Residency in Low Vision/Ocular Disease
Hampton VA Medical Center, Hampton, Virginia
SOUTHERN COLLEGE OF OPTOMETRY
The mission of this residency program is to provide residents with the clinical education necessary to become practitioners who are able to deliver low vision/rehabilitative eye care and therapeutic management of ocular disease in a multidisciplinary environment. This program will provide academic and clinical experiences that will enable residents to expand their knowledge base, strengthen their patient care skills, and participate in clinical and academic education. Individuals who complete the program are expected to be able to deliver a high level of clinical care and to serve as optometric educators.
Residency Program Goals, Objectives, Outcomes, and Measures
Goal 1: Strengthen the residents’ confidence and clinical competence in delivering low vision/rehabilitative eye care
Objective 1: Ensure the resident performs a minimum number of low vision/rehabilitative eye care evaluations
Outcome: The resident will perform a minimum of 60 new and/or follow up low vision/rehabilitative eye exams
Measure: Using data collected from the Encounter Forms and the patient care log, the resident will report quarterly on the number and type of low vision/rehabilitative eye exams performed
Objective 2: Expose the resident to a diverse range of low vision patient presentations
Outcome: The resident will examine patients with a variety of levels of visual impairments, representative of the visually impaired population at the Hampton VAMC
Measure: Using data collected from the Encounter Forms, the resident will report quarterly on levels of visual impairments encountered as defined by the ICD-9 diagnostic codes.
Objective 3: Ensure the resident gains experience in the prescribing of the full scope of low vision devices
Outcome: The resident will prescribe the full range of nonoptical, optical, and electronic low vision devices as clinically indicated and appropriate for the visually impaired patient population
Measure: Using data collected from the Encounter Forms and the patient care log, the resident will report quarterly on the categories and types of low vision devices prescribed. The categories will include the following: Hand Magnifiers, Stand Magnifiers, Telescopes, Hands-free devices, Custom devices (e.g. Designs for Vision telescopes and microscopes), and Electronic Optical Devices. This information will be collected quarterly and tabulated at the end of the residency year.
Goal 2: Enhance the residents’ understanding of their role within a multidisciplinary health care environment as well as part of the low vision rehabilitation team
Objective 2: Ensure that the resident fully utilizes hospital clinical services and personnel outside of the Eye Clinic
Outcome: The resident will refer patients and consult with other hospital ancillary, rehabilitative, and supportive health care service providers when indicated.
Measure: Using data collected from the patient care log, the resident will report quarterly on the number and types of referrals and consultations made. Review of the resident’s records in accordance with the resident supervision policy will be used as an opportunity to educate the resident on the need for consultation and referral on a case-by-case basis
Objective 3: Expose the resident to the clinical activities observing non-optometric hospital and rehabilitative health care providers within a multidisciplinary setting.
Outcome: The resident will spend a minimum of 30 hrs observing non-optometric hospital and rehabilitative health care providers
Measure: The resident will be scheduled for a minimum of 30 hours of rotation through non-optometric clinics and for observation of hospital-based procedures. The resident will be evaluated by the preceptor for each rotation and will also evaluate each rotation.
Objective 1: Enhance the resident’s understanding of the team nature of low vision rehabilitation
Outcome: The resident will spend a minimum of 30 hours observing and interacting with and the low vision rehabilitation specialist
Measure: The resident will be scheduled for a minimum of 30 hours of observation of the low vision rehabilitation specialist’s role. These observational hours will be logged and monitored by the Program Supervisor
Goal 3: Provide the resident with experience in therapeutics and in the diagnosis and management of complex ocular disease.
Objective 1: Provide the resident with adequate experience and training in the management of complex ocular disease
Outcome: The resident will manage and treat an adequate number of patients with complex ocular disease presentations.
Measure: Using data collected from the Encounter Forms and the patient care log, the resident will report quarterly on the numbers of patients seen with complex ocular disease presentations (as defined as those patients with three or more ICD-9 diagnoses relating to the eye).
Objective 2: Ensure the resident gains adequate experience with advanced diagnostic ocular procedures.
Outcome: The resident will perform advanced diagnostic procedures (including gonioscopy, fundus contact lens examination, optical coherence tomography, B-scan ultrasonography, posterior segment photography and fluorescein angiography) when clinically indicated.
Measure: Using data collected from the Encounter Forms and the patient care log, the resident will report quarterly on the number of advanced diagnostic procedures performed (including gonioscopy, fundus contact lens examination, optical coherence tomography, B-scan ultrasonography, posterior segment photography and fluorescein angiography)
Objective 3: Ensure that the resident gains experience in ordering non-ophthalmic diagnostic tests and procedures necessary for the evaluation of complex ocular disease
Outcome: The resident will order non-ophthalmic diagnostic tests and procedures when clinically indicated.
Measure: Using data collected from the Encounter Forms and the patient care log, the resident will report quarterly on the numbers and types of diagnostic tests and procedures ordered. Review of the resident’s records in accordance with the resident supervision policy will be used as an opportunity to educate the resident on the need for special diagnostic tests and procedures on a case-by-case basis
Objective 4: Provide the resident with experience in the fitting and management of medically indicated contact lenses for ocular disease
Outcome: The resident will perform contact lens fittings and evaluations on patients with anterior segment disease requiring the use of contact lenses.
Measure: Using data collected from the Encounter Forms, the resident will report quarterly on the number and type of contact lens evaluations performed
Objective 5: Provide the resident with experience in the triage and management of urgent ocular conditions
Outcome: The resident will serve as a referral source for urgent eye care consultations requested of the Eye Clinic
Measure: Using data collected from the Encounter Forms and the patient care log, the resident will report quarterly on the number of urgent ocular consultations performed
Goal 4: Provide the resident with the experience and opportunity to become an effective educator
Objective 1: Develop the residents’ ability to effectively share knowledge and disseminate information
Outcome: The resident will prepare and present lectures for Grand Rounds conferences that involve the local optometric community.
Measure: Documentation of the resident’s handouts for lectures presented.
Objective 2: Develop the residents’ ability to effectively share knowledge and disseminate information about vision impairment and low vision services
Outcome: The resident will actively participate in low vision outreach activities targeted for the community as well as in-services for relevant stakeholders within the hospital
Measure: The resident will participate in at least 5 (five) outreach and/or inservice activities on vision impairment and low vision services
Objective 3: Develop the resident’s instructional and clinical teaching skills.
Outcome: The resident will participate in weekly optometric educational conferences and in the clinical supervision of optometric externs as well as the didactic instruction of ophthalmology residents
Measure: A record will be kept of the topics covered during teaching conferences and the resident will report quarterly on the number of patients precepted with the externs.
Goal 5: Instill in the resident an appreciation for the significance of research and other scholarly activity.
Objective 1: Develop the residents’ ability to critically evaluate clinical research from the ophthalmic literature.
Outcome: The resident will read clinically relevant ophthalmic research literature for discussion with the Program Supervisor and/or staff. A minimum of 20 journal articles will be reviewed.
Measure: Documentation of the ophthalmic research literature read by the resident and discussed with the Program Supervisor and/or staff.
Objective 2: Develop the residents’ ability to use library resources to investigate clinically relevant topics.
Outcome: The resident will become familiar with methods of library research, including literature searches.
Measure: The resident will present a bibliography for each of his or her Grand Rounds presentations.
Objective 3: Guide and educate the resident as to the process of preparation of a manuscript of publishable quality.
Outcome: The resident must prepare of a manuscript of publishable quality.
Measure: The resident will be evaluated quarterly on the progress of his or research paper or case report manuscript preparation.
The residency program has a strong clinical emphasis, with a diverse patient base and clinical experiences. The resident examines and evaluates low vision patients as part of the Intermediate Low Vision program, which includes working directly with a full time vision rehabilitation therapist. The resident also manages patients with ongoing and chronic ocular diseases as well as performs fluorescein angiograms and fits contact lenses for medically indicated conditions such as keratoconus and aphakia. Academic and didactic activities include a weekly conference as well as monthly Grand Rounds with the resident presenting cases and lectures for private practitioners in the area for continuing education credit through the State Board of Virginia.
With its emphasis on direct patient care, the curriculum is designed to provide a significant number of patient encounters as well to ensure a diverse range of experiences. In the clinic, the resident is given priority with regard to number of patient encounters, urgent or emergency consultations, and complex or challenging cases. Approximately 85% of the residents’ time is spent in direct patient care, and the remaining 15% in observation, didactic, or academic activities.
Approximately 50% of the residents’ time will be spent in low vision care as part of the Hampton VAMC’s new Intermediate Low Vision Clinic. This clinic includes a full time low vision therapist as well as a fully equipped low vision examination room and comprehensive array of low vision devices. The resident will gain experience in full scope of low vision care, including the prescribing of optical, nonoptical, and electronic and computer based devices., as well as developing a team-based approach to visual rehabilitation.
The resident will also gain experience in managing patients with complex ocular disease. Established patients requiring ongoing care for chronic and/or acute ocular diseases are scheduled in the resident designated clinic, thus ensuring that the resident can establish ongoing follow care for his/her own patients. Ocular disorders managed by the resident include but are not limited to diabetic retinopathy, glaucoma, macular degeneration, uveitis, anterior segment disease, peripheral retinal disease, and neurologic disorders. The resident is also given priority for evaluating patients with acute or emergent eye conditions.
When clinically indicated, the resident orders diagnostic tests from the laboratory (serology, blood chemistry, etc.), imaging (X-rays, computed tomography, MRI, etc), nurse injection clinic (ppd and anergy panel), peripheral vascular lab (carotid doppler studies), and cardiology (echocardiograms). Within the Eye Clinic, advanced diagnostic procedures such as fluorescein angiography or ultrasound scanning are performed independently by the resident after a period of supervised training by the Program Coordinator. When necessary, consultative services outside the Eye Clinic can be obtained through Neurology, Otolaryngology, Vascular Surgery, Infectious Diseases, and other specialties and subspecialties.
The resident also provides specialty contact lens for medically indicated ocular conditions. This includes the fitting and follow-up of contact lenses for keratoconus, aphakia, high myopia, and corneal irregularities or scarring
The vast majority of patients are examined on an outpatient or ambulatory basis. However, the resident also evaluates patients undergoing long-term intermediate (domiciliary) care, short term inpatient care, and long term inpatient care (e.g. Nursing Home or Spinal Cord Injury patients) when requested by their providers. Inpatient bedside examinations on the hospital wards are also performed when indicated.
Academic and didactic activities include the following:
Optometry Grand Rounds
The resident is responsible for presenting lectures at monthly Optometry Grand Rounds. These Grand Rounds are sponsored by the Virginia Chapter of the American Academy of Optometry, for which the Program Coordinator serves as President. Grand Rounds are held at the VAMC with examination of patients from 7:00-7:45 pm, followed by lectures presented by the optometry resident, optometry extern, and/or optometry staff from 8-9:30pm. Presentations include a well-researched literature review of the topic, a 15-20 minutes discussion of the condition involved, and a handout. Optometry grand rounds are routinely attended by local practitioners in the area and have been approved for continuing education credits by the Virginia State Board of Optometry. Grand Rounds are held on the second Tuesday of each month for seven of the 12 months of the residency year.
Throughout the year, the resident is assigned journal articles to read which are reviewed and discussed with the Program Coordinator and Optometry staff.
Each Friday afternoon an academic conference is held in which case presentations and lecture topics are presented. The presentations are given by the optometry student, resident or staff.
The resident is scheduled to rotate through other clinics in the hospital, primarily Primary Care, Urgent Care, and Diabetes Instruction clinic. These rotations are scheduled in the second or third quarter of the year and are designed to give the resident experience with and exposure to Primary Care and other supportive disciplines
One of the requirements for the awarding of a residency certificate is the completion of a manuscript of publishable quality. This paper may be a case report with literature review or a research project
A. All applicants must complete the SCO application and return by January 30. Supporting documents should be submitted to the Director of Residency Programs of Southern College of Optometry no later than January 30. This program uses Optometry Residency Match (ORMatch). Applicants must complete the ORMatch application by the SCO deadline of January 30, to be considered. Applicants are responsible for ensuring that all supporting documentation is submitted to each entity involved, e.g., the College, ORMatch, and the residency site supervisor.
In order to take part in the Match you must have passed NBEO Part I, Part II (PAM) and TMOD. Those applying to a VA hospital or a state that does not require TMOD to obtain licensure are an exception if TMOD is not passed on first attempt.
B. Applicant must have earned an O.D. degree, or will have earned such a degree by the time of matriculation from a school/college of optometry accredited by the Accreditation Council on Optometric Education.
C. Applicant will furnish an official transcript from his/her school/college of optometry. An applicant should have a cumulative grade point average greater than 3.0 on a 4.0 scale in the professional optometric curriculum.
D. Applicant must pass all parts of the National Board of Examiners in Optometry examinations required for state licensure and furnish official transcripts when available. If accepted, the resident is expected to obtain a state optometry license.
E. Three letters of recommendation are required.
The College affirms that no person shall be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity at or affiliated with Southern College of Optometry on the basis of race, color, creed, religion, gender, age, disability, or national origin.
LETTER OF INTENT
All applicants selected for admission must sign a standard letter of intent.
LENGTH OF RESIDENCY
Each residency is one calendar year in length, commencing July first.
STATUS OF THE RESIDENT
A. The residents are defined as employees of the Hampton VAMC and the residency stipend is paid by the VAMC. No tuition or fees are applicable.
B. Applicant must pass all parts of the National Board of Examiners in Optometry examinations required for license and furnish official transcripts when available.
C. Professional liability protection for residents for professional activity performed at the Hampton VAMC.
D. Residents will be required to present credentials according to the Hampton VAMC policy for credentialing of residents.
F. Residents privileges will be determined by Hampton VAMC policy.
All residents are eligible for sick and annual leave.
CRITERIA FOR COMPLETION OF RESIDENCY
A. The resident is required to deliver clinical services at a level which is satisfactory to the Residency Supervisor, the Residency Committee, Director of Residency Programs, and the SCO and Hampton VAMC administrations.
B. The resident is required to keep a record of patient contacts. Cases will be reviewed periodically by the Supervisor of the Residency Program, the Director of Residency Programs, and the Residency Committee.
C. The resident is required to write a publication quality paper based on original research, literature review, or a clinical case.
D. The resident will be required to deliver an oral presentation at the annual Resident Weekend, held on the campus at SCO.
E. The resident is expected to perform in a professional manner in the delivery of patient care services and to observe those proprieties of conduct and courtesies that are consistent with the rules and regulations governing Hampton VAMC.
F. The resident is required to participate in and complete the requirements set forth in the curriculum.
G. Upon successful completion of the Residency Program, the Residency Supervisor and the Director of Residency Programs will recommend the granting of certification to the Vice President of Academic Affairs.
H. Any resident accepted for training can be dismissed, without receiving a certificate of completion, for infractions of the rules and regulations of the Hampton VAMC or those set forth by Southern College of Optometry, or for any action which jeopardizes the safety of patients, personnel, or physical facilities.
A resident rotating through a hospital based (or similar) residency program must adhere to all facility policies and procedures, including but not limited to, receiving all required immunizations or showing appropriate medical documentation that he/she is in full medical compliance with required immunizations. In addition, if a resident cannot receive a flu or similar immunization due to potential allergic reaction, medical documentation must be made available to the Program Supervisor prior to the program's start date. A resident should receive the required immunizations provided by the facility when appropriate. Otherwise, any costs incurred will be the resident's responsibility. Any grievances should be submitted in writing to SCO's Director for Residency Programs utilizing the procedures found in the Residency Handbook.
The current stipend is $32,018. Compensation is not contingent upon productivity of the resident.
Health insurance is available through the VA at decreased group rates. Part of the premium is also paid by the Department of Veterans Affairs.
Other employment (moonlighting) is permissible during the residency year provided it does NOT interfere with the primary responsibility of veteran care. Also, the VA malpractice insurance does NOT cover work performed outside the VA facility to non-veterans.
The residency program at Hampton VAMC is fully accredited by the ACOE, 243 N. Lindbergh Blvd., St. Louis, MO 63141, 314-991-4100.
CERTIFICATE OF COMPLETION
Upon satisfying all the requirements for completion of the program as determined by the Supervisor of the Residency Program and the Director of the Residency Programs, a Certificate of Completion will be awarded to the resident by Southern College of Optometry.
The resident reports to the Supervisor of the residency program. The Supervisor reports directly to the SCO Director of Residency Programs who in turn reports directly to the Vice President of Academic Affairs at Southern College of Optometry.
FOR FURTHER INFORMATION, PLEASE CONTACT:
Cheryl E. Ervin, O.D.
Director of Residencies
Southern College of Optometry
1245 Madison Avenue
Memphis, TN 38104