Pediatric Optometry Residency: Emphasis on Vision Therapy and Vision Rehabilitation

Non-Accredited: Pediatric Optometry Residency: Emphasis on Vision Therapy and Vision Rehabilitation

General description of the residency

This residency will provide advanced clinical experience that focuses on pediatric eye care and the management of vision disorders involving amblyopia/strabismus, traumatic brain injury, developmental delays and vision related learning difficulties. The resident will gain experience in further developing skills in the treatment and management of the above conditions including myopia management, pediatric ocular pathology, neuro optometry and the development of vision rehabilitation plans. This residency will be divided per week between Bolton Optometry, Bolton ON (Mon – Wed) and the University of Waterloo, School of Optometry and Vision Science (Fri, Sat).

Dates of residency: August 1, 2024 – August 31, 2025.

Salary: $42,000 per year, with an additional $2000 to be used toward travel to optometric meetings. For benefits and other information, please see the Residency FAQs.

Facility and supervisor information

Primary Supervisor at Bolton Optometry Clinic: Dr. Michelle McKenzie, address: 12 Parr Blvd. Unit 12, Bolton, ON L7E 4H1

Additional supervisors at BOC: Dr. Virginia Donati

Primary supervisor at the School of Optometry and Vision Science (WOVS): Dr. Julie Shalhoub and Dr. Lisa Christian

Additional supervisors at WOVS: Dr. Lisa Christian (Pediatrics), Dr. Nadine Furtado (Primary Care and Acute Care)

Location: The Residency is split approximately 60% at Bolton Optometry Clinic and 40% at WOVS. The first part of each week is spent at Bolton Optometry Clinic and the last part at WOVS. For the WOVS component, the residency will take place in the School of Optometry and Vision Science, but some attendance at the Health Science Optometry Clinic (HSOC), Kitchener may be assigned.

Hours: The clinical components of the residency are scheduled during operating hours at either WOVS or Bolton Optometry Clinic for five days per week or equivalent. Self-study is expected in the resident’s own time, although half a day per week is also given for self-study, administration tasks and didactic components. Evening clinics may be scheduled, in lieu of clinic during a weekday. The resident will also be scheduled to be on-call after hours. The attendance at Bolton Optometry Clinic will be scheduled within Monday, Tuesday and Wednesday. The attendance at WOVS will be scheduled within Thursday, Friday and Saturday of each week.

Anticipated Weekly Curriculum:

Term 1 Fall

(September– December)

Term 2 Winter

(January – April)

Term 3 Spring

(May – August)

Direct Patient Care

(Peds, BV/VT or PC) = 4.5

Clinic Supervision

(Peds or BV/VT) = 1 or 2

Direct Patient Care

(Peds, BV/VT or PC) = 2.5 or 3.5

Clinic Supervision

(Peds, BV/VT) = 2

Direct Patient Care

(Peds, BV/VT or PC) = 2.5

0.5 days = Self Study (Bolton Optometry Clinic)

Residency Goals and Objectives

Goal 1 To train the resident to provide advanced optometric and vision therapy care for pediatric and special needs patients

Objective 1 To train the resident to accurately and efficiently examine patients of all types/needs, implement all relevant optometric management and make the appropriate referrals when necessary

Outcome measures:

I. The resident will experience approximately 300 direct patient encounters with pediatric patients during the year.

II. At Bolton Optometry Clinic, the resident will discuss each patient encounter with their supervisor until the resident displays adequate competency for each specific type of examination/level of difficulty.

III. At WOVS there will be bi-weekly meetings with a supervisor to discuss cases.

IV. At both Bolton Optometry Clinic and WOVS, the resident will be provided with facilities and equipment to provide specialised pediatric, binocular vision and vision therapy care.

V. The resident will maintain an accurate log of their patient encounters

VI. The resident will submit ePortfolio/Reflections based on a patient or teaching situation in which they will reflect on experiences gained, knowledge and skills learnt and changes to implement for improvement.

Objective 2 To train the resident to conduct a complete binocular vision examination on visual skills cases as well as strabismus and amblyopia evaluations, with appropriate treatment and management through lenses, prisms and/or vision therapy

Outcome measures:

I. The resident will experience approximately 100 binocular vision patient encounters during the year.

II. The supervisor will review all therapy plans until the resident displays adequate vision therapy sequencing, planning and implementation.

III. After each binocular vision evaluation, the resident will generate a detailed report outlining all tests given, results and interpretation for the patient/parent and referring professional.

IV. The resident will be provided with facilities and equipment to provide full binocular vision assessments and therapy.

V. The resident will maintain an accurate log of their patient encounters.

VII. The resident will submit an ePortfolio/Reflections based on a patient or teaching situation in which they will reflect on experiences gained, knowledge and skills learnt and changes to implement for improvement

Objective 3. To train the resident to conduct visual perceptual evaluations, including scoring, interpretation, treatment, and management of any visual perceptual deficiencies.

Outcome measures:

I. The resident will experience approximately 150 vision therapy patient encounters

II. The supervisor will review all therapy plans until the resident displays adequate vision therapy sequencing, planning and implementation.

III. After each visual perception evaluation, the resident will generate a detailed report outlining all tests given, results and interpretation for the patient/parent and referring professional.

IV. The resident will be provided with facilities and equipment to provide visual perception evaluations and therapy.

V. The resident will maintain an accurate log of their patient encounters.

Objective 4. To increase the residents comfort and efficiency in examining and managing special needs patients of all ages, and make the appropriate referrals when necessary

Outcome measures:

I. The resident will experience approximately 20 special needs patient encounters.

II. The resident will discuss each patient encounter with their supervisor until the resident displays adequate competency for each specific type of examination/level of difficulty.

III. The resident will maintain an accurate log of their patient encounters.

IV. The resident will submit ePortfolio/Reflections based on a patient or teaching situation in which they will reflect on experiences gained, knowledge and skills learnt and changes to implement for improvement.

Objective 5. To train the resident to plan and successfully implement a vision therapy program on all of the above-described patients when appropriate and necessary.

Goal 2: To enhance the residents skills in optometric primary care for patients of all ages.

Objective 1. The resident will provide direct patient care during approximately 75 primary care or acute care patient encounters during the year.

Outcome measures:

I. The resident will take part in bi-weekly meetings with an experienced optometrist to discuss cases, progressing to monthly meetings based on good progress.

II. Appropriately licensed faculty will be available for consultation to advise the resident on assessment, diagnosis and management of patients.

III. The resident will maintain an ePortfolio/Reflections based on a patient or teaching situation in which they will reflect on experiences gained, knowledge and skills learnt and changes to implement for improvement

IV. The resident will maintain an accurate log of their patient encounters.

Goal 3: To increase the residents knowledge of pediatric optometry, binocular vision management and vision therapy.

Objective 1: The resident will participant in a program of didactic activities and self-study.

Outcome measures:

I. The resident will attend at least one clinical optometric conference during the year

a. Preferred meetings include the American Academy of Optometry (AAO) and the College of Optometrists in Vision Development (COVD)

II. The resident will have access to the Witer Learning Resource Centre (library) resources.

III. Participate and present in short and grand rounds sessions with other residents and faculty.

Goal 4: To develop the residents ability to critically review the literature

Objective 1: The resident will participate in directed readings and prepare a written paper.

Outcome measures:

I. The resident will read specified articles/chapters/on-line material and participate in discussions based on the material.

II. The resident will write a paper suitable for publication in a peer reviewed journal.

III. As part of the residents didactic curriculum, the resident will participate in the Evidence Based Medicine (EBM)/Journal club, which is a directed reading class with the focus of developing skills to critically appraise the clinical literature with an emphasis on evidence based medicine and clinical statistics.

Goal 5: To train the resident to become an effective communicator and educator

Objective 1: The resident will participate in speaking and writing opportunities under guidance and will receive feedback from their supervisor(s)

Outcome measures:

I. The resident will present at least four oral presentations during their residency

II. The resident will prepare a paper of publishable quality in an academic or clinical journal

III. The resident will submit a poster or paper of a case report for presentation at AAO or COVD

IV. As part of the resident’s didactic curriculum, the resident will participate in a series of workshops on writing skills, oral communication skills and case study development.

Objective 2: The resident will be involved in the clinical supervision of optometry interns during their rotation in the clinic.

Outcome measures:

I. The resident will be scheduled to supervise undergraduate Waterloo optometry students in the primary care or pediatric clinic for one day per week in the 2nd and/or 3rd term of the residency.

II. As part of the resident’s didactic curriculum, the resident will participate in a series of workshops to prepare and develop the resident’s skills for supervising undergraduate Waterloo optometry students.

III. The resident will receive teaching evaluations from the undergraduate students in the clinic.

Supervision

Supervision at Bolton Optometry Clinic

While the resident is at Bolton Optometry Clinic, the resident will be directly supervised by Dr. Michelle McKenzie for all patient care. If for some unforeseen reason Dr. McKenzie is unavailable, Dr. Virginia Donati will be available either in person or by phone.

Supervision/guidance on each patient interaction will be mandatory until the resident displays adequate competency for each specific type of examination/level of difficulty. As competency improves, the level of difficulty of each case will increase.

Dr. McKenzie will review ALL vision therapy activities planned by the resident prior to execution in the therapy room until the resident displays adequate vision therapy sequencing, planning and implementation. By the end of the residency the resident should be able to plan and implement therapy for all non-strabismic, strabismic/amblyopic and visual perceptual cases (for patients of all ages and level of development).

After each binocular vision and visual perceptual evaluation, the resident will generate a detailed report outlining all tests given, results and interpretation for the patient/parent and referring professional.

Supervision at WOVS

While the resident is at WOVS, the resident will be directly supervised by Drs. Lisa Christian and Julie Shalhoub for all patient care.

Dr. Shalhoub will review ALL vision therapy activities planned by the resident prior to execution in the therapy room until the resident displays adequate vision therapy sequencing, planning and implementation. By the end of the residency the resident should be able to plan and implement therapy for all non-strabismic, strabismic/amblyopic and visual perceptual cases (for patients of all ages and level of development).

After Hours On-Call: The resident will also be scheduled to be on-call throughout the year.

Clinical Experience:

The complexity and number of patients that the resident is expected to manage will increase throughout the residency. By the end of the Residency, the resident should be able to competently examine and treat the following patients: pediatric, infant, special needs patients of all complexities, non-strabismic binocular vision patients, strabismic/amblyopic patients, and patients with visual perceptual difficulties.

The patient complexity will increase, from visually normal examinations (infant and pediatric) to special needs evaluations (increasingly complex). Binocular vision evaluations will progress from non-strabismic evaluations to strabismic/amblyopic evaluations and visual perceptual evaluations.

Similarly, the resident will progress in their assessment and management of primary care patients. It is expected that the resident will progress in terms of the selection of tests which comprise the examination, from undertaking a full battery of tests, to more expert selection of tests based on patient presentation and case history.

Pediatric and Binocular Vision Clinic at WOVS (Winter term) - at this point in the program, it is expected that the resident would manage pediatric and binocular vision patients of varying complexity.

Scholarly/didactic activities:

The resident will:

Participate in a directed reading journal club (EBM/Journal club) with the focus of developing skills to critically appraise the clinical literature. This will include topics on clinical statistics, evidence-based medicine, and research design.
The resident will write an article in a form suitable for publication in a peer reviewed, clinical or academic journal by the end of the residency.
Attend seminars and lectures at the School of Optometry and Vision Science whenever possible.
Attend the meeting of the American Academy of Optometry (AAO) and/or the College of Optometrists in Vision Development (COVD) meeting, if possible.
Participate and present in short and grand rounds sessions throughout the year [see a) below].

Educator/knowledge sharing component

The resident will:

Present four oral presentations throughout the year. Two of these will be short rounds presentations, one will be a full Grand rounds presentation and one will be an open style oral presentation such as a continuing education lecture, grand rounds or seminar.
Submit an abstract for consideration at either the AAO or COVD annual meeting, if possible
The residency will prepare a paper for publication in an academic or clinical journal. This may be based on one of the oral presentation cases or topics.
As part of the residents didactic curriculum, the resident will participate in a series of workshops on writing skills, oral communication skills and case study development.
As part of the residents didactic curriculum, the resident will participate in a series of workshops to prepare and develop the residents skills for supervising undergraduate UW optometry students.

Assessment and evaluation of the resident

The resident will receive feedback from their supervisor on the grand rounds and oral open-style presentations, which will be graded by their supervisor(s) and by Faculty, other residents and students for content and delivery using a written evaluation.
Feedback will be given on the review paper for content and writing style by the supervisor(s).
At the bi-weekly meeting with the WOVS supervisors, the resident will be given feedback on their clinical performance. Any major concerns with performance will be provided in written format.
Regarding teaching, the resident will receive teaching evaluations from the undergraduate students in the clinic.
While at Bolton Optometry Clinic, the resident will be given feedback on their clinical skills bi-weekly. Vision Therapy sessions will be reviewed and prepped weekly prior to the patient’s next session. Any major concerns with performance will be provided in written format.
The resident will receive a written evaluation at least once per term on their overall progress in the residency.
The resident will receive an evaluation of their ePortfolio/Reflections