VA N Indiana Health Care System Residency

Goal 1: Provide experience in the evaluation and management of patients with ocular disease or ocular manifestations of systemic disease, utilizing advanced diagnostic and treatment modalities when indicated.

• The resident will provide care for a large number of patients with complex and/or multiple ocular problems.
• The resident will become proficient in performing and interpreting advanced diagnostic procedures.
• The resident will become proficient in performing and interpreting advanced therapeutic procedures

 

Goal 2: Enhance the resident’s ability to communicate with patients and other health care providers in a way that promotes patient-centered care.

• The resident will promote effective patient-centered care by effectively communicating with patients and their families.
• The resident will promote collaborative patient-centered care by effectively communicating with other health care providers.

 

Goal 3: Provide an opportunity for the resident to function as a valuable member of the health care team in a way that promotes appropriate resource utilization and effective, coordinated care.

• The resident will practice cost-effective health care and resource allocation without compromising quality of care.
• The resident will be aware of health care system resources and will collaborate with other health professionals to ensure provision of comprehensive patient-focused care.
• The resident will be exposed to a multidisciplinary model of low vision care.

 

Goal 4: Foster continuous patient care improvement through quality improvement activities, including the resident’s self-evaluation.

• The resident will be responsible for life-long learning and their own practice assessment and improvement strategies.
• The resident will participate in quality improvement activities within the hospital and utilize the information to improve patient care.

 

Goal 5: Facilitate the resident’s acquisition, analysis and application of current medical and scientific information to improve their patient care practices.

• The resident will develop critical thinking and problem solving skills that will enhance their ability to form differential diagnoses and management plans.
• The resident will improve his/her knowledge of basic and medical sciences and apply this knowledge in the evaluation, diagnosis and management of patients.
• The resident will demonstrate the ability to acquire, analyze and apply scientific and medical literature to improve the care of patients, and will utilize information technology where applicable.

 

Goal 6: Provide the resident with experiences and skills that will facilitate continued contribution to the profession of optometry through a variety of venues including: teaching, scholarly activities and involvement in community and professional organizations.

• The resident will facilitate the learning of optometry students and other health care professionals through participation in scholarly activities
• The resident will facilitate the learning of optometry students and other health care trainees by participating in preceptor assignments.
• The resident will be exposed to community and professional organizations and will be given the opportunity to participate.

A minimum of 40 hours per week is required. The majority of the time is spent providing direct patient care in the outpatient setting.  Also included in the schedule are weekly journal club and optometry conference, time for research and development, surgical observation, interdisciplinary rotations, and instruction of fourth-year optometry students.  Additional time beyond assigned hours will be necessary for purposes of charting, patient follow-up, independent study and scholarly activities.  Residents do not officially take call, but are occasionally called upon to provide after-hours urgent care or follow-up in consultation with attending staff. 

Clinical Activities:

Over 80% of the resident’s scheduled time is dedicated to clinical education, and the vast majority of this time is spent providing direct patient care primarily in the outpatient clinical setting.  The resident is responsible for attending to the patient in a comprehensive fashion, taking into account the patient’s subjective complaints, general medical health, examination findings, as well as psychosocial, cultural, and religious factors.  Comprehensive care provided by the resident includes: 

• Primary eye care, including screenings, wellness exams, and diagnosis/treatment of vision disorders
• Diagnosis and treatment of ocular diseases, including emergency and urgent care
• Diagnosis and treatment of ocular manifestations of systemic diseases
• Pre- and post-operative care, including suture removal
• Excision of ocular adnexal lesions
• Low vision counseling and rehabilitation (very minor component)
• Performance and interpretation of specialized ophthalmic testing procedures
• Ordering and interpretation of laboratory, radiology and other diagnostic studies
• Counseling of patient and their family
• Interaction with other health care providers to ensure continuity of care; this includes consultation, referrals, and follow up

The resident’s experience is enhanced by daily case discussions with faculty and review of clinical images (photographs, OCTs, FAs, CTs, MRIs, etc.) during clinic and conference time.   Strong emphasis is placed on development of critical thinking and problem solving - two skills that are essential for independent practice and life-long learning.  A continuous effort to improve patient care through acquisition, analysis, and application of current medical information is expected of the resident. 

Observational interdisciplinary rotations assist the resident in understanding the role of other health professionals.  Rotations may include:  dermatology, neurology, emergency care, primary care, imaging (MRI, CT, ultrasound), physical therapy, occupational therapy, cardiac stress testing and other specialties as available.   The resident also has the opportunity to observe ophthalmic surgery and/or laser.

While not a formal part of the curriculum, participation in medical mission trips is facilitated and encouraged.

Didactic Activities:

The resident participates in weekly optometry conference with attending staff and students.  This conference utilizes a variety of didactic instruction methods including:  case presentations and slide review, journal club, interactive faculty lectures, and resident/student presentations. 

The resident is encouraged to attend outside continuing education offerings through the affiliate, as well as those offered by the American Academy of Optometry, the local optometric society and other academic or professional organizations. 

It is expected that the resident will undertake a variety of independent study activities.  To facilitate the resident’s efforts, a large library of medical and ophthalmic resources is readily available. 

Scholarly Activities:

The following scholarly activities are required of the resident in order to satisfy program completion criteria.

• Complete a manuscript of publishable quality OR present a poster or grand rounds presentation (or equivalent) at the American Academy of Optometry (or other similar approved venue) prior to the end of the residency year; Residents who submit a poster/paper (or equivalent) for presentation at an approved meeting will be eligible for a $500 travel scholarship from the Michigan College of Optometry.  
• Present a lecture or case report to students, staff and/or colleagues at Michigan College of Optometry’s Residency Day (or other similar approved venue)  

Additional scholarly activities may include:  journal club, lectures, and case presentations.

Teaching Activities:

The resident is responsible for clinical instruction and supervision of 4^th year professional students from Indiana University and Michigan College Optometry during the latter part of their residency year.  At minimum, the resident will be assigned to work with the students an average of one half day per week for 6 months.

Educational Resources:

The program enjoys a wide variety of current educational and informational resources that are readily available to the resident.

• Extensive on-line journal and medical references are available through VA NIHCS, Michigan College of Optometry and Indiana University.  Well over 100 ophthalmic journals are available with full on-line text.  These resources are also available to the resident 24 hours per day; 7 days per week. 
• Numerous ophthalmic and general medical textbooks are located in the clinic and area available to the resident 24 hours per day; 7 days per week.
• Full access to library facilities and services through Michigan College of Optometry, including article retrieval and inter-library loan. 

Physical Facilityies and Equipment:

The learning environment is enhanced by state of the art facilities and equipment including the following:  

 

Description	Contents
Patient waiting areas	Main and sub-wait (for patients who are dilating)
Medical Support Assistant’s office	Fax machine/copier/printer, computer, telephone
Auxiliary Examination Equipment (various locations)	Topcon auto-lensometers (2) and several manual lensometers Humphrey FDT Tonopen (3) Kowa handheld slit lamp
Patient restroom
Conference room	50” high definition LCD monitor for lectures/presentations Networked computers (3) and networked printer (1) Ophthalmic and general medical references Conference table and work stations for students and residents
Imaging and special testing room	Topcon digital imaging system/retinal camera Haag Streit BX photo slitlamp Corneal pachymeter Heidelberg HRT 3 Heidelberg Spectralis (spectral domain OCT with enhanced depth imaging, anterior segment OCT, infrared reflectance, fluorescein angiography, ICG angiography and fundus autofluorescence) Aviso A/B ultrasound (with 10 MHz/20MHz posterior segment probes, 25 MHz linear high resolution anterior segment probe and axial length probe)
Visual field room	Humphrey Visual Field Analyzer II, model 750
Pre-testing room	Topcon automated refracting system (including auto-refractor/keratometer/lensometer) Haag Streit slit lamp IOL Master
Fully equipped examination room with ophthalmic lasers	Fully equipped exam room including Haag Streit BQ slit lamp with teaching tube attachment Argon, YAG and SLT lasers CO2 laser available in OR for oculoplastic cases
Fully equipped examination room with low vision equipment	Fully equipped exam room Contrast sensitivity chart Tangent screen Low vision distance acuity chart Low vision devices
6 Fully equipped examination rooms	Six additional fully equipped standard examination lanes -Heine binocular indirect ophthalmoscopes, Haag Streit biomicroscopes 900 LED series, applanation tonometers, Reliance chair/stand units with wheel chair glides and computerized acuity testing systems Additional exam room equipment includes:  Sussman style 4-mirror, Goldman style contact 3-mirror, blood pressure cuff and stethoscope, ophthalmoscope, retinoscope, transilluminator, exophthalmometer, occluder, maddox rod, prism bars, color plates, amsler grid plates, trial lens set, trial frame, Feinbloom chart, red/green glasses, stereo fly/glasses, lacrimal dilator, lacrimal cannula, syringes, forceps, blades, and foreign body removal instruments including Alger brush
Patient education corner	TV/VCR with educational videos Educational brochures and posters
Private offices for program supervisor and faculty	Printers Additional ophthalmic and general medical references, journals and audio-tapes
Tech work station	Networked computers (2) and scanner
Staff restroom
Staff break room	Refrigerator Microwave Sink Table/chairs
Other	Numerous networked computers are located in offices and clinical areas (including each exam lane) and all are connected to a networked laser printer.  From these computers, residents may access the following: Internet Word processing, database management and presentation software Electronic medical records (including teleretinal photographs,  radiologic studies and other remote images) Medical reference material including an extensive assortment of full text journals and text books (ophthalmic and general medical)

• A stipend in the amount of $43,924 for this period, paid in 26 biweekly payments
• 13 days of paid annual leave, accrued at the rate of 4 hours per pay period; Unused leave may be “cashed out” at the conclusion of the program
• 13 days of paid sick leave, accrued at the rate of 4 hours per pay period; Extended sick leave requires documentation of medical necessity from the resident’s physician.
• 10 paid Federal Holidays
• Additional days of “authorized absence” may be granted at the supervisor’s discretion for purposes of attending professional activities that are part of the formal program curriculum.
• Eligibility to participate in the Federal Employees Health Benefits Program and the Federal Employees Group Life Insurance Program.

• Serve as a resident for the entire period of time specified above (or the equivalent)
• Complete a manuscript of publishable quality OR present a scientific poster or grand rounds presentation (or equivalent) at the American Academy of Optometry (or other similar approved venue) prior to the end of the residency year
• Maintain patient and activity logs in a timely and accurate manner
• Provide periodic self-assessment and summary reports as requested by the program supervisor to assist in determining whether the program and resident are meeting stated goals and objectives
• Actively participate in didactic activities including conference, journal club, and lectures/case presentations
• Prior to the end of the residency year, present a lecture or case presentation to students, staff and/or colleagues at Michigan College of Optometry’s Residency Day (or other similar approved venue)
• Log at least 1500 patient encounters by the end of the residency year; exceptions may be made at the discretion of the program supervisor
• Demonstrate overall “satisfactory” or better clinical performance throughout the residency year