their skills had improved, the quality of their mentorship experience, and the barriers that had previously limited their surgical training.

The results were striking in their consistency. Every one of the eight residents reported moderate to significant improvement in surgical skills and in their understanding of retinal pathoanatomy, the structural changes that disease produces in the retina. Participation in key surgical steps increased substantially over the course of the rotation, indicating that the more the residents operated, the more responsibility their mentors entrusted to them. Surgical mentorship was universally rated as excellent, a detail that the authors highlight as central to the model’s success. All residents also affirmed the educational value of preoperative fundus drawings, detailed sketches of the retina made before surgery that force the trainee to study the pathology and plan the operation in advance.

Those fundus drawings deserve particular attention, because they embody a teaching principle that extends far beyond the operating room. Before a vitreoretinal procedure, the surgeon maps out the location of retinal tears, detachments, membranes, and other pathology on a paper diagram. For a resident, producing this drawing is not a clerical chore but a cognitive exercise: it requires interpreting imaging studies, correlating them with the clinical examination, and mentally rehearsing the sequence of surgical maneuvers needed to address each finding. By the time the patient is under anesthesia, the resident has already performed the operation once in their mind, a form of deliberate practice that cognitive scientists associate with durable skill acquisition.

The technical steps that residents performed during the study span the core repertoire of vitreoretinal surgery. In a typical vitrectomy, the surgeon first creates three small ports in the sclera, the white outer coat of the eye, to introduce a cutting instrument that removes the vitreous gel filling the eye’s interior. Subsequent steps may include inducing a posterior vitreous detachment to separate the gel from the retina, peeling epiretinal membranes with fine forceps, applying laser photocoagulation to seal retinal tears, and injecting gas or silicone oil to tamponade the retina in place while it heals. Each of these maneuvers rewards repetition, and the study’s finding that resident participation increased substantially during the rotation reflects the graduated autonomy that defines effective surgical apprenticeship: as competence grows, so does the share of the operation the trainee performs.

Yet the study is equally candid about the obstacles that keep residents away from the retina. The most commonly cited barriers were clinical responsibility, the competing demands of ward and clinic duties that eat into operating time, and the presence of fellows at other sites, which diverts surgical cases to advanced trainees ahead of residents. This structural competition is a well-known feature of American ophthalmology training. Programs with their own retina fellows often relegate residents to the observation deck, reasoning that fellows need the volume to become independent retina surgeons. The Columbia-Harlem model demonstrates that this either-or framing is false: with structured mentorship and deliberate case allocation, residents can gain meaningful operative experience without compromising fellow education or patient safety.

The educational stakes are considerable. Vitreoretinal disease, including diabetic retinopathy, retinal detachment, and age-related macular degeneration, is a leading cause of vision loss worldwide, and the demand for retina surgeons continues to outpace supply. Residents who graduate without operative confidence in retinal surgery face a steeper path to fellowship and independent practice, and communities served by general ophthalmologists may lack access to timely surgical care. The authors argue that direct hands-on participation, combined with structured mentorship and preoperative planning, may serve as a replicable model to improve vitreoretinal surgical education nationally, a claim that carries weight given that the study took place at a public hospital serving a diverse urban population rather than at an elite private center.

The study’s design does impose limits on how far its conclusions can be stretched. As a retrospective observational study with eight residents at a single center, it relies on self-reported perceptions of skill improvement rather than objective assessments by blinded raters, and it lacks a comparison group of residents trained under the traditional observation model. Still, the uniformity of the responses is difficult to dismiss: when all participants independently report substantial gains and rate mentorship as excellent, the signal is strong enough to justify broader testing. The work received an ethics exemption from Columbia’s Institutional Review Board and was funded in part by Research to Prevent Blindness unrestricted funds to the Department of Ophthalmology.

What makes the study resonate beyond ophthalmology is the simplicity of its prescription. Surgical education across specialties has long wrestled with the tension between patient safety and trainee autonomy, and the default solution has too often been observation. The Columbia-Harlem experience shows that the alternative, placing residents in the surgeon’s seat for defined steps under vigilant supervision, beginning with meticulous preoperative planning, and scaling responsibility as competence grows, is both safe and transformative. For the residents of Harlem, thirty operations did more than teach surgical technique; they converted spectators into participants, and participants, the evidence suggests, into surgeons ready to carry the specialty forward.

Subject of Research: Medical Education

Article Title: Enhancing resident education through active participation in vitreoretinal surgery

Article References: Oh, J. K., Li, C. Y., Kassotis, A., Gu, S. Z., Moussa, O., Shabto, J. M., Yu, S. N., Hirji, S. H., & Sharma, T. (2026). Enhancing resident education through active participation in vitreoretinal surgery. BMC Medical Education. https://doi.org/10.1186/s12909-026-10634-8

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10634-8

Keywords: vitreoretinal surgery, ophthalmology, resident education, surgical training, medical education, retina, mentorship, Enhancing, resident, education, active, participation