Ophthalmology residency training is constantly evolving, and 2025 marked a year of notable developments that are shaping how programs prepare their residents. Changes in accreditation standards, increasing clinical demands, and new educational tools—particularly in simulation and artificial intelligence (AI)—have all influenced how residents learn and how faculty teach.

To get a clearer picture of what these changes mean on the ground, the Eye Care Network caught up with 3 residency program directors to learn about the developments they have seen, the challenges they have navigated, and what they expect in the years ahead.

Joining in this Q&A are the following:

• Chris R. Alabiad, MD
  Brand Butcher Youngdahl Chair in Ophthalmology
  Professor of Clinical Ophthalmology and Medical Education
  Assistant Dean for Student Affairs
  Director, Ophthalmology Residency and Fellowship Programs
  Oculofacial Plastic and Reconstructive Surgery and Orbital Oncology
  Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
  Miami, Florida
  
• Andrew Melson, MD
  Residency Program Director and Associate Professor, Department of Ophthalmology
  James P. Luton, MD Endowed Chair in Ophthalmology
  University of Oklahoma Health Campus, Dean McGee Eye Institute, Oklahoma City, Oklahoma
  
• Michael Sulewski Jr, MD
  Residency Program Director and Assistant Professor of Ophthalmology
  Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland

Note: Transcript edited for clarity and length.

Which changes implemented in 2025 do you think will have the most lasting impact on residency training?

Chris R. Alabiad, MD: There wasn’t one single national rule change in 2025 that transformed residency training overnight. Instead, what really stood out was how programs had to adapt to ongoing pressure from declining reimbursement, funding uncertainty, and increasing patient demand—all at the same time.

The most lasting change in our program has been a renewed focus on protecting education despite those pressures. Faculty everywhere are being asked to do more clinically, often with fewer resources. We’ve been very intentional about maintaining strong teaching, mentorship, and protected educational time—even when it’s difficult financially—because that’s how you sustain the future of the specialty.

Another important shift has been our emphasis on professionalism, teamwork, and advocacy. Our residents work closely with optometrists every day, and we’ve focused on helping them build respectful, productive partnerships while also learning how to advocate for ophthalmology in a professional and constructive way.

Finally, as financial pressures grow, philanthropy is playing a larger role in supporting education—things like simulation, leadership development, and global initiatives that are harder to fund through traditional clinical revenue alone.

Andrew Melson, MD: The biggest shift in ophthalmology residency training that was put into place in 2025 is the major revision of the Accreditation Council for Graduate Medical Education (ACGME) ophthalmology program requirements. This update, set to go live July 1, 2026, contains multiple substantive redefinitions and curricular reforms geared towards modernizing the educational experience for ophthalmology residents nationwide.

One of the primary revisions was a re-definition of the role of an ophthalmologist with new language that broadens ophthalmology from a technical, specialty-focused description to a patient-centered, holistic medical discipline, emphasizing integration of history, exam, imaging, systemic disease, and social determinants of health in diagnosis and care. It adds expectations of leadership, lifelong learning, technology adoption, ethical behavior, communication, cost-consciousness, and shared decision-making, reflecting a wider set of professional and societal responsibilities beyond simply procedural expertise. Recognizing that curricular innovations require a great deal of time and energy, the revision also includes increased requirements for protected time for both program directors and program coordinators, relative to the number of residents per year.

Michael Sulewski, MD: Widespread investment and enthusiasm for AI as we have seen in 2025 may certainly change how residents train. Although many are researching clinical applications of AI, I imagine trainees engaging more with AI as a study tool or clinical handbook, especially if accuracy continues to improve.

How have residents’ learning needs or expectations evolved over the past year, and how has your program adapted?

Alabiad: Today’s residents want 3 things at the same time: excellent training, efficient systems, and a sustainable lifestyle. They value high surgical volume, but they also care deeply about how their time is structured.

We’re fortunate to have tremendous patient volume, so we’ve focused on improving efficiency and flow rather than simply adding more work. That’s meant:

• Streamlining clinic logistics
• Creating clearer service lines within resident clinics
• Improving referral patterns so residents see the right patients at the right time

One of our most successful changes has been restructuring overnight and emergency coverage in partnership with optometry. By adding a night-float rotation for optometry residents and expanding daytime optometry coverage in our 24-hour Eye ER, we:

• Reduced overnight fatigue for ophthalmology residents
• Improved optometry training
• Strengthened teamwork between two fields that don’t always see eye-to-eye

We also expanded our residency class to help meet the growing national demand for ophthalmologists. Throughout all of this, the biggest driver of change has simply been listening to our residents and responding thoughtfully.

Melson: Residents today are highly motivated, self-directed, and pragmatic, but they expect directed learning, psychological safety, and purposeful feedback, not just volume of experience.

Over the past few years, I’ve noticed 3 clear evolution points:

• Residents increasingly prefer well-defined expectations at each stage of training. They want to know what “good” looks like at PGY-2 versus PGY-4. We address this in summative semiannual evaluations through transparent milestone frameworks for surgical readiness, clinical complexity, and consult independence, coupled with 360 evaluations and de-identified peer milestone comparison charts.
• Residents prefer active learning, not just passive information exposure. The traditional 60-minute slide decks are no longer sufficient in isolation. Mixed media, asynchronous learning resources through the American Academy of Ophthalmology ONE Network and other sources provide powerpoints, directed learning modules and even podcasts that allow residents to cater to their specific learning styles to preparing for high-yield case conferences, flipped learning models, and procedural simulation.
• Newer trainees are more comfortable with acknowledging uncertainty, and they value both professional identity support and a collegial work environment. Our program protects 1-hour per week with all residents and program leadership to meet and create a safe space to discuss the pulse of the residency, proactively set expectations and manage issues as they arise, and to celebrate successes both individual and collective. Mentorship, both formal and informal, provides deeper individual, bidirectional relationships whose value spans clinical ability, research productivity, career development, and resident well being.

We continue efforts to move from “provide everything and they’ll absorb it” to purposefully structured learning where residents can receive the right challenge at the right moment, supported by faculty who are trained to teach, not only to supervise.

Sulewski: Residents are increasingly interested in surgical laboratory and training sessions beyond the direct OR experiences. We wish to provide frequent and specialized simulation sessions in our surgical wet lab to meet these needs and expectations.

What challenges did you encounter when rolling out new educational approaches or policies in 2025, and how did you address them?

Alabiad: The biggest challenge continues to be the tension between education and productivity. Faculty want to teach, but clinical demands and shrinking margins make it harder to protect that time. We addressed this in a few ways:

• By being very transparent about the value of education and implementing an educational/academic relative value unit system to support teaching efforts
• By using philanthropic support to help fund simulation and teaching initiatives
• And by reinforcing a departmental culture where education is viewed as a core mission—not a secondary task

Another challenge was simply change fatigue. Between health care policy shifts, staffing pressures, and rising patient volumes, people can feel overwhelmed. We tried to roll out changes in stages, gather real-time feedback, and show residents that their input directly shaped the final decisions.

Melson: I think I [have already] answered the challenge part in other sections.

Sulewski: One exciting change to our curriculum is the introduction of a fully NEI-funded research year for 1 member of our intern class to be performed between PGY-1 and PGY-2 year. It requires advanced planning with a research mentor to ensure this upcoming year will be high yield and ultimately a steppingstone for an academic career.

What areas of residency education still need improvement, and what changes are you hoping to see in the next few years?

Alabiad: There’s a lot of opportunity ahead. Some of the biggest areas for growth include:

• Modernizing didactics. We need more efficient, digital, high-yield learning tools that fit residents’ real schedules, including greater use of simulation, virtual reality, and on-demand content.
• Expanding surgical simulation. Cataract and vitrectomy simulation are well developed, but we need the same level of innovation for glaucoma, cornea, and oculoplastics.
• Training future clinician-scientists. More structured research pathways/pipelines and increased access to R38/T32-type funding would be a major step forward.
• Interfacing with AI. It will be critical to learn to work with this technology than against. However, it will take a bit of balancing as some may resort to it as a crutch and thus not meet their maximal potential. When used responsibly it can augment an amazing baseline skill set to the benefit of all stakeholders.
• Developing future health care leaders. Residents need exposure to leadership, operations, and health care economics if they’re going to run departments, practices, and health systems.
• Global ophthalmology. There is enormous interest in sustainable international training and outreach, and we’re just scratching the surface.
• Real-world professional skills. Things like contract negotiation, billing and coding, practice management, financial planning, and even family planning are all areas where residents want more guidance.

Residency training is incredibly strong clinically, but the next evolution will be about building well-rounded surgeons, scientists, leaders, and professionals.

Melson: Residency education needs to continue the move toward competency-based progression rather than time-based advancement across specialties. Instead of assuming that surgical skill, diagnostic judgment, or consult readiness mature uniformly by PGY or calendar year, programs would be well served to increasingly implement entrustable professional activities (EPAs) or milestone-based advancements with granular skills assessments and tiered autonomy. It is ideal for residents to advance when they demonstrate mastery, and faculty can calibrate both expectations and feedback transparently. It is a philosophical departure from “time served” toward “competencies achieved,” and though it will have notable logistical challenges with implementation, I believe it can reframe how we assess and progress towards readiness for independent practice.

Similarly, there is an ongoing need to reset how we view resident well-being and workload sustainability. Rather than framing wellness as extracurricular or optional, many institutions are restructured call systems, expanding access to behavioral health, and embedding protected time for mentorship and academic development. The messaging needs to continue this shift: wellness is no longer an intervention to “fix burned-out residents.” It should be a structural foundation for training high-quality physicians by creating safer learning environments, normalizing help-seeking behavior, and improving retention and career longevity necessary to mitigate against our impending workforce shortages.

Sulewski: I think we as a field can improve by having more formal evaluation and feedback for surgical teaching. I think often the apprenticeship model prevails in training programs but sometimes there is an unknown gap in the communication between attending and trainee. Studies have shown attendings may overestimate how much instruction and feedback is given. Similarly, residents may not have a good sense of where there are on the learning curve as they progress. To our benefit, however, since most of our cases are recorded through the operating microscope, we do possess a tremendous teaching tool in ophthalmology that our colleagues in other surgical fields may not have. More discussion as a field surrounding surgical feedback and maintaining objective milestones may be a helpful step for our field.

Chris R. Alabiad, MD
E: [email protected]
Brand Butcher Youngdahl Chair in Ophthalmology
Professor of Clinical Ophthalmology and Medical Education
Assistant Dean for Student Affairs
Director, Ophthalmology Residency and Fellowship Program
Oculofacial Plastic and Reconstructive Surgery and Orbital Oncology
Bascom Palmer Eye Institute
University of Miami Miller School of Medicine, Miami, Florida

Andrew Melson, MD
E: [email protected]
Residency Program Director and Associate Professor, Department of Ophthalmology
James P. Luton, MD Endowed Chair in Ophthalmology
University of Oklahoma Health Campus, Dean McGee Eye Institute, Oklahoma City, Oklahoma

Michael Sulewski Jr, MD
E: [email protected]
Residency Program Director and Assistant Professor of Ophthalmology
Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland