Pediatric Optometry Residency / Emphasis on Vision Therapy and Vision Rehabilitation

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

Objective 1 You will accurately and efficiently examine patients of all types/needs, implement all relevant optometric management and make the appropriate referrals when necessary.

Outcome measures:

1. You will experience approximately 300 direct patient encounters with pediatric patients during the year.
2. At APOPC, you will discuss each patient encounter with her supervisor until you display adequate competency for each specific type of examination/level of difficulty.
3. At WOSOVS there will be bi-weekly meetings with a supervisor to discuss cases.
4. At both APOPC and WOVS, you will be provided with facilities and equipment to provide specialised pediatric care.
5. You will maintain an accurate log of your patient encounters.
6. You will submit ePortfolio/Reflections based on a patient or teaching situation in which you will reflect on experiences gained, knowledge and skills learned and changes to implement for improvement.

Objective 2 You will 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:

1. You will experience approximately 100 binocular vision patient encounters during the year.
2. The supervisor will review all therapy plans until you display adequate vision therapy sequencing, planning and implementation.
3. After each binocular vision evaluation, you will generate a detailed report outlining all tests given, results and interpretation for the patient/parent and referring professional.
4. You will be provided with facilities and equipment to provide full binocular vision assessments and therapy.
5. You will maintain an accurate log of your patient encounters.
   7. You will attend a 1-day Vision Therapy training course given individually at Vaughan Family Vision Care.
   8. You will submit ePortfolio/Reflections based on a patient or teaching situation in which you will reflect on experiences gained, knowledge and skills learned and changes to implement for improvement.

Objective 3. You will conduct visual perceptual evaluations, including scoring, interpretation, treatment and management of any visual perceptual deficiencies.

Outcome measures:

1. You will experience approximately 150 vision therapy patient encounters
2. The supervisor will review all therapy plans until you display adequate vision therapy sequencing, planning and implementation.
3. After each visual perception evaluation, you will generate a detailed report outlining all tests given, results and interpretation for the patient/parent and referring professional.
4. You will be provided with facilities and equipment to provide visual perception evaluations and therapy.
5. You will maintain an accurate log of your patient encounters.
6. You will attend a 1-day Vision Therapy training course given individually at Vaughan Family Vision Care
7. You will submit ePortfolio/Reflections based on a patient or teaching situation in which you will reflect on experiences gained, knowledge and skills learned and changes to implement for improvement

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

Outcome measures:

1. You will experience approximately 20 special needs patient encounters.
2. You will discuss each patient encounter with her supervisor until you display adequate competency for each specific type of examination/level of difficulty.
3. You will maintain an accurate log of her patient encounters.
4. You will submit ePortfolio/Reflections based on a patient or teaching situation in which you will reflect on experiences gained, knowledge and skills learned and changes to implement for improvement

Objective 5. You will plan and successfully implement a vision therapy program on all of the above-described patients when appropriate and necessary.

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

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

Outcome measures:

1.   a. You will take part in bi-weekly meetings with an experienced optometrist to discuss cases, progressing to monthly meetings based on good progress.
2. Appropriately licensed faculty will be available for consultation to advise the resident on assessment, diagnosis and management of patients.
3. You will maintain an ePortfolio/Reflections based on a patient or teaching situation in which you will reflect on experiences gained, knowledge and skills learned and changes to implement for improvement
4. You will maintain an accurate log of your patient encounters.

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

Objective 1: You will participate in a programme of didactic activities and self-study.

Outcome measures:

1. You will attend at least one clinical optometric conference during the year (American Academy of Optometry or COVD).
2. You will have access to the UW Witer Learning Resource Centre (library) resources.
3. You will participate and present in short and Grand Rounds sessions with other residents and faculty.

Goal 4: To develop your ability to critically review the literature.

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

Outcome measures:

1. You will read specified articles/chapters/on-line material and participate in discussions based on the material.
2. You will write a paper suitable for publication in a peer-reviewed journal.
3. As part of your didactic curriculum, the resident will participate in the Evidence-Based Medicine/Journal club, which is a directed reading class focused on developing skills to critically appraise the clinical literature with an emphasis on evidence-based medicine and clinical statistics.

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

Objective 1: You will participate in speaking and writing opportunities under guidance and will receive feedback from her supervisor(s).

Outcome measures:

1. 1. You will present at least four oral presentations during their residency
   2. You will prepare a paper of publishable quality in an academic or clinical journal
   3. You will submit a poster or paper of a case report for presentation at AAO or COVD
   4. As part of the Resident’s didactic curriculum, you will participate in a series of workshops on writing skills, oral communication skills and case study development.

Objective 2: You will be involved in the clinical supervision of optometry interns during your rotation in the clinic.

Outcome measures:

1. You will be scheduled to supervise undergraduate UW optometry students in the primary care or pediatric clinic for one day per week in the 2^nd and/or 3^rd term of the residency.
2. As part of the Resident’s didactic curriculum, you will participate in a series of workshops to prepare and develop your skills for supervising undergraduate UW optometry students.
3. You will receive teaching evaluations from the undergraduate students in the clinic.

Drs. Shalhoub and Peddle will act as your primary supervisors.

Supervision at APOPC

While you are at APOPC, you will be directly supervised by Dr. Angela Peddle for all patient care. If for some unforeseen reason Dr. Peddle is unavailable, Dr. Jeff Speers will be available either in person or by phone. 

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

Dr. Peddle will review ALL vision therapy activities you plan prior to execution in the therapy room until you display adequate vision therapy sequencing, planning and implementation. By the end of the residency, you 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, you will generate a detailed report outlining all tests given, results and interpretation for the patient/parent and referring professional.

Supervision at WOVS

Pediatric and Special Needs Clinic: Dr. Shalhoub will be the main supervisor. Dr. Debbie Jones and Dr. Lisa Christian will be secondary supervisors. On occasions when Dr Christian or Jones are not directly available in person or by phone, another optometrist scheduled in Internal Pediatrics will be identified to consult.

Primary Care: Dr. Nadine Furtado will be the main supervisor.

For supervision of the AC/PC components, arrangements will be made so that you know which clinician to consult regarding a patient (at the time of the appointment), should you need to do so. File review meetings for the primary care and/or acute care portions will take place at least once per month with a designated Faculty member but may be more frequent at the start of the residency and depending on the number of days per week that you are scheduled for these activities.

After Hours On-Call: You may also be scheduled to be on-call throughout the year.

The complexity and number of patients that you are expected to manage will increase throughout the residency. By the end of the Residency, you 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, you will progress in your assessment and management of primary care patients. It is expected that you 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 Clinic at WOVS (Winter term) - at this point in the program, it is expected that you will manage pediatric patients of varying complexity.

As you progresses through the residency, you will be expected to undertake supervision of undergraduate optometry students in Primary Care and Pediatric and Special Needs Clinics.

You will:

1. 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.
2. Submit an abstract for consideration at either the AAO or COVD annual meeting, if possible
3. Prepare a paper for publication in an academic or clinical journal. This may be based on one of the oral presentation cases or topics.
4. As part of your didactic curriculum, you will participate in a series of workshops on writing skills, oral communication skills and case study development.
5. As part of your didactic curriculum, you will participate in a series of workshopss to prepare and develop your skills for supervising undergraduate optometry students.

1. You will attend a 1-day Vision Therapy training course (equivalent to the COPE-approved course given at the 2012 COVD Annual Meeting Applied Concepts). This course will be provided individually by Dr Peddle.
2. You will be trained to give visual perceptual testing, including scoring and interpretation of test results, if needed.

1. You will receive feedback from your supervisor on the Grand Rounds and oral open-style presentations, which will be graded by your supervisor(s) and by Faculty, other residents and students for content and delivery using a written evaluation.
2. Feedback will be given on the review paper for content and writing style by the supervisor(s).
3. At the bi-weekly meeting with the WOVS supervisors, you will be given feedback on your clinical performance. Any major concerns with performance will be provided in written format.
4. Regarding teaching, you will receive teaching evaluations from the undergraduate students in the clinic.
5. While at APOPC, you will be given feedback on your clinical skills on a bi-weekly basis. 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.
6. You will receive a written evaluation at least once per term on their overall progress in the residency.
7. You will receive an evaluation of your ePortfolio/Reflections.