Faculty Chair:

John Andazola, MD

Contacts:

Robert Villalobos, MD

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Required Experiences:

Memorial Medical Center

Optional Experience:

Weekly Schedule PGY2:

Sunday	Monday	Tuesday	Wed	Thursday	Friday	Saturday
	Ophtho	Ophtho	Clinic	Ophtho	Clinic
	Ophtho	Ophtho	Didactics	Ophtho	Clinic

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Requirements:

AOA

Surgery

The program must provide at least twenty weeks of training in surgical disciplines, including at least four weeks of general surgery training during the OGME-1 year.

At a minimum this shall include:

• Preoperative and post-operative care.
• Training in the following sub-specialties, which may be ambulatory or inpatient.
• Ophthalmology.
• Orthopedics.
• Urology.
• ENT.

ACGME

Residents must have at least 100 hours (or one month) dedicated to the care of surgical patients, including hospitalized surgical patients. (Core)

This experience must include operating room experience

There must be specific subspecialty curricula to address the breadth of patients seen in family medicine. (Core)

The program must ensure that every resident has exposure to a variety of medical and surgical subspecialties throughout the educational program. (Detail)

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Description of Rotation or Educational Experience:

Preamble

Family physicians help patients and their family members adjust to acute or chronic illnesses that may significantly affect daily life and family function. Ocular dysfunction presents unique challenges to patients. Family medicine residents must learn to:

Maximize visual function through the control of environmental factors, the management of disease and preventive care. Deterioration of function can be minimized through initiation of appropriate treatment, including rapid referral where necessary. The family medicine resident must also learn when social and/or psychological intervention is appropriate in patients who have ocular dysfunction.

During the Ophthalmology Rotation the resident will obtain the skills necessary to diagnose, treat, and refer disorders that are common in the family physicians office. It is expected that the resident spend time in the clinic setting, and the OR. Hands-on education must be provided.

Expectations:

Residents

Residents are expected to arrive to the Ophthalmology rotation on time and to dress and act in a professional manner. They are expected to contact the preceptor’s office prior to their first day on the rotation in order arrange the initial meeting time and location on day one of the rotation. It is expected that while at the preceptor’s office the residents will be respectful of the office space and personnel. The resident is responsible for maintaining a procedure log as well as completing assigned readings.

Faculty

Family medicine faculty will provide precepting of ophthalmology cases and procedures as seen in resident continuity clinics. Dr. Villalobos, and possibly other physicians in his practice, will provide precepting during the focused ophthalmology rotation. The faculty and preceptors are expected to allow the resident to participate in active patient care as well as procedures when appropriate. The preceptors should also provide time and allowance for explanation and teaching of eye conditions and their treatments.

Call

There is no specific call responsibility for this rotation.

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Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of the patient with an eye condition. Residents are expected to:

Competencies

• Be able to perform an eye exam and assessment and develop an appropriate treatment plan. (Medical Knowledge, Patient Care)
• Coordinate ambulatory, in-patient and institutional care across health care providers, institutions and agencies. (Systems-based Practice, Patient Care)

Objectives

• Obtain and report appropriate history
• Generate an appropriate differential diagnosis
• In the appropriate setting, the resident should demonstrate the ability to independently perform or appropriately refer:
  • Evaluation
    • Perform specific procedures and interpret results
      • Tests of visual acuity, visual fields and ocular motility
      • Direct ophthalmoscopy
      • Flashlight examinations
      • Fluorescein staining of the cornea
      • Tonometry
      • Slit-lamp examination
    • Perform physical examination in patients of all ages, with emphasis on understanding normal neurologic and motor responses as well as appearance
    • Localize the problem and generate a differential diagnosis and management planning
    • Formulate a rational plan for investigation and management, including assessment of severity and the need for immediate expert assistance
  • Management
    • Formulate a plan for management, investigation and acquisition of expert advice, with an awareness of the potential risks, costs and value of information that can be obtained
    • Manage and recognize the prevalent and treatable diseases listed in the “Medical Knowledge ” section of this guideline with consultation as appropriate
    • Manage and coordinate psychosocial and family issues, including long-term care of debilitating ocular conditions, necessary environmental adaptation and use of community resources
    • Manage appropriate medications
    • Use appropriate diagnostic tests and medications
      • Mydriatics
      • Topical anesthetics
      • Corticosteroids
      • Antibiotics
      • Glaucoma agents

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Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:

Competencies

Be able to demonstrate surgical knowledge and assessment and develop an appropriate treatment plan. (Medical Knowledge, Patient Care)

Objectives

In the appropriate setting, the resident should demonstrate the ability to apply knowledge of:

• Normal anatomy, physiology and aging of the eye and ocular function
• Psychological and adaptive needs of patients with chronic ocular deterioration
• Effects of drugs and toxins on ocular function and disease
• Effects of ocular drugs on systemic function
• Understanding of ocular disability in elderly patients and the importance of regular assessment and maintenance of functional capacity
• Ocular complications of systemic illness
• Guidelines for appropriate vision evaluation (including recommended time between evaluations) from birth to senescence
• Initial diagnosis, management and appropriate referral criteria for common eye problems
  • Refractive errors
    • Nearsightedness (myopia)
    • Farsightedness (hyperopia)
    • Presbyopia
  • Skin and adnexal disorders
    • Infections
      • Hordeolum
      • Pre-septal cellulitis
      • Orbital cellulitis
      • Dacryocystitis
    • Inflammation
      • Graves’ disease
      • Chalazion
    • Eyelid disorders
      • Entropion and extropian
      • Ptosis
    • Benign tumors
      • Milia
      • Papilloma
      • Keratoacanthoma
      • Nevus
      • Xanthelasma
      • Dermoid
    • Malignant tumors
      • Basal cell carcinoma
      • Squamous cell carcinoma
      • Lymphoma
      • Malignant melanoma
      • Retinoblastoma
  • Conjunctival disorders
    • Conjunctivitis
      • Viral conjunctivitis
      • Herpes simplex conjunctivitis
      • Herpes zoster conjunctivitis and keratitis
      • Bacterial conjunctivitis
      • Allergic conjunctivitis
    • Conjunctival nevus
      • Pterygium
      • Pinguecula
    • Conjunctival tumors
  • Corneal diseases
    • Superficial trauma and infection
      • Corneal abrasion (including those caused by contact lenses)
      • Keratitis
      • Corneal ulcers
    • Dry eye and associated diseases
  • Iritis
    • Unequal pupils
    • Afferent pupillary defect
    • Adie’s pupil syndrome
    • Horner’s syndrome
  • Cataracts
  • Glaucoma
  • Retinal disease
    • Associated with visual loss
      • Central retinal vein occlusion
      • Branch retinal vein occlusion
      • Central retinal artery occlusion
      • Retinal detachment and vitreous hemorrhage
    • Associated with medical conditions
      • Hypertension
      • Diabetes mellitus
    • Macular degeneration
    • Age-related changes
  • Optic nerve disorder
  • External muscular disorders
    • Cranial nerve palsies
  • Trauma
    • Blunt
    • Penetrating
• Appropriate indications for special procedures in ophthalmology and ophthalmoradiology
  • Fluoresceinangiography
  • Ocular ultrasound
  • Visual field testing
  • Magnetic resonance imaging (MRI) and computed tomography (CT) of the eye
• Indications, contraindications, limitations and follow-up care of elective eye procedures, including the spectrum of refractive surgery, cosmetic surgery and procedures.(including the procedures of lens transplant and laser keratomy)
• Prevention of eye injury and vision loss

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Practice Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. Residents are expected to develop skills and habits to be able to:

Competencies

• Identify strengths, deficiencies and limits in one’s knowledge and expertise
• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems
• Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident’s teaching abilities by faculty and/or learners

Objectives

• Ask questions as an engaged, critical learner
• Use information technology to manage information, access on-line medical information, and support their own education.

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System Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to:

Competencies

• Incorporate considerations of cost awareness and risk-benefit analysis in patient care
• Work in interprofessional teams to enhance patient safety and improve patient care quality

Objectives

• Practice cost-effective health care and resource allocation that does not compromise quality of care
• Advocate for quality patient care and assist patients in dealing with system complexities to minimize discomfort or confusion
• Demonstrate an understanding of the ophthalmic consultant’s role, including the different responsibilities of ophthalmologists, optometrists and opticians.

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Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

Competencies

Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

Objectives

• Accept responsibility for patient care
• Consistently performs in a punctual, reliable and collegial manner
• Demonstrate an understanding of the impact of ocular illness and dysfunction on patients and their families

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Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to:

Competencies

• Communicate effectively with patients and families across a broad range of socioeconomic and cultural background
• Communicate effectively with physicians, other health professionals, and health related agencies
• Work effectively as a member of leader of a health care team or other professional group

Objectives

• Make organized and effective oral presentations
• Communicate with the patient, family and members of the healthcare team in a timely, developmentally and culturally appropriate manner

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Teaching Methods

Residents will provide medical care to patients under the direct supervision of the attending physician. They will be supervised on all procedures performed in the hospital. The will participate in weekly conferences at the FMC. Residents will be assigned specific reading topics to be completed by the end of their month on the service.

Assessment Method (Residents)

Direct observation with a final global assessment based on a competency scale. All procedures will be recorded on New Innovations.

Assessment Method (Program Evaluation)

Residents will be provided with an evaluation of their experiences and given the opportunity to provide feedback of the rotation during their quarterly IEP assessments.

Level of Supervision

The resident is directly supervised by the attending physician during all procedures performed in the hospital. The attending will see all patients on the service each day and will document their involvement in the patient’s care. An Attending will be available the entire time the resident is on service

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Educational Resources

Readings:

Resources

Berson FG. Basic Ophthalmology for Medical Students and Primary Care Residents. San Francisco, Calif.: American Academy of Ophthalmology, 1999.

Chawle HB. Ophthalmology: A Symptom-based Approach. Woburn, Mass.: Butterworth- Heinemann, 1999.

Trobe JD. The Physician’s Guide to Eye Care. San Francisco, Calif.: American Academy of Ophthalmology, 2000.

Vaughan D, Asbury T, Riordan-Eva P. General Ophthalmology. Stamford, Conn.: Appleton and Lange, 1999.

Wu G. Ophthalmology for Primary Care. Philadelphia, Pa.: WB Saunders, 1997.

Web Sites

American Academy of Ophthalmology: http://www.aao.org 􏰀

EyeNet Magazine: http://www.aao.org/news/eyenet

National Eye Institute: http://www.nei.nih.gov

Eye and Vision Disorders – AAFP:

http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=66