Ocular Disease Residency: Emphasis on Glaucoma

Goal 1: Expert Role - To train you to competently examine and manage patients with diverse and complex clinical findings in the sub-discipline areas of glaucoma, anterior segment disease, posterior segment/neurological disease, and acute care.

Objective 1: You will accurately and efficiently assess patients in each of the identified subdiscipline areas

Outcome measures:

1. You will be required to examine patients in each clinic or disease area listed above.
2. You will be required to provide primary care to new refugees/underprivileged patients – this diverse subset of patients presents with unique challenges such as language barriers and a higher incidence and range of disease(s).
3. You will be scheduled approximately one day per week in the acute care clinic.
4. You will meet bi-weekly (at minimum) with your supervisor to discuss patient encounters and/or have patient files reviewed until you display adequate competency for each specific type of assessment.
5. You will meet bi-weekly (at minimum) with your supervisor to discuss case management.
6. You will experience a minimum of 250 encounters for patients with glaucoma, 300 with anterior segment diseases/disorders, 200 with posterior segment/neuro diseases; as well as 70 independent encounters in imaging services and 200 in an acute care setting. Visits will be primarily in direct care and supervised care, as well as some shadowing.
7. You will submit ePortfolio/Reflections based on a patient or teaching situation(s) during which experiences were gained or knowledge and skills learned, as well as changes to implement for improvement.
8. You will maintain an accurate log of all patient encounters.

Objective 2:  You will become proficient in utilizing and analyzing the results of imaging instruments for the management of ocular disease

Outcome measures:

1. Training will be provided to allow you to become more proficient with the use of the following:
   1. Optical Coherence Tomography (OCT-Spectralis, Zeiss, Nidek) – anterior and posterior segment.
   2. Scanning laser tomography – Heidelberg Retina Tomography (HRT).
   3. Fundus Autofluorescence.
   4. B-Scan Ultrasonography.
   5. Fundus photography.
   6. Perimetry.
2. You will spend one half-day per week for at least 2 of three terms in the imaging clinic providing imaging services to patients.
3. A supervisor will review the files from the patients you see in imaging clinic until an adequate level of competency has been demonstrated.
4. You will maintain an accurate log of all patient encounters.

Goal 2: Expert Role - To develop and solidify strong clinical diagnostic and management skills in the area of ocular disease and primary care.

Objective 1: You will understand advanced management options for more complex cases and appropriately identify when a referral is required.

Outcome measures:

1. The resident will spend at minimum one half-day per month with a glaucoma specialist/general ophthalmologist (or a total of 6 days over the year)
2. Information from the resident patient log will be used to ensure exposure to the following:
   1. Fluorescein angiography analysis.
   2. SLT/ALT, peripheral iridotomy, YAG – including post-op care.
   3. Glaucoma filtration surgery – including post-op care, where appropriate.
   4. Cataract surgery – including post-op care.
   5. Anti-VEGF injections – including post-op care.
   6. Pan-retinal photocoagulation and macular grid laser – including post-op care.

3. The resident will discuss outcomes of patient care during meetings with supervisor.
4. The resident will submit ePortfolio/Reflections based on a patient or teaching situation during which experiences were gained, and knowledge and skills learned, and changes developed to implement for improvement.
5. The resident will maintain an accurate log of all patient encounters.

Objective 2: You will examine patients for both primary care and ocular disease conditions in diverse settings.

Outcome measures:

1. The resident will be required to provide primary care to new refugees/underprivileged patients.
2. The resident will be scheduled approximately one day per week in the acute care clinic.
3. The resident will be expected to provide continuity of care and follow-up with all patients seen whenever possible and necessary.
4. The resident will discuss patient management and/or have patient files reviewed by a supervisor until the resident displays adequate competency in diagnosis and management.
5. A supervisor will be available on-call or on-site for consultation on patients when needed.
6. The resident will submit ePortfolio/Reflections based on a patient or teaching situation in which s/he reflects on experiences gained, knowledge and skills learned and changes to implement for improvement.

Goal 3: Scholar Role - To develop your knowledge in the area of ocular disease and management and the ability to critically review the literature.

Objective 1: You will create at least two evidence-based rounds/presentations.

Outcome measures:

1. Your supervisor will work with you to develop:
   1. two evidenced-based rounds to be presented during scheduled UW residency rounds sessions. One case must be glaucoma-related.
   2. a third case which you will be encouraged to present in a venue other than in internal rounds (e.g. continuing professional development venue).

Objective 2: You will be exposed to different continuing education experiences on various disease topics.

Outcome measures:

1. Attend at least one large optometric/vision conference (AAO preferred).  If the resident attends the AAO meeting, s/he will be required to attend the Optometric Glaucoma Society meeting as a guest – the OGS meeting is an annual meeting that outlines contemporary clinical and translational research in glaucoma.
2. Attend Continuing Education events held at the University of Waterloo School of Optometry & Vision Science whenever possible
3. Attend evening local optometry meetings whenever possible.
4. Participate in the Residents’ Evidence-Based Medicine/Journal club.

Objective 3: Efficiently and effectively use library and other on-campus resources to develop skills, access literature and use evidence-based medicine.

Outcome measures:

1. Attend a library tutorial as scheduled through the Witer Learning Resource Centre.
2. Attend and participate in resident enrichment didactic activities and workshops on topics such as writing skills, oral communication skills, case study development and supervision skills.
3. Participate in the Residents’ Evidence-Based Medicine/Journal club.

Goal 4: Communicator role - To become a skilled clinical communicator

Objective 1: You will participate in speaking and writing opportunities.

Outcome measures:

1. You will present at least four oral presentations during the year: two of these will be short rounds presentations and one will be a Grand Rounds (case-oriented) presentation. The final one may be another Grand Rounds or instead may be a lecture-style oral presentation. All formal presentations should be suitable for COPE-approval. The two main presentations will be given at scheduled Residency Grand Rounds sessions/Residency seminar setting, as part of the WOVS Graduate Conference or in a continuing professional education setting.
2. You will be encouraged to submit a poster to a recognized optometry conference. Your supervisor will work with you as early as possible to develop an acceptable abstract with the goal of submitting it for ‘Resident’s Day’ at the AAO (abstract submission is due at the end of August) or if not feasible, to another conference.
3. You will develop a publishable quality paper based on a case in which you were involved.
4. You will participate in a series of enrichment workshops on topics such as writing skills, oral communication skills, case study development and clinical teaching.

Goal 5: Educator role - To develop skills to become an effective clinical educator

Objective 1: You will be scheduled as a lab-teaching assistant in the advanced clinical disease lab (OPT 375L) and the clinical medicine in optometric practice lab (OPT 385) for third-year students.

Outcome measures:

1. You will instruct in the lab on a weekly basis in the term it is offered. 
2. You will work with the course instructor to instruct one of the clinical techniques in the lab. You will be responsible for preparing a pre-lab and performing a demonstration as well as be responsible for ensuring all the materials for the lab are prepared in time for the lab. Feedback will be provided by the lab instructor/s.
3. You will assist with the injections and/or minor surgical procedures for optometry workshop that is normally held over the course of a day in the winter term for third-year optometry students (usually on a weekend day).

Objective 2: You will be involved in the clinical supervision of optometry interns.

Outcome measures:

1. You will be scheduled to supervise undergraduate UW optometry interns in the Ocular Health Clinic and the Health Sciences Optometry Clinic, and may supervise in the Imaging and/or Acute Care and/or Primary Care clinics as needed.
2. You will participate in a series of workshops to prepare and develop the resident’s skills for supervising undergraduate optometry students.
3. When supervising, you will discuss cases with the residency supervisor if they are present – a supervisor or attending will be available for consultation in person or by phone.

Goal 6: Collaborator role - To develop your communication and knowledge base to be able to engage in interprofessional education, collaboration, and care.

Objective 1: You will collaborate with the family health team while at the Health Sciences Optometry Clinic.

Outcome measures:

1. You will have access to the EMR of the patients at Centre for Family Medicine (CFFM) to check blood work, request blood work, and send reports about mutual patients.
2. When available, you will sit in on trans-disciplinary/inter-professional rounds that run for the family medicine, pharmacy and optometry learners
3. You will participate in optometry teaching days to the family medicine residents and medical students.
4. You will have an opportunity to participate as a facilitator in an IPE (interprofessional education) event with first-year students of optometry (Waterloo), dentistry (Western), pharmacy (Waterloo) and medicine (Schulich School of Medicine), held at the University of Western Ontario.

Objective 2: You will communicate effectively and collaborate with ophthalmology and other health professionals through referrals/reports/other communication methods.

Outcome measures:

1. The resident will have a seminar with their supervisor(s) on how to effectively and efficiently communicate with other health professionals.
2. Letters/reports for complex patients (e.g. Blood work requests, glaucoma surgery referrals, etc.) will be reviewed by supervisor(s) prior to sending until the appropriate level of competency has been demonstrated.

Objective 3: You will collaborate with ophthalmology.

Outcome measures:

1. As above, you will be required to work with a local ophthalmologist one half-day each month (or accumulation of 6 days in the year)

Dr. MacIver will be your main mentor and supervisor and Dr Prokopich will be the secondary supervisor. They will both be involved in your scheduling, as well as reviewing files and consulting with you. Dr MacIver will be the primary supervisor involved in your evaluation but evaluations will be discussed between all supervisors who have worked with you.

You will start in the fall session with direct care focusing on the areas of disease management, acute care, and glaucoma management, as well as some primary care when at HSOC. The number of patients per session will depend on the clinic in which you are providing care. Patient numbers and complexity of assessment and management skills will be expected to increase during the year. This will be monitored to ensure that you are examining patients with a variety of disease states, with an emphasis on management including glaucoma. You will gain increasing autonomy as the residency year progresses, as your competency is demonstrated and supervision of optometry interns commences. A portion of your time will also be devoted to reflection, critical analysis of the literature, and professional development.

In addition to the clinic curriculum, you must also complete the following:

1. Present at minimum two presentations presented in resident GR sessions, or alternate venues including the graduate students' conference or a continuing professional development venue.
   1. One case is to be on some aspect of glaucoma.
   2. The second may be another GR case presentation. Alternatively, it may be a didactic presentation suitable for COPE approval. This could be presented at a CE event, scheduled rounds session or residency seminar setting.
2. Submit a case report/review article in a form suitable for publication.
3. Attend one external optometry meeting (the American Academy of Optometry, if possible - a travel budget is made available) and the University of Waterloo Optometry & Vision Science annual continuing education program, when possible. The resident is encouraged to submit a poster or participate in the development of a poster for the meeting they are to attend, for example, submitting for the Resident’s day at the AAO. If the resident would like to submit a poster for the Resident’s day, the supervisors will work with the resident ahead of time to prepare their submission.
4. Participate in the Residents’ Evidence-based Medicine/Journal club.
5. Participate in scheduled didactic activities designed to enhance your residency experience (includes topics on writing skills, oral communication skills and case study development).

You will:

• Be a Teaching Assistant (TA) for a lab course in the optometry curriculum (two sections OPT 375L)
• Be a TA for the Injections for Optometry Workshop that runs during winter term for third years usually (OPT 385; a day-long workshop)
• Supervise the fourth-year optometry interns in ocular disease clinic setting.
• Develop and present evidence-based Grand Rounds.
• Present an open style oral presentation such as a seminar, lecture or Grand Rounds suitable for presentation at annual University of Waterloo School of Optometry & Vision Science continuing education event or equivalent and suitable for COPE approval. This will be presented at a CE event, Grand Rounds or alternate residency seminar setting.
• Participate in a series of workshops to prepare and develop your skills for supervising undergraduate optometry students/interns.

Further, you are encouraged to:

• Prepare and submit a minimum of one abstract on a case to a credible optometry conference (e.g. AAO).

• Clinical research projects: if you are interested in expanding clinical research skills, then an opportunity to participate in ongoing clinical research projects may be explored. This is not mandatory but would be made available whenever possible if you are interested in this opportunity. Please speak with your primary supervisor about clinical research interest.

Clinical skills evaluation:

• There will be at least one evaluation of skills and case management each term (oral and written feedback generated by supervisors).
• Final evaluation of skills and case management (oral and written feedback generated by supervisors).
• You will receive ongoing oral feedback during bi-weekly meetings with supervisors.
• You will receive an evaluation of your ePortfolio/Reflections.

Teaching evaluations:

• Peer-evaluation of the teaching seminar in the lab course (by supervisor or designate) with optometry student feedback incorporated.

Didactic component evaluations:

• Review paper will be reviewed for content and writing style by the supervisor(s). 
• Grand Rounds/Seminars will be graded by your supervisors using a written global rating scale. The audience (faculty, other residents and students) also provide comments and feedback.
• Reflections will be reviewed and graded by the supervisor(s)

Overall progress

• You will receive a written evaluation at least once per term on their overall progress in the residency.