University of Iowa's Ophthalmology Residency Program Forms

Dr. O'Brien had definite ideas about how to teach ophthalmology and wanted his program to be one of the very best. He structured the program so that each resident was trained thoroughly with a gradually increasing sequence of responsibilities. Lectures in the basic sciences of pathology, histology, pharmacology and optics were given every afternoon. First year residents were put to work doing complete ocular examinations (mostly on university students) including refractions and some visual fields. Later in the first year they began to do simple surgery of the extraocular muscles, enucleations, and some lid procedures to learn the mechanics and fundamentals of ophthalmic surgery. They began cataract surgery in the second year. Research was encouraged, but it was not permitted to interfere with patient care.

Dr. O'Brien felt that if he selected residents from different states, Iowa's reputation in ophthalmology would be spread far and wide.

In 1927 Dr. O'Brien chose Merle Taylor from Oregon as his first resident before the new University Hospital was built. A new resident was selected every six months and rotated through the program. Dr. O'Brien felt that if he selected residents from different states, Iowa's reputation in ophthalmology would be spread far and wide. This philosophy produced many department chairmen including James H. Allen (Tulane University), Alson E. Braley (New York University and later University of Iowa), Kenneth C. Swan (University of Oregon), Thomas D. Duane (Wills Eye Hospital), Philip P. Ellis (University of Colorado), Phillips L. Thygeson (Director of the Proctor Foundation at the University of California, San Francisco).

O'Brien was a strict disciplinarian and was said to have run his department like the Marine Corps. The residents respected and adhered to the policies and routines established by Dr. O'Brien. Residents were expected to be present and on time wearing a tie and a clean white coat regardless of outside factors such as their own weddings, floods, or department parties the night before. First year residents were required to live in the hospital (that's why they were called "residents" after all). If a resident wished to be married and wanted to stay in the program, he needed to have O'Brien's—generally reluctant—approval.

"He gave me hell during practically every surgery. Finally I said, 'Dr. O'Brien, I thought I was doing everything you wanted me to do. Why do you still give me hell?' Dr. O'Brien replied with a characteristically rough compliment, 'Otis, I just want to remind you that it costs me a lot of effort to give you hell. So if I chew you out, it is because I think you are worth the investment.'"

Many of his former residents mentioned in interviews that they had concerns as new residents about having to work with O'Brien, but all were quick to say that their fears soon resolved into respect for his knowledge and for his determination to train residents well.

Morning rounds began at 8:00 a.m. sharp, seven days a week, even on Sunday.

Daily routines were established and very strictly followed. Many of these routines are still practiced today at the University and many are carried on at other academic facilities influenced by Iowa. Morning rounds began at 8:00 a.m. sharp, seven days a week, even on Sunday. Patients were brought into the clinic for these rounds. Everyone then had the opportunity to see all the interesting patients and discuss the problematic cases. When Dr. O'Brien asked a question, the resident was expected to provide an answer complete with a reason or explanation. Following the presentation of cases in the clinic, the residents followed O'Brien to the ward to examine the post-operative patients that were still confined to bed. On Sundays, a paper was given by one of the residents. During the week, daily lectures were given promptly at 4:00 p.m. in the lecture room. If clinic patients were not finished in time for the lecture, the patient was asked to wait until after the lecture. The lecture topics were chosen by Dr. O'Brien, but the lectures were given by the faculty.

 O'Brien with his faculty (P.J. Leinfelder, Jimmy Allen) and residents in 1940

Dr. O'Brien supported and encouraged his residents, yet he demanded perfection. He was himself a facile surgeon and he would not tolerate work below his standards. Residents began by helping Dr. O'Brien in the operating room, first as a surgical assistant and then, on all except private patients, doing increasing amounts of the operation. They were expected to have read up on the procedure and to be alert enough to be helpful and to be cool enough to withstand sharp orders and reprimands.

O'Brien was a strong, forceful disciplinarian. Dr. Otis Lee (resident, 1941-1944) remembered Dr. O'Brien's method of discipline. "He gave me hell during practically every surgery. Finally I said, 'Dr. O'Brien, I thought I was doing everything you wanted me to do. Why do you still give me hell?' Dr. O'Brien replied with a characteristically rough compliment, 'Otis, I just want to remind you that it costs me a lot of effort to give you hell. So if I chew you out, it is because I think you are worth the investment.' "

When not in the clinic, Dr. O'Brien was gracious, friendly, and helpful. He hosted parties for the residents and faculty at his home in the country every week or two. Although these parties lasted until late at night, the residents and faculty were expected to report on time for morning rounds the following day.

An annual reunion of former residents was held at his home. Many alumni returned for these reunions to share stories with the current residents.

*This sketch of Dr C.S. O'Brien and the residency program was adapted from a paper by Drs. John C. Lee and H. Stanley Thompson published in Documenta Ophthalmologica 94: 161-178, Jan 1997 and read at the tenth annual meeting of the Cogan Ophthalmic History Society, Philadelphia College of Physicians, March 8 and 9, 1997.