Download Wills peds optho fellowship handbook

PEDIATRIC OPHTHALMOLOGY AND STRABISMUS FELLOWSHIP
2014-2015
WILLS EYE HOSPITAL
DIRECTOR
Alex V. Levin, M.D., MHSc, FRCSC
2 Acknowledgment: Many thanks to all members of the Pediatric Ophthalmology and Ocular Genetics service at Wills who assisted in reviewing and editing this Handbook. Note: The details of the fellowship program described herein may change during your training due to unexpected circumstances. 3 Table of Contents I. Introduction .......................................................................................................................................... 5 II. Clinical Responsibilities........................................................................................................................ 6 A. Personnel......................................................................................................................................... 6 B. Wills Clinic Sessions ......................................................................................................................... 9 C. Retinopathy of Prematurity .......................................................................................................... 13 D. Post-­‐operative follow-­‐up.............................................................................................................. 13 E. Fellow’s clinic ................................................................................................................................ 13 F. Other clinical activities................................................................................................................... 13 1. Overbrook School for the Blind................................................................................................. 14 2. Electrophysiology and Diagnostic Unit ...................................................................................... 14 4. Other Wills Subspecialty Clinics ................................................................................................ 14 5. Clinic for Special Children ......................................................................................................... 14 6. Wills on Wheels ........................................................................................................................ 14 7. Give Kids Sight Day.................................................................................................................... 15 8. Third World Rotation ................................................................................................................. 15 9. Eagles Clinic……………………………………………………………………………………………………………………………15 10. Emergency Room Coverage…………………………………………………………………………………………………..15 III. Surgery………………………………………………………………………………………………………………………………………….16 A. Wills Eye..................................................................................................................................... 16 1. Strabismus ................................................................................................................................ 16 2. Oculoplastics ............................................................................................................................. 16 3. Cataracts and Glaucoma ........................................................................................................... 17 4. Retinoblastoma......................................................................................................................... 17 5. Other subspecialty pediatric surgery ........................................................................................ 17 B. Additional Strabismus Surgery...................................................................................................... 17 C. Adult Strabismus:.......................................................................................................................... 18 D. Jefferson Hospital for Neurosciences (JHN) .................................................................................. 18 E. On Call Surgery.............................................................................................................................. 18 F. Consents for Surgery..................................................................................................................... 19 G. Miscellaneous............................................................................................................................... 19 4 IV. Inpatient Consults............................................................................................................................. 20 A. Outpatient Consults...................................................................................................................... 21 V. Research ............................................................................................................................................ 22 VI. Administration.................................................................................................................................. 23 A. Schedules...................................................................................................................................... 23 B. Call Schedule................................................................................................................................. 24 C. AAPOS/AUPO Data........................................................................................................................ 24 E. Administrative/computer/library support..................................................................................... 25 F. Charting and Prescriptions ............................................................................................................ 27 G. Vacation........................................................................................................................................ 28 H. Evaluation..................................................................................................................................... 29 I. Fellows Breakfast ........................................................................................................................... 30 J. Dress Codes ................................................................................................................................... 30 K. Malpractice Coverage ................................................................................................................... 30 L. Expenses/Benefits ......................................................................................................................... 30 M. Miscellaneous.............................................................................................................................. 30 VII. Educational Activities ...................................................................................................................... 31 VIII. Appendices ..................................................................................................................................... 34 5 I. Introduction Congratulations and welcome to the Wills Eye Hospital Fellowship Program in Pediatric Ophthalmology and Strabismus. During your year in Philadelphia we hope you will have fun, learn a lot, and interact with the many facets of the wonderful world of pediatric ophthalmology and strabismus. This Handbook will offer you an introduction to the year, while outlining your roles and responsibilities. Should you have any questions or concerns, please direct them to the Fellowship Director, Dr. Levin, who will be your main liaison. The Fellowship Secretary is also the Departmental Secretary (Karen Scannapieco at [email protected] or 215-­‐928-­‐3914). She assists the Fellowship Director in all aspects of the application process and administration of the fellowship. Please do not hesitate to contact the Fellowship Director at any time (24/7/365) either in person, by phone (home, cell, pager or office), or by email to address any questions or personal concerns you may have. During the fellowship, your daily activities will revolve around four different "streams" of work: clinics, surgery, research, and other learning opportunities. A sample schedule can be found in the Appendix. A flexible attitude should be maintained in terms of time allocation to accommodate unforeseen changes and maximize your learning opportunities. You are immediately eligible and encouraged to apply as soon as possible to the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) for membership-­‐in-­‐training (Candidate-­‐in-­‐Training) status, via the AAPOS website (http://www.aapos.org/). AAPOS does not accredit fellowship training. There are four requirements for a fellowship position to be listed as “approved” by AAPOS. (Note: the administration of this approval process is provided by the Association of University Professors of Ophthalmology [AUPO] on behalf of AAPOS, but uses the criteria developed by AAPOS) 1. Candidates attain the position through the Match 2. Fulfillment of the AAPOS/AUPO educational and staffing requirements 3. Stipend provided to fellows 4. Training institution located in North America Full membership in AAPOS for fellowship graduates requires 1. Graduation from an AAPOS/AUPO “approved” fellowship position 6 2. Graduation from a North American ophthalmology residency program The fellowship position at Wills is designated by AAPOS/AUPO as “approved.” Wills Eye Hospital will provide you with an annual salary in the range of approximately $30-­‐35,000.00 with benefits. Fellows may supplement their salary from external sources that do not interfere with the requirements of the fellowship (one option is to “moonlight” in the Wills Emergency Room). Benefit packages are available from the hospital. If you have any problems with receiving your pay correctly via the hospital, please contact Karen Scannapieco. Applications for the fellowship are considered on merit. Whether or not a candidate has his/her own funding is a secondary consideration. II. Clinical Responsibilities A. Personnel Our attending pediatric ophthalmologists are listed with their main activities at Wills/DuPont/Cooper for which you will be interacting with them, are: Dr. Alex Levin (Chief) Glaucoma/Cataract/Uveitis/Anterior Segment/General/Ocular Genetics Dr. Leonard Nelson (Co-­‐Director and Director Wills Eye Strabismus Center) Strabismus/General Dr. Donelson Manley(Co-­‐Director) Strabismus (non surgical)/General/Emergency Room Dr. Kammi Gunton (Director Resident Education, Coordinator Adult Strabismus) Strabismus/General Dr. Cynthia Alley Strabismus/General Dr. Cara DeBenedictis Pediatric cataract/strabismus/general 7 Dr. Mark Engel Strabismus/General Dr. Dorothy Hendricks (DuPont Nemours) ROP/ Strabismus/General Dr. Jin Jing (DuPont Nemours) ROP/ Strabismus/General (DuPont Nemours) Dr. Judy Lavrich Strabismus/General Dr. Sharon Lehman (Chief, DuPont Nemours) ROP/ Strabismus/General Dr. Harold Koller Strabismus (non surgical)/General Dr. Sepideh Rousta Strabismus/General Dr. Jonathan Salvin (DuPont Nemours) ROP/ Strabismus/General Dr. Bruce Schnall Strabismus/General Dr. Barry Wasserman Strabismus/General/Refractive Surgery/ROP at Cooper
Dr. Scott Goldstein from the Wills Oculoplastic Department, conducts and advanced pediatric oculoplastic clinic once monthly with the fellow. Dr. Adele Schneider, Chief of Clinical Genetics at Albert Einstein Medical Center in Philadelphia, is also on staff at Wills and conducts a joint clinic with Dr. Levin once every 2-­‐4 months. 8 Note: Wills is the Ophthalmology Department of Jefferson Medical College of Thomas Jefferson University. DuPont Nemours in Delaware is the Pediatrics Department of the Sidney Kimmel Medical College of Thomas Jefferson University. DuPont has their own pediatric ophthalmology service (Drs. Lehman, Hendricks, Jin and Salvin). Our fellow does not participate in the DuPont activities. The Clinic Administrator for Wills Eye Ophthalmology Clinics (WEOC, includes all subspecialty clinics at Wills including the Cataract and Primary Eye Care Service [CPEC]) is Sara Rapuano. The Clinic Administrator assists the Fellowship Director in ensuring our equipment is in up-­‐to-­‐date and functioning order, maintaining the business aspects of the service, and other duties related to the administration of the clinic. Our Surgical Coordinator, Colleen Davis works with our other clinic personnel (Donna Shaner, Venus Russell and Marie Michel ) to book appointments for and register all patients seen through the clinics. Colleen has an office in the clinic. The others are located at the clinic desk. The front desk staff should be notified if a patient is coming into the clinic who does not have a pre-­‐booked appointment (i.e., inpatient, patient from Emergency Department, add on). The Surgical Coordinator books all clinic surgical cases both at Wills and Jefferson Hospital for Neurosciences (JHN). She also handles the printing and distribution all surgical dictations, aphakic contact lens inventory and booking of neuroimaging studies. Drs. Gunton and Nelson have office staff which attend their private session days at Wills. The DuPont staff ophthalmologists are accompanied by their staff/technicians when they come to Wills. Jenina Capasso is our full time genetic counselor. George Holliday runs our Wills Eye Center for the Visually Impaired . George is a past President of the Pennsylvania Council for the Blind. He assists families and adult patients coping with low vision issues. Rizwan Alvi is our departmental Research Assistant. He will be available to assist the fellow with his/her projects. There may also be a Research Fellow , medical students, or other research personnel. Brian Burke is the hospital’s grants administrator for research funding. Ann Larsen is the coordinator for the Institutional Review Board. Melanie Snitzer MSW , LSW, is the Social Worker for our department. She is responsible for the management of the Children’s Eye Care Adherence Program (CECAP). She works with our health care team at Wills, the Eagles Youth Partnership (EYP), Deerbrook vision screening program (Deerbrook), Wills on Wheels (WOW), and Philadelphia public school nurses to ensure that children who are identified as needing ophthalmic follow-­‐up care post-­‐exams/screenings following Give Kids Sight Day (GKSD), Deerbrook screenings, and/or from our Eagles Clinics, get the care they need. She conducts phone interviews, schedules appointments, provides case management, and identifies barriers that may prevent these children from seeking proper vision treatment. She is also available to assist with other challenging cases that require social work intervention. She is located on the 12th floor, next to the Wills Eye Center for the Visually Impaired in the hall way leading to CPEC. 9 B. Wills Clinic Sessions The Pediatric Ophthalmology and Ocular Genetics service conducts clinics almost every half day of each week (excluding holidays) except for Friday afternoons and every other Friday morning. Residents are present at each clinic. Twice monthly you will have your own supervised follow-­‐up clinic. The first Saturday of each month you will be seeing patients in Lancaster with Dr. Nelson. From October through June, every other Tuesday morning is our Eagles Clinic where Dr. Levin sees children referred from the Eagles Eye Mobile that visits schools to see children who have failed their school nurse vision screen. The fellow schedule will be conducted in alternating two month blocks: 1. Strabismus/general ophthalmology/ROP/pediatric oculoplastics 2. Anterior segment/genetics/retinoblastoma During the strabismus block the fellow will not attend clinics or surgery with Dr. Levin unless there are no activities related to the areas within that block. During the anterior segment/genetics block, the fellow will attend all clinics and surgery with Dr. Levin as first priority and only attend other activities when Dr. Levin does not have clinics or surgery. The fellow has junior attending status that allows them to bill. All income generated by the fellow is payable to WEOC and collected to help support the fellow’s salary. All patients seen should have a billing sheet (Superbill) completed including patients seen at night, on weekends, and on holidays provided that the patient is seen by the fellow or one of our attendings. All of the staff ophthalmologists, except Dr. Levin and the ophthalmologists who work at DuPont Nemours Children's Hospital, have private practice offices in the community. Dr. Manley staffs the Wills Emergency Room (the only 24/7/365 dedicated eye emergency room in the country, located in the Jefferson Hospital for Neurosciences across the stree.t Your daytime clinic patient duties will be confined to Wills with exception of Cooper ROP and the one Saturday per month with Dr.Nelson in Lancaster. Although fellows may observe the private practices of Drs. Nelson, Gunton and Koller at Wills if time permits, they may not perform examinations on private patients at either Wills or the community offices of any of our staff ophthalmologists. Every attempt should be made to have all patients registered. During the usual work hours this is accomplished at the clinic registration desk. If patients are being seen before the clinic personnel arrive (usually by 7:30 am), they can be asked to wait until someone is available to register them after their clinical examination is completed. For patients being seen for urgent care after hours please make a photocopy of their insurance card and attach it to a Superbill. When possible and you know that an off hours patients is coming in, t is preferred that you see the patient in the clinic at Wills rather than directing them to the ER. If you are asked to see an ER patient, the patient can only be transferred to our clinic if they are actually discharged from the ER. Otherwise, 10 you must see the patient in the ER (assuming it is emergent) in which case, please get a copy of the insurance information from the chart and give that to the clinic staff on the next work day. If arrangements are made in advance (e.g. post-­‐ops) for a patient to be seen electively on the weekend, evening or holiday, please let the clinic know and they will prepare the chart in the electronic medical record (EMR) for you in advance. It is important that the residents and fellow assigned to the clinic for a given half day remain until all patients are seen. If the resident sees that the clinic may not finish on time, they can call for assistance of another resident. If the clinic finishes early, and there is a simultaneous private office session ongoing, you have the option to observe in that private clinic. Fellows may not observe in private clinics if there is an active ongoing clinic that has not finished. If the fellow has no other clinical responsibility at any time and wishes to join in any clinic or private office session, they may do so with the advance permission of the staff doctor. If a morning clinic runs overtime and the fellow in that clinic is assigned elsewhere for the afternoon (which we consider to start at 1:30), please anticipate this and discuss with the clinic staff ophthalmologist to plan where you should be if the clinic runs over 1:30pm. Fortunately, this rarely occurs. There may be times when your duties elsewhere (surgery, other clinical activities) make you unavailable to the clinic. The clinic will hopefully be down scheduled accordingly. Please try to confirm the following month’s schedule with regard to your clinical activities with the front desk staff no later than the 15th of the preceding month. Research and didactic activities should not take priority over clinic except in exceptional circumstances. The Fellowship Director is available to help sort out coverage as needed. The following clinics run in parallel: Pediatric Oculoplastics Clinic, staffed by Dr. Scott Goldstein, occurs on the first Monday morning of each month as well as Dr. Cynthia Alley’s clinic. Your primary responsibility is to DR. Goldstein’s clinics and the residents cover DR. Alley’s clinic. We encourage you to pull in residents to see interesting cases, but also to help out in Dr. Alley’s clinic if Dr. Goldstein’s clinic is slow or finished early. Ocular Genetics Clinic, staffed by Dr. Levin, occurs every Thursday morning and throughout the afternoon, often during another doctor’s clinic. When in the strabismus block, the fellow’s primary responsibility is to the afternoon non-­‐genetics clinic but may go back and forth between the two clinics provided that non genetics clinic patients are being seen in a timely fashion. When in the genetics block, the fellow should remain in Dr. Levin’s clinic. There is also a Wills Ocular Genetics Fellows. This is a non-­‐
surgical position (with the exception of examinations under anesthesia). The Wills Ocular Genetics Fellow will attend the Ocular Genetics clinics. The patient load will be booked to support the education of all fellows in that clinic. We look forward to all fellows working harmoniously together when they overlap in the clinics. 11 Miscellaneous: When you are in the clinic you may use any lane at any time. When the DuPont clinic is ongoing, they are assigned to Lanes 2 and 3. When Dr. Nelson has private office hours he uses Lane 4. Drs. Manley, Koller, and Gunton prefer to use Lane 1 when they are in clinic or office hours. As we finish renovating our clinic over the next year, there may be changes in lane assignments. Flexibility is encouraged. Fellows desiring more or less exposure to specific subspecialties should discuss this with the Fellowship Director before changing the distribution. During clinics, the fellow and residents see patients by taking a chart from the front of the rack of waiting patient charts. Although no sorting through the waiting patients is allowed (for fear of upsetting families when they see someone taken out of turn), you may see patients that you are following from that clinic who you would specifically like to see yourself. In those cases, ask the parent/guardian to give your name when they register and your name will be placed on that patient’s chart to be seen by you when their turn arrives to be seen. Each staff member will have his/her own way of running his/her clinic. Morning clinics begin at 0830 and afternoon clinics at 130. We suggest that you speak with each staff member or the front desk staff when you first attend a specific clinic to get a feel for the staff doctor’s preferences. In general, we require our staff doctors to see all patients at some time during the visit with the trainees, in keeping with our educational mission. Patients cannot be billed for a visit by the attending unless they are seen by the attending in person. Visits can be billed under your name if you are credentialed with the patient’s insurance, but usually this takes many months. Until that time, patients you see must also be signed off in the EMR by an attending in order to bill. Residents and fellows should not order tests or arrange consultations or procedures, including imaging, without staff ophthalmologist approval, except for their own clinic patients after that time at which they are able to bill independently. Even after the fellow is approved to bill independently, when working in an attending’s clinic, all billing should be done by the attending of record and decisions regarding testing or surgery must be approved by the attending. Because clinic patient loads are pre-­‐booked long in advance, and there may be variations in resident activity, fellows may be asked to "help out" occasionally in a clinic for which he/she may not have been originally scheduled. Rather than cancel a clinic when the resident(s) are on holiday, you may be asked to do the clinic alone with the attending or if the attending is away to staff the clinic for the residents. IN the latter case, if you are not approved yet for billing, the cost of care for these patients is waived. Usually, the fellow is reallocated from a research time slot (see below) or other activity. We will avoid pulling you from surgery whenever possible. All efforts are made to avoid pulling fellows away from other activities. 12 The Ocular Genetic Counselor, Jenina Capasso, helps families understand their genetic diagnosis, the pros and cons of genetic testing and presymptomatic testing and other issues that may be present for other family members. The Genetic Counselor reviews the information in the consent forms for gene testing with our ocular genetics patients. She co-­‐ordinates DNA samples to be sent or banked. Her services are usually accessed through referral of the patient to the Ocular Genetics clinic but should issues arise in a non-­‐genetics clinic, and she is available to assist, please feel free to call upon her (with approval of the staff ophthalmologist running the clinic) to provide services. You will have the opportunity to join Jenina for some genetic counseling sessions and her pre-­‐clinic calls to create pedigrees. Although the Eye Clinic lanes are fully stocked with modern equipment, fellows are required to bring their own indirect ophthalmoscope lenses and slit lamp fundus lenses, in particular one 20 diopter, one 28 diopter and a minimum of one non-­‐contact slit lamp fundus lens (any magnification). If there are financial obstacles to this requirement, please consult with the Fellowship Director. Fellows are expected to maintain the lanes they use and keep them clean and organized and close them up at the end of the session (i.e. bottle caps on, equipment stored away). Dr. Levin should be informed of any malfunctioning equipment. Inpatient activity is usually located on the pediatric floor (11th floor Pavillion, see Appendix) of Thomas Jefferson University Hospital. Pediatric patients cannot be admitted to JHN or Wills. This is most easily accessed via the entrance at 10th and Sansom streets. When a patient needs to be admitted to the hospital, please contact the floor (215-­‐955-­‐6511) and speak both to the charge nurse and the pediatrics resident. The ophthalmology attending should make direct phone contact with the admitting pediatrics attending. Admission should always occur after obtaining approval of the staff ophthalmologist. Not all of our attendings have admission privileges. Most often, the patient is admitted to the pediatrics service with ophthalmology as a consult but we can also occasionally admit patients under ophthalmology. In the former scenario, the pediatric residents are responsible for admission and discharge with our collaboration and support. If a patient is admitted to the ophthalmology service, consultation with the pediatric service is recommended particularly if the child has medical issues or requires intravenous treatment. All inpatients must have a “Responsible Attending Ophthalmologist” other than the fellow. This should be clearly indicated on the patient chart. The fellow does not have admitting or consulting privileges but the patient may be admitted to the Pediatric service Inpatients may come to Wills for follow-­‐up needs but bedside examination on the Jefferson floor is preferred. If the service can only be provided at Wills (e.g. ultrasound) then the patient must travel by the JeffStat ambulance. The pediatrics floor will make those arrangements. A patient may be discharged from Jefferson and walk to Wills for an appointment (e.g. 1st post-­‐operative day) if they are well enough to do so but this only if they are not returning to their inpatient bed. The resident or fellow, unless otherwise instructed by the attending, are responsible for dictating letters to referring physicians/optometrists on all new patients they see in the clinics. 13 C. Retinopathy of Prematurity The fellow will attend the Cooper NICU with Dr. Wasserman every 2nd and 4th Thursday morning both for screening and treatment. During the anterior segment/genetics block, the fellow would still attend these sessions even though it means being late for the genetic clinic. If other duties are met and Dr. Lehman’s ROP follow-­‐up clinic on the 1st Wednesday afternoon of each month does not conflict with other duties, the fellow may attend. D. Post-­operative follow-­up The fellow is welcomed and encouraged to follow patients after surgery. Please make arrangements, after approval from the attending ophthalmologist, to see post-­‐operative patients at a time that is mutually convenient to the attending (if they want to see the patient with you), the patient and you. Please do not arrange to see post-­‐operative patients for one attending ophthalmologist during another attending ophthalmologist’s clinic or surgery time. Rather, make arrangements to see the patient either before or after clinics or during the responsible ophthalmologist’s clinic where possible. E. Fellow’s clinic You will have your own clinic (under supervision) twice monthly (usually the first Friday PM and the 3rd Monday PM). At the time of this writing we are evaluating in which month this will start and the process for billing and supervision. More details will follow. The purpose of this clinic is to give the fellow a greater longitudinal experience in caring for surgical and non surgical patients while also using different booking patterns as if this was your "own practice". These may be interesting patients drawn from the clinics, follow-­‐up visits for former inpatients that were seen as consults or in the emergency room, or post-­‐operative follow-­‐up visits. Please be sure to first get clearance from the responsible attending ophthalmologist for that patient to be followed by you and make arrangements to allow for on-­‐going supervision of your care either by phone or in person with that physician. We will also book some “routine” new patients for you. F. Other clinical activities 14 The fellow is required to participate in the following activities. Please ensure that you have no competing clinical duties during these activities. Usually the fellow goes to these activities instead of a research block. 1. Overbrook School for the Blind The fellow will attend at least two sessions. The Fellowship Secretary will assist in arranging dates. Please do not cancel a scheduled visit except for emergency. The first visit will include a tour of the facility. The other day will be spent in the low vision clinic at the school. 2. Electrophysiology and Diagnostic Unit Under the direction of Libba Affel, the Wills Diagnostic Center performs a wide range of services including VEP, 3-­‐lead VEP, ERG, multifocal ERG, EOG, dark adaptation, contrast sensitivity, color vision testing ultrasound (A, B, and UBM), OCT (including hand held and anterior segment), photography, keratometry and more. The fellow has an open invitation to attend imaging or electrodiagnostic sessions. The fellow should observe at a minimum during the fellowship: 2 ERGs (plus one under general anesthesia), mfERG, VEP, and 3-­‐lead VEP. Exposure to all other testing will occur naturally without scheduling during your fellowship. 3. Other Wills Subspecialty Clinics Wills is an enormously active facility and pediatric patients are being seen on multiple services on any given day (except glaucoma and CPEC for whom all pediatric patients are seen in the pediatric ophthalmology clinic). The fellow is welcome to see specific patients when they attend these other clinics (cornea, neurophthalmology, retina, oculoplastics) provided it does not conflict with other duties. 4. Clinic for Special Children This is a unique learning experience where Dr. Levin, the ocular genetics fellows, pediatric ophthalmology fellow, genetics counselor, and other members of the team, attend the Clinic for Special Children in the Lancaster region. The Clinic services the Amish/Menonnite/”Plain People” of the area in which there is a high rate of autosomal recessive disease. The dates of this trip will vary throughout the year, but you will attend at least one. 5. Deerbrook Vision Screening Program This grant funded outreach program sends a team of vision screeners and an optometrist from Wills to Philadelphia public schools (and in the summer Girls and 15 Boys Clubs) to provide vision screening and where needed manifest refraction and free glasses. Children needing follow-­‐up are seen at our Wills pediatric ophthalmology clinics. The fellow will fill the role of supervising and manifest refracting on 2-­‐3 Deerbrook visits during the year. 6. Give Kids Sight Day Each year on a Saturday, Wills opens up its doors, in collaboration with Jefferson University and the Philadelphia Vision Coalition, to provide free eye care to children from the Philadelphia area. We average approximately 1200 children per day. You will be asked to provide pediatric ophthalmologic care that day. It is a wonderful experience staffed by hundreds of volunteers throughout Wills. 7. Third World Rotation Our department will provide you with an optional one week elective in the developing world, accompanied by one of our pediatric ophthalmologists. We will pay reasonable expenses associated with travel and accomodations. We believe this is an important part of your development as a pediatric ophthalmologist. If you chose not to partake in this activity, there is no penalty. 8. Electrophysiology and Diagnostic Imaging The fellow should arrange to attend our Diagnostic Center to become familiar with all aspects of testing commonly used in pediatric ophthalmology and coular genetics. Opportunities will also be provided in the operating room for the fellow to learn how to do ultrasound and RetCam photography independently. 9. Eagles Clinics Dr. Levin runs a Tuesday morning clinic every other week during the school year during which we see children referred to Wills by the Eagles Eye Mobile vision screening programs in public school or by the optometrist for children seen on their mobile unit. The fellow will join these clinics unless otherwise committed. On some weeks, when Dr. Levin cannot run the clinic, the fellow will ask as the attending for this session. 10. Emergency Room Coverage Two residents are in house (1st and 2nd year) and once resident (3rd year) on call every day in the Wills ER. In general Drs Levin and DeBenedictis take all ER call. If they have a case of interest t the fellow, especially if surgical, the fellow will be notified to attend if available. In January, if the fellow’s performance has been satisfactory, then the fellow 16 will be asked to take first call for the ER. Attending the ER rarely is necessary. The fellow may be out of town when covering the ER as this is phone call. III. Surgery A. Wills Eye The Department has surgical time throughout each week with the schedule varying each week (see Appendix). Surgery takes place in the Wills operating room on the 7th floor. The fellow should attend as many OR sessions as possible, understanding that we do not want this to conflict with any particular clinic each month. The fellow is expected to be present at least 15 minutes before the surgical start time. The fellow is granted privileges at Wills and at JHN to independently perform uncomplicated ruptured globe repair without cataract extraction, simple lid laceration repair, and examination under anesthesia. This rarely occurs. All surgery and exams under anesthesia are otherwise done with an attending present 1. Strabismus Our strabismus surgeons feel that primary uncomplicated horizontal muscle surgery done at Wills should be reserved primarily for the residents (when a resident is present). Other types of strabismus surgery, including inferior oblique surgery, occasionally may be triaged this way as well. More complicated cases, re-­‐operations, vertical muscles and obliques (especially superior obliques) will be allocated to the fellow. The fellow should consult with the staff surgeon at the beginning of the list to determine his/her responsibilities for that operating session. If the residents are serving as the primary scrub, the fellow is welcome to observe but not required to do so. The final distribution of cases is left to the discretion of the staff surgeon. Residents only attend some of the strabismus OR sessions. It is particularly favorable for the fellow to ensure he/she attends those OR sessions when the resident is not present. (Also see Additional Strabismus Surgery below-­‐ as a fellow, you will do most of your strabismus surgery at the Wills surgical centers rather than at Wills) 2. Oculoplastics The fellow should attend all pediatric oculoplastic cases performed by Dr. Goldstein. Dr. Goldstein and Colleen will notify the fellow when these cases are occurring. The fellow is also 17 welcome to attend when other oculoplastic surgeons are doping pediatric cases (e.g. lid laceration repair) Our staff pediatric ophthalmologists also do some oculoplastic and nasolacrimal work during their strabismus lists. 3. Cataracts and Glaucoma Drs. Levin and DeBenedictis do the majority of pediatric cataract cases, and Dr. Levin does all of the glaucoma cases at Wills. These cases are considered to be cases for the fellow to scrub when on the anterior segment block (or if no other obligations when on the strabismus block). Residents will sometimes also attend, largely in an observer or minor assistant role. For goniotomy, the presence of a second assistant (senior resident) is necessary so that the fellow has the opportunity to act as primary surgeon (under supervision). For all bilateral surgical intraocular cases on his service done on different days, Dr. Levin prefers that the fellow be involved with the surgery on both eyes and all follow-­‐up surgeries provided they are in block. If other surgeons have similar preferences, these will be explained to you as the year progresses. The fellow should attend as many exams under anesthesia as possible as these are critical to developing an understanding ofpediatric anterior segment disease. 4. Retinoblastoma Retinoblastoma operating room days are conducted by Dr. Carol Shields on Wednesdays all day. The fellow is scheduled for one AM session on one Wednesday (usually the 4th Wednesday) of each month during the anterior segment/genetics block. Dr. Carol Shields cares for over 50% of all retinoblastoma in the United States. In addition to retinoblastoma, there will be other pediatric retina conditions seen on those days. You will be welcomed as an active participant in the care of these patients. 5. Other subspecialty pediatric surgery Assuming no conflict in duties, the fellow is welcome to attend any pediatric surgery going on at Wills on any service. Simply ask the staff surgeon if you can observe for that case. In particular, much of the pediatric corneal care is managed with joint examinations under anesthesia involving both the cornea surgeon and Dr. Levin. B. Additional Strabismus Surgery 18 1. Dr. Nelson’s sessions at the Main Line Wills Surgicenter. The fellow is expected to attend every Friday unless there is a competing responsibility at Wills (e.g. Wills strabismus surgery when in block or anterior segment surgery when not in strabismus block) 2. Dr. Lavrich’s sessions once monthly at the Northeast Wills Surgicenter 3. Dr. Schnalls sessions once monthly at Cherry Hill Wills Surgicenter These are purely surgical experiences. At the Wills Surgicenters no residents are present. The cost to travel to these sites will be reimbursed by Wills. Please give receipts to the Fellowship Secretary. C. Adult Strabismus: You will see many adult strabismus cases and participate in many re-­‐operations both at Wills and the surrounding Wills Surgicenters. Nine of our attendings do adults. D. Jefferson Hospital for Neurosciences (JHN) Located across the street from Wills, this is where we do all surgery on children < 6 months old, children with significant medical issues, ER patients and inpatients. Dr. Levin has block time there as well (3rd Monday morning). If a patient needs to be admitted after surgery, the fellow should assist in the transfer by directly contacting the pediatric resident on the inpatient unit. See above for related information regarding inpatients. Surgery on inpatients must always be documented by a written operative note in the chart in addition to the usual operative dictation. E. On Call Surgery All on call surgery is done at JHN. The fellow is expected to attend if available. Drs. DeBenedictis(Thursday nights and one weekend per month) and Levin (all other nights and weekends) provide all ER on-­‐call coverage for the department. If they are not available, pediatric ruptured globes, 19 basic lid lacerations or examinations under anesthesia may be done by the fellow if approved by Dr. Levin and the fellow is available. If the fellow is not available, Dr. Levin will assist in making alternate arrangements. If an attending other than Dr. Levin/DeBenedictis is doing a pediatric emergency case because of their unavailability, then we encourage the fellow to still attend. Most on call ruptured globe and lid laceration surgery is done by 3rd year Wills residents within the discretion of the attending, but the fellow is often given a role as well. We do not transfer children to other institutions unless they are over one year old and need an Intensive Care Unit bed No patient may be booked for surgery without attending ophthalmologist approval. Urgent neuroimaging off hours is also done at JHN unless anesthesia is require din which case the patient is usually admitted to the pediatric floor at Jefferson for the study. NOTE: the anesthesia coverage at JHN is changing as of July 1 and may offer more opportunities for outpatient neuroimaging under anesthesia at JHN off hours as well as conscious sedation in ER for children. More information will be forthcoming as the new anesthesia team is underway. F. Consents for Surgery Consent for surgery (risk/benefit discussion) should be obtained by the attending ophthalmologist or by the fellow when acting in that role with approval of an attending ophthalmologist. The signature line of the consent form may be completed only by the staff ophthalmologist. The fellow is encouraged to observe surgeons getting consent from parents to learn this skill. Please direct any questions regarding the consent process to the Fellowship Director or the attending surgeon. When possible, it is required that the eye to be operated upon be marked before the child leaves the pre-­‐operative waiting room and enters the operating theatre. This should be performed by the attending ophthalmologist. At some point in the operating room, before surgery actually begins, a “time out” is called by the nurses to ensure that the patient on the table is the correct patient, the correct eye is being operated upon, and the procedure is correct. Please refrain from any other activity during the time out as this is a critical moment in any patient’s surgery. G. Miscellaneous Most of our patients have outpatient surgery. If a patient is to have an unscheduled post-­‐operative admission, the fellow or resident in the OR for that case is responsible for arranging the admission by contacting the pediatric floor. 20 The fellow should notify the ophthalmology resident on consults as well as the pediatric resident on the inpatient unit of unplanned admissions. The Wills ophthalmology resident cover all inpatient consults including pediatrics. They will follow pediatric inpatients along with the fellow. It is useful to coordinate bedside visits with the resident. All surgery must be documented by an operative dictation to be performed by the attending ophthalmologist, fellow or resident according to attending discretion. The resident and fellow usually assist the attending ophthalmologist in completing the postoperative outpatient paper work. The Wills operating room has charts that are separate from the clinic charts. The operating room is not yet on HER. The OR begins at 0730 each day except for Fridays when it begins at 0815 at Wills and Thursdays when it begins at 0830 at JHN. The fellow should leave early morning teaching sessions to attend surgery on time (15minutes minimum before start time) unless the attending surgeon suggests alternate priorities (see below). Whenever possible, the fellow should review the charts in advance, meet with the family, child and attending surgeon in the preoperative waiting room, and accompany the attending surgeon to the post-­‐
operative family waiting area. Showing this type of commitment to patient care will serve the fellow not only educationally but also in demonstrating their interest to the attending which will likely lead to increased willingness to allow the fellow surgical opportunities. Charts for surgery are prepared in advance by Colleen and can be made available to you by the Surgical Coordinator the day before. In the case of private patients who do not have Wills charts, the fellow can consult with the attending surgeon by phone or email to make arrangements for viewing the charts. Each attending may have different preferences. Please consult with the attendings to learn what they prefer IV. Inpatient Consults Inpatient consults are infrequent. There is always a resident assigned to the inpatient service. In the case of pediatric consults, the resident has been instructed to contact you so that you may do the consult together or on your own. Please contact the attending ophthalmologist in clinic that day or Dr. Levin, after you have been notified of the consult. All consults should be seen and signed off by the attending ophthalmologist during whose half-­‐day clinic the patient is seen, with the following exceptions: 1. Refer to the afternoon clinic when morning clinic attending cannot see the patient. Otherwise refer to Dr. Levin. 2. In the absence of a staffed clinic, Dr. Levin may be contacted. 3. On holidays, nights and weekends, Drs. Levin and DeBenedictis may be contacted as indicated above regarding ER on-­‐call coverage. 4. Dr. Levin should see suspected child abuse patients if he is available. 21 5. Attendings who do not have privileges at Jefferson cannot do inpatient consults. Whenever the fellow dilates an inpatient (or outpatient) child’s eyes, a note must be made in the child’s chart, either in the Progress Notes or on the consultation form. If a child is in the NICU, please consult with the nurse or neonatologist before instilling drops. Remember to ask permission from the nurses to handle patients who are intubated or otherwise unstable or monitored. On weekends, nights and holidays the resident usually does consults with the fellow as back-­‐up (see below). As needed, the fellow may phone Dr. Levin for advice. Communication with Pediatrics: It is essential for good patient care on the ward that •
•
•
•
the nurses have easy and direct access to the fellow via his/her pager or cell phone, admitting notification and orders be carried out promptly at the end of a surgical procedure or transfer from the clinic/emergency whenever cases are admitted either from the Emergency Room, clinic or Operating Room (NOTE: If patient admitted to pediatric service then the fellow can inform the resident of the desired orders, but only the pediatric resident can write those orders), the nursing staff be advised of any extraordinary circumstances surrounding the child, e.g., respiratory distress that might require urgent pediatric consultation on the ward unexpected findings or findings with serious implications are communicated directly by phone to the medical service caring for the patient who requested the consult (in addition to completion of the written consult form). This applies both to patients being followed by the ophthalmology consult service and ophthalmology service inpatients. The on-­‐call ophthalmology resident, pediatric resident and fellow should discuss the inpatient service each morning before the work day begins and at the end of the work day. All consults should be seen within 24 hours and if not, the reason should be documented on the patient’s chart. NB: All inpatient consults are documented on the Jefferson consult forms a copy of which should be given to our clinic front desk staff for billing. For inpatients on the ophthalmology service, a note must appear in their inpatient chart every day from the ophthalmology service. The daily note must include an updated treatment plan. For patients on the inpatient pediatric service, visits and notes should be written at the discretion of the fellow and attending, but ateach visit a note should be written in the patient’s chart. A. Outpatient Consults 22 Patients referred by the Emergency Department or other services at Wills during clinic hours should be asked to come to the clinic (unless there is a compelling reason that they are unable to leave the Emergency Department). The staff ophthalmologist should be asked to accept the patient before the patient is told to come to the clinic. If the clinic staff ophthalmologist cannot see the patient, or if there is no clinic that day, the fellow should contact Drs. Levin or DeBenedictis (see above for call coverage schedule) for back-­‐up and supervision. The fellow may see these patients independently and bill appropriately (see above). V. Research All fellows must complete a minimum of one research project with submission of the first draft of their manuscripts to their supervisors by May 1st. We believe that teaching the techniques of research and manuscript preparation is an integral part of your training. This concept is endorsed also as a requirement by AAPOS/AUPO. While we do realize that fellows have a relatively short time period for completion of research projects, there are many opportunities available to allow you to do so. Early identification of your project is essential. This is particularly important since most projects require Wills Institutional Review Board (IRB) approval and this can add a minimum 1-­‐month delay to the process. Retrospective chart reviews or any chart case review including more than two case reports also require an IRB submission and IRB approval (short form – expedited review). A case report of only 1 or 2 patients should have written consent from the family where possible. Our Research Assistant, Rizwan Alvi, can assist you with the submission process. The IRB requires online training for human research subjects protection and HIPPA. Rizwan can help you access the required online training site. This process is required prior to the start of any research activity. IRB applications will be returned to the primary investigator as incomplete if certification for each co-­‐investigator is not provided. We welcome projects that are clinical or basic science, animal subject or human subject and virtually anything else you might think of. If you have a particular area of interest in which you would like to do your research, or a specific project, let us know as early as possible and we will attempt to identify the appropriate supervisor. At least one of your supervisors should be a Wills pediatric ophthalmologist. Fellows should inform the Fellowship Director about their project title and supervisor as soon as it has been selected. Fellows who do not submit a manuscript for publication (i.e. after reviews and editing by supervisors) before the end of their fellowship may not be certified as having completed their fellowship unless approved by the Fellowship Director. 23 The opportunity also exists for fellows to begin projects that might be multi-­‐year projects that can be continued by the next fellow. A preliminary manuscript must still be submitted to your supervisor according to the same time lines in order to be eligible for completion of your fellowship. All submissions related to your research for any presentation, poster or publication, including abstracts, PowerPoint and oral presentation must be reviewed with your project supervisors well in advance and certainly no later than two weeks before submission/presentation. One potential problem, quite common in active fellowships with multiple attending ophthalmologists such as Wills, is that of taking on too many projects! There are many research opportunities available on our service. While it may be difficult to reject a project proposed by a potential supervisor, it is important that the fellow confines his/her activities to those projects he/she knows they can complete satisfactorily rather than overextending oneself. The Fellowship Director will monitor your progress to help avoid this common dilemma. You will be given blocked free time, usually on Friday afternoons or when there is no clinic or surgery going on to work on your project. Research time is only blocked after the schedule ensures that all other clinical and surgical activities are covered. Decisions regarding authorship and authorship order should, wherever possible, be made as early as possible in the development and implementation of a research project. The following questions need to be asked regarding authorship: Is the individual able to take responsibility for the content of this paper? For at least a specific section did the individual have (a) input into conception and design, or analysis and interpretation of data; and (b) were they involved in drafting the article/section of article or revising it critically for important intellectual content; and (c) were they involved in the final revision of the version to be published? If answer is “yes” to all above then that person is justified as author. The fellow is required to submit an abstract for presentation at the spring Wills Annual Alumni Conference Research Day and “Joe’s Meeting” (see below). VI. Administration A. Schedules 24 The fellow is given some discretion to schedule their activities as there are many attractive but competing possibilities at a busy center like Wills. Our attendings and clinic staff understand that you have competing responsibilities and will not be with them for every clinic or surgery. Using your surgical log book (see below), attempts should be made to ensure that you receive a satisfactory experience in all surgical areas. The schedule is flexible to allow for any special/unforeseen circumstances. The Fellowship Director will periodically review your experiences with you to ensure that your training is well balanced. B. Call Schedule There are no formal call obligations for the fellow or the attending ophthalmologists. As discussed above, the ER resident or Drs. Levin and DeBenedictis (who take all staff ophthalmologist call for the department) will notify the fellow of any cases for which they desire the fellow’s participation and any potential surgical cases. If the fellow is available, they should come in to see the patient and assist with or perform surgery. C. AAPOS/AUPO Data AAPOS/AUPO requires that the following data be collected during your fellowship. Data should be submitted to the Fellowship Director and Secretary at the end of your fellowship. 1. All local presentations: record date, audience, and subject for ALL presentations you do at any type of group setting. This includes talks you give locally outside our Department (e.g. to pediatric residents), at “Joe’s Meeting” in the fall, and at national/international conferences during your fellowship (e.g. AAPOS). 2. All lectures and journal clubs that you have attended including morning didactic sessions, strabismus nights, fellows breakfast, ocular genetics case meetings, Chief’s rounds, pediatric ocular oncology Monday meetings, lunch time conferences, talks at conferences in Philadelphia outside Wills (e.g. Dept. of Pediatrics Grand Rounds), etc. 3. Surgery performed. List all surgeries (including EUAs) that you attend and categorize them as either observation only, procedure partially done by you, or procedure completely done by you. Do not enter patient names, birth dates or health records numbers. The Wills clinic and operating room numbers (note these are different) or any other identifying information may not leave the hospital at any time. We suggest that you group these surgeries according to discipline (e.g. strabismus, 25 cataract) to make it easier to tally up at the end of the year. AUPO/AAPOS has required categories which you should use as well. NB: Strabismus cases are categorized by case (e.g. if you do 4 muscles on one patient it only counts as one case) for AAPOS/AUPO but for your own records and that of the Fellowship Director, please also keep separate track of the number of muscles you have done and what roles you had for each. 4. Publications: List all publications which result from work performed at Wills. Include items that have been submitted for publication. You may wish to keep a separate list for items that are published while you are here but result from work completed elsewhere and projects that are underway and unfinished at the time of your departure. The suggested forms from AAPOS/AUPO for tracking this data are available at http://www.aupofcc.org/samples/ped_exit_sample.html The fellow will not receive graduation certificates unless these data have been handed in before leaving the program. Before graduation, you will receive an exit questionnaire from the AUPO. Completion of this is required for AAPOS membership and fellowship graduation. You will not receive your graduation certificate unless you complete and return this questionnaire to AUPO. Failure to return the questionnaire can result in penalties to our fellowship program and will affect subsequent fellows. It is essential that these questionnaires be completed. AUPO notifies us when the questionnaire has been submitted by you. E. Administrative/computer/library support Dr. Levin’s office is the Departmental Office. The Departmental Secretary is also the Fellowship Secretary. The Fellowship Director and Secretary are your resources for most administrative aspects of your fellowship. Each fellow will receive an email address provided through the Wills system (@willseye.org). If you have a laptop computer, we can have the Wills software for email access loaded at no charge. Your Wills address and internet access via the Wills network should be restricted to work related activities rather than personal use. While you are here, our IT service will provide technical support to the computer you use for work related activity. Laptop computers, palm devices, memory sticks, external hard drives and any other portable electronic devices that store information and which leave Wills must not contain any identifying information regarding Wills or Jefferson patients or patients cared for at any site (e.g. Cooper, Lancaster, Surgicenters) during the fellowship. This includes names (in the document or document label), health records numbers, addresses, phone numbers, labeled pedigrees, research databases with identifiable information, or identifiable photographs. Note that photographs may be identifiable 26 even if the face is not shown (e.g. a unique hand deformity or a limb with a tattoo or piece of jewelry). Server space and remote access can be provided for secure storage. The Fellows office and all clinic rooms should be kept locked at all times when no one is in the office. Your ID badge will give you access to the clinic off hours and you will have a key to your office area. Do not share your ID badge or key with others. Do not leave your personal belongings, cell phones or computer unattended. Report any suspicious persons or activities to the security guard in the building lobby. Dr. Levin’s office is not to be accessed by the fellow when it is locked. Drs. Levin and Manley maintain their personal libraries and files in the clinic which you are welcome to access. These books are not to leave the clinic unless signed out with the Fellowship Secretary. For research projects, secretarial support is usually provided by your project attending ophthalmologist supervisor. If you have any other secretarial needs, contact the Fellowship Director. Wills has a remarkable ophthalmic library (8th floor) and Jefferson has a full medical library. Dr. Levin has access to the library services of the College of Physicians. Between these three institutions you should be able to access virtually anything you need. The Department will pay for the cost of ordering but we ask you to be financially conscious and use free internet access where possible to find needed references. The Fellowship Secretary can assist you with library access to Jefferson. Jack Scully, Bill Romano and Roger Barone provide a full range of graphics and imaging support. They assist with poster presentations and publications. They are located behind the auditorium on the 8th floor. Requests to create digital images for any presentation or poster must be in their hands no later than two weeks before the due date. Any late submissions will be directed to commercial providers outside of Wills and you will be responsible for the charges. Posters are printed externally and the cost covered by the grant for that project or the department with DR. Levin’s prior approval. They also provide clinical photography for external features (e.g. faces) although we have our own departmental camera in Dr. Levin’s office which you may use (please ensure that the camera is kept in his locked office). Photographs of clinical patients should be requested with the approval of the supervising attending ophthalmologist. You will find the requisition forms and consent forms in each examination lane. These consent forms must be completed even if you are taking the photographs or video yourself. The supervising attending name should be placed on the form and the requisition and consent forms completed in full. Fellows may obtain copies of digital images of all cases used for presentations. Wills uses the Synergy system for image storage (including all testing done in our diagnostic imaging center but not including those taken by Jack, Bill and Roger). For images obtained in the OR (surgical videos, RetCam) you must provide your own jump drive, external drive or CD. Images obtained at Wills may not be used for publication without the knowledge of the supervising attending ophthalmologist for the patient. 27 Consent for identifiable images taken in the operating room must be obtained in advance where possible. If you plan to use identifiable photographs (see above) for presentation anywhere outside of the hospital or for publication, please ensure that written informed consent is on file in the patient’s chart and the attending ophthalmologist is aware. The signed consent forms should go on the patient’s chart. F. Charting and Prescriptions Wills use the NextGen electronic health record system. Dr. Levin still has some patients whose paper charts have not yet been scanned in and some paper charts are not fully scanned in. Although adult patient charts have been shipped for storage off site, pediatric and Levin genetics patient charts are for now being retained at Wills until the HER is in fully in operation for them. No charts or any patient information of any kind may leave the premises. If you are using a chart in your office area, please ensure that the clinic front desk staff is aware. Be sure to record in the HER all patient contacts including phone calls or if hard copy documents are involved, you may write on the document and ask for the front desk to scan it into the EHR. Check with each attending regarding the ways in which he/she prefers chart documentation to be completed. For hard copy documents on which you write, including the operating room chart, sign all handwritten notes and print your name legibly underneath your signature with the date and where relevant, time. You may be asked to dictate an operative report or patient letter. The Fellowship Secretary will assist you in obtaining the appropriate ID numbers to do so. Note that the JHN, Wills operating room, and WEOC dictation systems are separate and require different access numbers and codes. Do not share your passwords for any computers or dictation system with any other individual. Patients or their substitute decision makers do have the right to request to see all parts of their chart but it is advisable that this be done only with attending ophthalmologist supervision so as to prevent misinterpretation and to increase comprehension of chart entries. All requests for copies of the chart should be directed to Medical Records. If you become aware of such requests from patients or any potential legal action, or should you receive communication regarding a patient from a lawyer, please direct this to the attending ophthalmologist for that patient. To help reduce calls from pharmacies to the clinic, when hand writing prescriptions for inpatients at discharge or any other patient please 1. write the patient’s name clearly, 2. date the prescription, 28 3. indicate the generic drug name unless there is a specific indication for a commercial label product, 4. write out “right eye”, “left eye” and “both eyes” rather than using OD, OS or OU to avoid confusion with other abbreviations (e.g. OD vs. QD), 5. indicate an amount to be dispensed (e.g. 1 bottle, or 5 cc), 6. indicate number of refills, 7. indicate 1 drop per dose, 8. indicate frequency for use, 9. sign and print your name. 10. avoid writing numerals for the number of refills. Instead spell out the refill number Please try to discharge inpatients and give the written prescriptions to family in the mornings. This allows the family time to get the medications before leaving the hospital and increases bed availability for new patients coming in. For fortified antibiotics, please request the floor nurse to dispense the remaining bottles directly to the patient. Some preparations are only available at the JHN pharmacy (e.g. atropine 0.5% ophthalmic solution, acetazolamide oral suspension) located on the main floor of JHN next to the PNC bank at 9th and Walnut streets. G. Vacation AAPOS does not set a minimum length for a fellowship. Our policy requires that no fellow may miss more than two months of the fellowship including all allowed vacation and leave as listed below. Fellows who are away from the fellowship for more than 2 months must develop a plan with the Fellowship Director to make up the additional time missed. Graduation certification will be withheld until such time as a minimum of 10 months of fellowship has been completed. Vacation or other forms of allowed away time that are not used are not compensated for by financial remuneration or an increase in away time in another category (e.g. if a fellow only uses 2 of the allowed 5 days of interview time, they will not get an extra 3 days of vacation and they will not receive remuneration for days not taken). All time away should be requested in advance through Dr. Levin and the Fellowship Secretary (Karen) notified. 29 The fellow is entitled to the following time off. Vacation: 2 weeks (in addition to either Christmas or New Years week). Vacation may not be taken in July or June without prior approval from the Fellowship Director at least two months in advance. Vacation in these months is strongly discouraged and only granted in extraordinary circumstances. Fellows may not take more than two weeks consecutively, except for extraordinary circumstances, with the Fellowship Director’s approval. Job Interview leave: Five working days. (Can be split) Conference leave: Five working days. (Can be split for more than one meeting) The Department will cover reasonable costs for you to attend AAPOS. Presentations at conferences are taken as part of conference leave. If you are presenting at a meeting other than AAPOS, please discuss costs for conference attendance with your senior author. Sick leave/emergency leave/religious holidays which are not statutory hospital holidays/maternity or paternity leave: To be reviewed upon request by Fellowship Director. Statutory Holidays Please give at least 6 weeks notification of away time (including /Christmas vs. New Year week) in writing (or by email) to Dr. Levin and the Fellowship Secretary who will then advise the necessary individuals. Note: Remember that the fellowship continues until June 30 without exception. You are expected to honor your clinical, surgical, and research obligations until the final day of your fellowship. H. Evaluation Fellows are evaluated formally 4 times each year (approximately every 3 months). An email inquiry by the Fellowship Director is sent to all attending ophthalmologists regarding the fellow’s performance for the 3 month period before each review. We also conduct a 360 evaluation by asking all members of our clinic staff to give feedback as well. These replies are collated by the Fellowship Director who will meet with you to review your performance. Fellows are asked to complete a self-­‐evaluation document before these meetings. The fellow is also asked also to complete a Program Evaluation and Attendings Evaluation at the end of the fellowship. 30 In the event of an adverse evaluation, or dismissal from the program, fellows have the right to appeal through the Ophthalmologist-­‐in-­‐Chief. Wills and its Pediatric Ophthalmology and Ocular Genetics Service reserve the right to recommend a probationary period when there is a concern about a fellow’s performance. I. Fellows Breakfast The Fellowship Director will meet with the fellow for breakfast every other Tuesday morning 0645-­‐0730 as availability permits in his office. Sessions are devoted to "paramedical" topics (e.g. ethics, dealing with difficult parents, practice management). This meeting is also designed as a forum to raise concerns, answer questions and share information relative to your fellowship program. Your feedback allows us to upgrade and improve the fellowship experience continuously. J. Dress Codes Professional dress is expected at all times. Hospital surgical scrubs may not be worn outside Wills, even if you are just crossing the street. The same applies for JHN. In hospital, you should be wearing a white lab coat over your scrubs when outside the operating room. Although a tie for men is preferred but not required, appropriate clean casual clothing is a minimum for both genders. K. Malpractice Coverage The fellow will be provided with malpractice coverage. L. Expenses/Benefits For more information contact Janice Frayne in Human Resources. M. Miscellaneous The photocopier in the clinic or Wills library is available for work-­‐related use at no charge. 31 ***************************** VII. Educational Activities It is left to the fellow’s discretion to choose between attending didactic sessions or clinic/surgery, but if the fellow will not be attending clinic/surgery, the attending surgeon should be advised. In general, clinic/surgery sessions must not be missed or delayed by didactic sessions. A. Chiefs’ Rounds: every Friday morning (except July and August) 0700-­‐0800 in the 8th floor auditorium. These are rounds for all of Wills. Although pediatric or genetic cases are not presented every week, it is a high yield learning opportunity. B. Eye Genetics Course: Second Thursday of each month 0730-­‐0830 in Dr. Levin’s office. C. Ocular Genetics Journal Club: Usually the 4th Thursday of every month in Dr. Levin’s office in place of Genetics Case Rounds. The article(s) will be provided in advance. The fellow should keep a record of the topics and articles discussed. D. Genetics Case Rounds: Every Tuesday and Thursday 0730-­‐0830 in Dr. Levin’s office except when replaced by journal club E. Resident Journal Club: Each resident class has one journal club held in the evening at the home of a Dr. Levin or another attending ophthalmologist. The fellow will attend and is encouraged to be an active participant. The fellow should keep a record of the topics and articles discussed. F. Strabismus Sessions: Periodic evening sessions to discuss surgical management of strabismus cases. (e.g., how many millimeters do I move which muscle?). The Fellowship Director will provide the case problems in advance. Sessions are led by Dr. Nelson and attending strabismologists will sometimes attend . Sessions are held in the Wills 8th floor classroom or our departmental waiting room. G. Pediatric Oncology Rounds: The second Monday (0645-­‐0730) of each month is devoted to pediatric cases, 32 H. Other Rounds: The fellow is welcome to attend Fluorescein Rounds (Wednesday 0645-­‐0730), Neurophthalmology Rounds (Wednesdays 1330-­‐1430), and Glaucoma Rounds (Fridays 1230-­‐1330 pm). Please communicate with the fellows on each service to identify sessions in which the presentations will include pediatric or genetics cases. I. Dr. Levin’s Research Lecture Series: Held periodically on Thursday mornings 0645-­‐0730 in Dr. Levin’s office. J. Research Rounds. Held periodically on Thursday mornings 0645-­‐0730 in Dr. Levin’s office. During this time all active research projects involving fellows are reviewed. K. Neuroradiology Rounds: Organized by the ocular genetics fellows periodically on a Tuesday in place of Genetics Case Rounds. The fellows are encouraged to bring cases for review. Case must be uploaded at JHN in advance. L. Genetics Consultation Meetings: Every 3-­‐4 months the Wills Ocular Genetics team meets with the clinical genetics teams from St. Christopher’s Hospital for Children, Cooper and Einstein Medical Center (home of the Microphthalmia/Anophthalmia Network). Jenina will provide details. M. Pediatric Ophthalmology Lunch (12:30-­‐1:30 on the 2nd and 4th Mondays in the classroom): This session is taught by Dr. Manley. It is designed to be a case based approach to basic pediatric ophthalmology and strabismus. N. Goniotomy and Ocular Endoscopy Courses: Conducted by Dr. Levin in the evening. Dates to be arranged by the fellow with the Fellowship Secretary. Didactic portion of the goniotomy conducted in Dr. Levin’s office. Wet lab conducted in operating room at Wills. For endoscopy, the fellow is responsible for obtaining pig eyes. It is suggested that these courses be completed in the first 6 months. The endoscopy course should be done first. O. Pediatric Ophthalmology Courses: (suturing, retinoscopy, lensometry). Provided to residents by several of our staff ophthalmologists under the direction of Dr. Gunton. The fellow is welcome to attend (and assist in teaching). Further details to follow. P. Pediatric Ophthalmology Listserv Discussion Group: Via the website http://lists.ucsd.edu/mailman/listinfo/ped-­‐ophth-­‐l, please add your email account to this international email discussion group for pediatric ophthalmologists. Fellows are invited as observers only and may not post replies. If you would like to reply to an inquiry/case, send your comments by email to the Fellowship Director or another Wills attending ophthalmologist who can act as your sponsor and post on the listserv for you. Q. Resident Teaching: The fellows are encouraged to give teaching sessions to the residents. This can be a very informal chat about virtually any topic in pediatric ophthalmology. R. Reading Materials: You will select much of your reading according to your interests and clinical exposure. Attending ophthalmologists are encouraged to direct you to important articles. There is 33 also a list of AAPOS recommended reading on their website. Fellows are required to read the Pediatric Ophthalmology and Strabismus volume of the American Academy of Ophthalmology (AAO) Basic and Clinical Science Course series and the AAO Preferred Practice Patterns relevant to pediatric ophthalmology all of which is available at the AAO website (www.aao.org). The fellow maintains a binder of all PEDIG studies. S. Visiting Professorships: These occur almost monthly at Wills. They may or may not include topics relevant to pediatric ophthalmology or ocular genetics. The first three hours (2-­‐5pm) are lectures to the residents and the Grand Rounds portion is actually cases presentations to the VP by the residents. The fellow is welcome to attend. T. “Joe’s Meeting”: Each year in the Fall, there is a special 3 day event dedicated to pediatric ophthalmology. 1. Thursday, we have the Annual Joseph Calhoun Visiting Professor. This involves afternoon lectures to the resident using the traditional VP format (see above). Topic alternates every year between strabismus (2014) and pediatric ophthalmology (2015). 2. Friday is “Joe’s Meeting”, a long standing tradition at Wills which was formerly run by our Chief of Pediatric Ophthalmology, Dr. Calhoun, who has since died. The meeting continues in his honor with this name. It is a unique meeting in which every participant is welcome to present a case or short series. The fellow is required to present. The meeting is attended by many pediatric ophthalmologists and offers a fun, lively forum for open discussion among peers. 3. Saturday is the CHOP half day pediatric ophthalmology meeting. The Calhoun VP is the main speaker. Topic alternates every year between strabismus (2014) and pediatric ophthalmology (2015). U. Wills Eye Hospital Annual Alumni Conference: Usually in March of each year in Philadelphia. The meeting starts with a Thursday afternoon Research Day at Wills followed by the main conference off site all day Friday and Saturday morning. There is one session devoted to pediatric ophthalmology. The fellow is required to submit an abstract for presentation at the Research Day. V. Residency Didactic Teaching: There is a robust didactic schedule for the residency (see Appendix) as well as a night review course for board review. The fellows is required to attend all sessions related to pediatric ophthalmology and ocular genetics. The fellow is welcome to attend any other sessions as desired. WELCOME TO THE FELLOWSHIP! HAVE A GREAT YEAR! 34 VIII. Appendices A. Schedule B. TJUH Campus Map C. Academic Schedule 1. Resident Lectures 2. VP Rounds 3. Pre-­‐residency Course