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Residency in Ocular Disease, with Emphasis in Primary Care Optometry
Ralph H. Johnson VA Medical Center
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 full primary care optometry, including therapeutic management of ocular disease, contact lenses for medically necessary needs, and low vision/rehabilitative eye care, 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.
Objective 1: Provide the resident with adequate experience and training in the management of complex ocular conditions.
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 (CPRS) and the patient care log (maintained by the resident), 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-10 diagnoses relating to the eye).
Objective 2: Ensure the resident gains adequate experience with advanced diagnostic ocular procedures.
Outcome: The resident will perform and/or interpret advanced diagnostic procedures (including gonioscopy, pachymetry, scleral indentation, optical coherence tomography, visual fields, B-scan ultrasonography, and posterior segment photography) when clinically indicated.
Measure: Using data collected from the Encounter Forms (CPRS) and the patient care log, the resident will report quarterly on the number of advanced diagnostic procedures performed (including gonioscopy, pachymetry, scleral indentation, optical coherence tomography, visual fields, B-scan ultrasonography, and posterior segment photography).
Objective 3: Ensure that the resident gains experience in ordering non-ophthalmic diagnostic tests and procedures necessary for the evaluation of complex ocular disease. Such tests may include, but are not limited to: neurological imaging, serum laboratory testing, and carotid studies.
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 residents 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 prism.
Outcome: The resident will perform binocular vision evaluations on patients with diplopia who require the use of ophthalmic prisms.
Measure: Using data collected from the Encounter Forms, the resident will report quarterly on the number and type of ophthalmic prism evaluations performed.
Objective 5: Provide the resident with experience in the triage and management of urgent ocular conditions
Outcome: At the beginning of the residency, the program supervisor will work with the resident closely to manage the triage of all phone-in emergency calls during clinic hours with a slow transition to solely the resident. All patients that need a clinical eye exam will be initially worked up in the optometry clinic, with some who will need to be expedited to ophthalmology. All patients within a global period after surgery will go straight to the ophthalmology clinic.
Measure: To document the number of urgent ocular conditions seen by the Resident, the Resident will be instructed to use the “After Hours/Emergency Exam” patient category is chosen and documented properly.
Objective 6: Provide the resident with experience in the fitting and management of ocular diseases with medically necessary contact lenses.
Outcome: The resident will perform a minimum of 75 new and/or follow up contact lens 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 contact lens fits performed.
Objective 1: Ensure the resident performs a minimum number of low vision/rehabilitative eye care evaluations
Outcome: The resident will perform a minimum of 75 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, including telehealth low vision, cerebral vascular stroke/TBI patients.
Outcome: The resident will examine 10 patients with a variety of levels of visual impairments, representative of the visually impaired population at the Ralph H. Johnson 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-10 diagnostic codes.
Objective 3: Ensure the resident gains experience in the prescribing of the full scope of devices to maximize vision.
Outcome: The resident will prescribe the full range of non-optical, 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.
Objective 1: Ensure that the resident gains experience and training in functioning as a clinical attending optometrist.
Outcome: The resident will experience consultative/attending training by discussion and provide co-attending services for the optometry externs that are doing rotations at RHJVAMC.
Measure: Using data collected from the patient care log, the resident will report quarterly on the number and types of consultation/attending services made for optometry externs.
Objective 2: Provide the resident with opportunities to train optometry student externs in clinical procedures in preparation for their board examinations.
Outcome: The resident will be available for clinical procedural training for each optometry student extern during their 3-4 month clinical rotation at RHJVAMC.
Measure: The resident clinical schedule will be arranged to provide ample time to provide attending optometry services and clinical procedural training to the optometry student externs.
Objective 1: Develop the resident's ability to effectively share knowledge and disseminate information
Outcome: The resident will have opportunities to help prepare and present lecture/journal club/workshops.
Measure: Documentation in patient care log, as well as Power Point presentations, and handouts for lectures presented.
Objective 2: Develop the resident’s instructional and clinical teaching skills.
Outcome: The resident will participate in weekly grand rounds, consisting of lecture or journal club format, and in the clinical supervision and training of optometric externs.
Measure: A record will be kept of the topics covered during case review or journal club and the resident will report quarterly on the number of patients where extern supervision or assistance was provided.
Objective 1: Develop the resident’s ability to critically evaluate clinical research from the ophthalmic literature.
Outcome: The resident will research articles that are relevant to patient cases, and preparation for posters, lectures, and journal club. The Program Supervisor and/or staff is available for discussion when necessary.
Measure: Each month, an article from a current peer-reviewed journal will be chosen by the resident. A log of these articles will be maintained by the resident.
Objective 2: Guide and educate the resident as to the process of preparation of a manuscript of publishable quality.
Outcome: The resident must prepare a manuscript/case report of publishable quality.
Measure: The manuscript/case report is due by the end of the residency period. Completion of residency certificate will not be given until this is turned in.
The residency program has a strong clinical emphasis, with a diverse patient base and clinical experiences. The resident examines and evaluates low vision patients, which includes working directly with a full time vision rehabilitation. The resident also manages patients with ongoing and chronic ocular diseases as well as evaluating contact lenses for medically indicated conditions such as keratoconus, anisometropia and aphakia. Academic and didactic opportunities include an optional daily “Huddle” (an informal meeting with the Program Supervisor), weekly Grand Rounds/Journal Club session at the VAMC, and optional weekly ophthalmology Grand Rounds at MUSC.
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 80% of the resident’s time is spent in direct patient care (75% general clinic, 15% low vision/contact lens), and the remaining 10% in surgical or clinical observation, didactic lectures, research, clinical and/or didactic teaching, and administrative activities.
Approximately 15% of the resident’s clinical time will be spent in low vision care as part of the Ralph H. Johnson's VAMCs Low Vision Clinic. This clinic includes at least one full time low vision specialist 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, non-optical, and electronic and computer based devices as well as developing a team-based approach to visual rehabilitation. Low Vision clinical experiences will be at the VAMC and possibly at MUSC Feldberg Vision Rehabilitation clinic, which would allow for informative comparisons between the VA’s low vision program and Medicare’s low vision program. Full time rehabilitation specialists work at both clinical sites, and are available for individual patient vision rehabilitation therapy planning.
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-up 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 and with the assistance of the attending optometrist, the resident orders diagnostic tests from the laboratory (serology, blood chemistry, etc.), imaging (X-rays, computed tomography, MRI, etc), peripheral vascular lab (carotid Doppler studies), and cardiology (echocardiograms). Within the Eye Clinic, advanced diagnostic procedures such as B-Scan ultrasonography, and ocular coherence tomography, can be performed independently by the resident after a period of training. 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 will participate in specialty contact lens fitting for medically indicated ocular conditions. This includes the fitting and follow-up of contact lenses for keratoconus, aphakia, and corneal irregularities or scarring.
The vast majority of patients are examined on an outpatient or ambulatory basis. However, the resident may be called upon to evaluate 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 possible when indicated.
The resident is eligible to attend the case report talks at the Ophthalmology Resident Grand Rounds at MUSC. Presentations include a well-researched literature review of the topic, a 15-20 minutes discussion of the condition involved, and frequently a handout. Ophthalmology grand rounds are routinely attended by local practitioners in the area. Grand Rounds are held Thursday early evening.
Optometry Grand Rounds are on Tuesday and Wednesday mornings from 7am – 8am. Every other Tuesday, a retinal specialist from MUSC lectures. The goal is to keep a rotation of guest lecturers, as they are available. Most come from the RHJ VAMC ophthalmology clinic. National board review, Journal Club, case presentations and wet labs have been typical. These are presented by the resident, the staff optometrists, or one of the student externs. The audience includes staff optometrists, student externs and other invited guests.
At the beginning of most work days, the Program Supervisor is available to meet with the Resident. Residency administrative reviews, review of an interesting case, ocular review topics, and future employment are common topics of discussion. With the busy resident schedule, it is optimal for the resident to communicate their desire to meet.
The resident has the opportunity to rotate through ophthalmology sub-specialty clinics at MUSC, Storm Eye Institute, or surrounding specialty clinics, depending on the interests of the resident. These rotations are scheduled throughout the year and are designed to give the resident experience with and exposure to secondary eye care specialties and other supportive disciplines.
The resident has the opportunity to rotate through ophthalmology sub-specialty clinics at MUSC, Storm Eye Institute, depending on the interests of the resident. 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 secondary eye care specialties and other supportive disciplines.
The resident has the opportunity to observe other VA sub-specialties throughout the year. As various specialty clinicians agree to allow this observation, they will be added to the options for each resident to consider. Clinics that may be of interest include: neurology, audiology, radiology, and dermatology, as well as others.
The Resident will be provided access to various medical literature and encouraged to use this access for conference poster preparation, Grand Rounds lectures, and for the residency manuscript. The depth of the “research study course” is optional in that it is up to the resident to decide how detailed the “research” will be. This is another topic that can be discussed during the optional Daily “Huddle”.
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. The Program Supervisor will assist the resident plan for the conduct of any research or case report project.
The educational objectives of the curriculum are intended to ensure attainment of the mission, goals, and objectives of the program. Consequently, each educational objective reflects a specific program goal. Specifically:
Objective: Provide the resident with experience in Primary Care Optometry including the role of ocular diagnostic and therapeutic drugs in the diagnosis and management of complex ocular conditions.
Learning Activity: The resident will provide primary eye care services involving a minimum of 1500 patient encounters, 60% of which will include obtaining a case history, visual acuity, refraction, tonometry, and external and internal ocular health assessment during the encounter.
Outcome: The resident will develop enhanced skills in the management of primary eye care patients.
Objective: Provide the resident with experience in Low Vision / Vision Rehabilitation Optometry to strengthen clinical competence in delivering Vision Rehabilitative eye care
Learning Activity: The resident will provide services to a significant number of patients with low vision (75 patients) and will formulate a diagnosis based on the results of the procedures performed.
Outcome: The resident will become highly proficient in the performance and interpretation of basic and advanced ocular examination techniques on patients with visual impairments, and will attain advanced skills in the management of these patients.
Objective: Provide the Resident with clinical teaching experiences and training to enable them to become Attending Optometrists in outpatient clinical or hospital-based primary eye-care settings
Learning Activity: The resident will learn to interpret B-scan ultrasonography, ocular coherence tomography, posterior segment photography, relevant laboratory testing and radiological imaging. The resident will teach optometry externs the clinical significance of the specialty testing as they gain expertise in each area.
Outcome: The resident will develop advanced knowledge of specialized diagnostic procedures and instrumentation.
Objective: Provide the resident with didactic teaching experiences and training to enable them to become Academic Optometrists or to pursue academic sub-specialty lectureships
Learning Activity: The resident will prepare and present didactic style lectures (Power Point computer presentations) for optometry externs.
Outcome: The resident will be able to communicate effectively with optometry students and ophthalmology residents in providing specialty eye care in the field of low vision and contact lenses. The resident will also prepare case reports and or journal article reviews for the optometry externs that rotate through the RHJVAMC. The resident will be providing small group discussions, small group didactic presentations, journal article review and discussion – in short, all those types of teaching activities that produces an experienced educator.
Objective: Provide the resident with research experiences and training to enable them to not only appreciate the significance of research in clinical practice, but to engage in, and conduct worthwhile clinical research and other scholarly activity.
Learning Activity: The resident will have several options to decide about before committing to one particular project. Initially, the Program Supervisor will conduct one-on-one discussions covering the following options: a case report format of an interesting case or cases encountered during clinic; a literature review of a topic the resident is deeply interested in; a clinical research project conducted with the Program Supervisor.
Outcome: The resident will produce a publishable quality manuscript designed as a case report, literature review, or clinical research project. It should be of publishable quality and highly encouraged to submit to a journal for review and publication. A case report, the same or different than the manuscript, is mandatory to be presented as a verbal presentation at the SCO Resident’s Day.
A. All applicants must complete the SCO application. All applicants must complete the Optometry Residency Match (ORMatch), and provide all required supporting documentation by the deadline to be considered for an SCO program. (PLEASE NOTE: This specific program has a January 1st deadline)
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 a transcript to ORMatch from his/her school/college of optometry. An applicant should have a cumulative grade point average of 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. If accepted, the resident is expected to obtain the appropriate state license.
E. A personal interview will be required.
F. 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.
All applicants selected for admission must sign a standard letter of intent.
Each residency is one calendar year in length, commencing July 1.
The resident is eligible for thirteen days annual leave. Hours of leave accumulate along the year.
A. The resident is defined as an employee of the Ralph H. Johnson VAMC and the residency stipend is paid by the VAMC. No tuition or fees are applicable.
B. The resident should apply for optometric license in at least one of the fifty states prior to the beginning of the residency. Past residents have found that South Carolina is an obtainable license that would allow for moonlighting opportunities throughout the year.
C. Professional liability protection for residents for work done at the Ralph H. Johnson VAMC is provided under the Federal Tort claims act.
D. Health insurance benefits are available through RHJ VAMC Federal Health Insurance Benefits Program. Leave benefits include 13 days annual leave and 13 days sick leave at a rate of 4 hours per pay period. Additional educational leave, or authorized absence, is typically allowed. Many factors are weighed before granting such leave, but history has shown that this has been generous with prior approval of the residency site program director in conjunction with the DRP and the Chief of the Optometry Service.
E. Residents will have access to the Internet for research purposes through the VAMC and the Southern College of Optometry.
A. The resident is required to deliver clinical services at a level that is satisfactory to the Residency Program Supervisor, Director of Residency Programs, and the SCO and Ralph H. Johnson VAMC administrations. Normal clinic hours are from 7:00 A.M. until 5:30 P.M., Monday through Thursday (four ten hour work days). The resident is expected to be present during all working hours, except attending conferences and doing study or research. The resident will carry a pager while in the clinic in order to address urgent eye problems. However, optometry residents are not required to answer calls during off-duty hours.
B. The resident is required to keep a record of patient contacts. Cases will be reviewed periodically by the Program Supervisor of the Residency Program and the Director of Residency Programs.
C. The resident is required to write a publication quality paper based on original research, literature review, or a clinical case. The resident will be encouraged to submit this paper to an approved journal.
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 Ralph H. Johnson 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 Program 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 Ralph H. Johnson 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.
A residency stipend will be provided for the year of training paid by Ralph H. Johnson VAMC. The stipend is $34,888. Compensation is not contingent upon productivity of the resident.
Other employment (moonlighting) during the residency year is allowed by the Ralph H. Johnson VAMC optometry program provided that the resident does not let outside employment interfere with ANY residency activities and that such employment does not take place during normal working hours. Residents who choose to moonlight will not be allowed to leave their post at the Ralph H. Johnson VAMC during normal office hours or before patient care duties are finished. Using sick leave or annual leave to work in the private sector is prohibited.
The residency program at the Ralph H. Johnson VAMC is is fully accredited by the ACOE, 243 N. Lindbergh Blvd., St. Louis, MO 63141, 314-991-4100.
Upon satisfying all the requirements for completion of the program as determined by the Program 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 Program Supervisor of the residency program. The Program Supervisor reports directly to the SCO Director of Residency Programs who in turn reports directly to the Vice President for Academic Affairs at Southern College of Optometry.
Cheryl E. Mengelt, O.D.
Director, Residency Programs
Southern College of Optometry
1245 Madison Avenue
Memphis, TN 38104
email: [email protected]