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Revised March 18, 2008 GOALS AND OBJECTIVES RESIDENT CURRICULUM FOR OPHTHALMOLOGY Rotation Coordinator: Marietta Nelson, MD Eye Clinic of Nevada 2800 N Tenaya Way # 102 Las Vegas, NV 89128 (702) 384-2020 OVERVIEW EDUCATIONAL PURPOSE Ophthalmology deals with diseases and disorders of the eye The general internist needs to have competency in the initial diagnosis and management of acute ocular disorders and in the appropriate and timely referral of eye diseases. Teaching Methods The rotation will be under the supervision of the attending ophthalmologist. The resident will see consultations and patients as assigned by the attending ophthalmologist in the outpatient eye center. The resident will obtain the initial data, write a consultation note, and present the patient to the attending physician. The attending will confirm the findings, teach about the case, and with the resident, craft the final recommendations. The attending physician will teach based on case material. The resident and attending will review and discuss any required reading. Mix of Diseases Patients present with a wide variety of ophthalmic problems including routine exams, visual disturbances, ocular trauma and inflammation, and the ophthalmic consequences of systemic diseases. Patient Characteristics The patient population is diverse, male and female, of all ages from adolescent to geriatric, representing most ethnic and racial backgrounds, from all social and economic strata. Types of Clinical Encounters Patient encounters occur in the office as initial consultations or ongoing care of patients with ophthalmic diseases. Common Clinical Presentations Nearsightedness (myopia) Farsightedness (hyperopia) Presbyopia Hordeolum Dacryocystitis Graves’ disease Chalazion Conjunctivitis Pterygium Pinguecula Corneal abrasion Dry eye and associated diseases Iritis Cataracts Glaucoma Diabetes mellitus retinopathy Macular degeneration Procedures Tests of visual acuity, visual fields, and test for ocular motility Direct ophthalmoscopy Fluorescein staining of the cornea Tonometry Slit lamp examination Resident Supervision Residents will be supervised by the attending ophthalmologist. The resident will see consultations and patients as assigned by the attending ophthalmologist write initial and follow up consult notes and review them with the attending ophthalmologist. Didactic Teaching Attending Teaching Didactic discussions will be held regarding patients seen in consultation during the month. Each resident is required to review common ophthalmologic topics. Core Reading Materials Bradford CA. Basic Ophthalmology for Medical Students and Primary Care Residents, 8th edition. San Francisco, CA: The American Academy of Ophthalmology, 2004. Chawla HB. Ophthalmology: A Symptom-based Approach. Woburn, MA: Butterworth-Heinemann, 1999. Trobe JD. The Physician's Guide to Eye Care, 3rd edition. San Francisco, CA: The American Academy of Ophthalmology, 2006. Wu G. Ophthalmology for Primary Care. Philadelphia, PA: WB Saunders, 1997. Ancillary Educational Materials Subspecialty Texts of Neurology, Pulmonary Medicine, Nephrology, Endocrinology, Infectious Diseases, Rheumatology as well as General Medical References (Harrison’s Principles of Internal Medicine, Cecil’s Textbook of Medicine) are available 24 hours a day, seven days a week in the resident lounge. Savitt Medical Library On-Line Residents have access to the on-line services of Savitt Library (the main library of the University of Nevada - Reno) via their computer in the resident room, Suite 300 of the 2040 W. Charleston Building. Access to this room is available 24 hours a day, seven days a week. Full text is available for many peer-review journals including, but no limited to: ACP Journal Club Annals of Internal Medicine British Medical Journal Cancer Circulation Journal of the American College of Cardiology The Lancet New England Journal of Medicine Stroke Also available on-line: Harrison’s Principle’s of Internal Medicine, 14th ed. Merck Manual, 17th ed. Guide to Clinical Preventive Services, 2nd ed. The Cochrane Library Medline and Grateful Med Databases Pathological Material and Other Educational Resources Pathological specimens are not anticipated. Training Sites Eye Clinic of Nevada This venue is a private practice ophthalmology office of a clinical faculty member. Competency-based Goals and Objectives Ophthalmology Rotation Learning Venues Evaluation Methods 1. Eye Clinic of Nevada 2. Self Study A. Attending evaluation B. Objective testing C. Self evaluation Competency Patient Care Level Specificity Not applicable – this elective is taken once during residency Learning Venues 1 Evaluation Methods A, C 1, 2 A, C NA 1 A, C NA 1 A, C NA 1, 2 A, C NA 1 A, C NA 1 A, C NA Competency : Medical Knowledge Learning Venues Evaluation Methods Demonstrate knowledge of proper use of diagnostic tests and medications: Mydriatics Topical anesthetics Corticosteroids Antibiotics 1, 2 A, B, C NA Demonstrate knowledge of normal anatomy, physiology, and aging of the eye and ocular function 1, 2 A, B, C NA Demonstrate knowledge of effects of drugs on ocular function and disease Demonstrate knowledge of effects of 1,2 A, B, C 1,2 A, B, C Demonstrate competency in obtaining ophthalmologic history from patients. Demonstrate competency in physical exam skills used to evaluate ocular function and disease Demonstrate competency in slit lamp examination Demonstrate competency in eye protection Demonstrate competency in tests of visual acuity, visual fields, and test for ocular motility Demonstrate competence in fluorescein staining of the cornea Demonstrate competency in tonometry Level NA Level Glaucoma agents NA ocular drugs on systemic function Competency: Interpersonal and Communication Skills Learning Venues Evaluation Methods Level Interact in an effective way with physicians, nurses and medical support staff. Demonstrate understanding of patient preferences in diagnostic evaluation and management Maintain accurate medical records. Serve as a patient advocate. Understand and communicate impact of visual loss 1 A, C NA 1 A, C NA 1 1 1, 2 A, C A, C A, C NA NA NA Competency: Professionalism Learning Venues Evaluation Methods Level Treat team members, primary care1, 2 givers, and patients with respect and empathy. Understand, practice and adhere to a code 1, 2 of medical ethics. A, C NA A, C NA Competency: Practice-Based Learning Learning Venues Review the outcomes of patient care in 1, 2 order to reflect on the approach taken in the delivery of care. Utilize established practice guidelines for 1, 2 individual diseases to devise care strategies. Identify limitations of one’s medical 1, 2 knowledge in evaluation and management of patients and use medical literature (primary and reference) to address these gaps in medical knowledge. Evaluation Methods A, C Level NA A, C NA A, B, C NA Competency: Systems-Based Practice Learning Venues Evaluation Methods Level Recognize the importance of the role of support systems in the health of patients with ocular disease. Understand the role of the ophthalmic consultant, including identifying the different roles of ophthalmologists, optometrists, and opticians. 1, 2 A, C NA 1, 2 A, C NA EVALUATION A. Of Residents At the completion of each rotation, all clinical faculty are required to complete the standard ABIM resident evaluation form. All clinical faculty are encouraged to provide face-to-face feedback with the residents. The night-float resident is evaluated by one of the three service attendings. In addition, residents may receive interim feedback utilizing the ABIM’s Praise and Early Warning cards. B. Of Rotation and Preceptor All residents are encouraged to evaluate the rotation, and the clinical faculty member, at the completion of the rotation. This evaluation form is included at the end of this document. These evaluations are then converted to type and shared anonymously with the clinical faculty. The program director also discusses the rotation with the residents to ensure rotation quality and satisfaction. Ophthalmology Rotation Resident Check List 1. Evaluation reviewed at mid-month and end of rotation by the supervising faculty member and resident. 2. Completed assigned readings 3. Attended all assigned activities (excluding scheduled time away, required clinics and emergencies). 4. Completed required case report abstracts and/or posters if assigned by the supervising faculty member. 5. Demonstrated understanding of the basic principals of ophthalmology. 6. Receive verbal feedback from attending at end of rotation. Intern/Resident Signature_________________________ Date___________________ Supervising Attending Signature___________________ Date___________________ All items must be completed for rotation credit and checklist returned to the Department of Medicine by the rotation’s end.