Vision Rehabilitation Residency: Emphasis on Low Vision Rehabilitation

Goal 1 – Expert Role: To be able to manage and implement advanced Low Vision Rehabilitation for a wide variety of conditions that include complex or infrequently seen visual disorders and conditions.

Objectives: You will be able to:

1. Understand the effect of ocular conditions on visual function.
2. Recognize the impact of systemic co-morbidities on Low Vision Rehabilitation.
3. Gather accurate and complete data in the case history.
4. Select and implement appropriate clinical tests to obtain the necessary information to proceed with Low Vision Rehabilitation.
5. Become familiar with a wide assortment of low vision assistive devices.
6. Develop necessary skills to develop and implement a rehabilitation plan for individuals requiring magnification or other approaches for both near and distance tasks including bioptic telescopes and head-mounted devices, contrast enhancement and field enhancement.
7. Develop necessary skills to demonstrate, train, fit and dispense low vision assistive devices and train patients on techniques to improve functional vision.
8. Recognize when a patient requires referral for auxiliary services (CCTV assessment, high tech assessment, orientation and mobility training, counselling, daily living assessment), or assessments for further evaluation of the ocular condition.
9. Increase familiarity with funding sources available for assessment fees, devices and other services.

The learning opportunities provided to meet these objectives include:

1. Attend the annual Envision low vision conference and/or the biannual Canadian Interdisciplinary Vision Rehabilitation Conference (CIVRC).
2. Attend the American Academy of Optometry conference.
3. Attend other conferences and seminars when available e.g. the WOVS Continuing Education weekend, the Canadian Optometry Schools Research Conference, the Vision Science Research Seminar Series, the Vision Science Graduate Research Conference.
4. Provision of patient care for approximately 180 patient encounters in the WOVS Low Vision clinic, which is part of the Centre for Sight Enhancement.
5. Provision of patient care for approximately 200 patient encounters in the Primary Care and Acute Care clinics and in the External Geriatrics outreach clinic combined.
6. Independent self-study.
7. Preparation of ePortfolio/Reflection(s).

The outcomes of the learning opportunities will be measured using these assessment tools:

1. In-training Evaluation Report(s) (ITER(s)) each term.
2. Chart-stimulated recall (CSR) monthly (once direct supervision is complete).
3. Direct observation by Supervisor(s) with feedback in the Low Vision clinic.
4. Checklist of advanced competencies for low vision rehabilitation based on ASCO LV Educators’ SIG Advanced-Level Competencies and Learning Objectives In Visual Impairment and Low Vision Rehabilitation.
5. Review of ePortfolio/Reflections.
6. The Resident will maintain an accurate log of his/her patient encounters.

Goal 2 - Communicator Role: To be able to provide patient-centred care for those with complex conditions through patient education, communication and shared decision-making with the patient.

Objectives: You will be able to:

1. Use clear record keeping and optimal letter writing.
2. Effectively communicate with a patient including those who have cognitive and physical challenges.
3. Demonstrate an ability to use principles of patient-centred care.
4. Demonstrate an ability to communicate effectively with other individuals within the patient’s circle of care (parent, guardians or substitute decision-makers).

The learning opportunities provided to meet these objectives include:

1. Complete records and write effective reports and referral letters.
2. Discuss the low vision rehabilitation plan with the patient and families and others involved in the patient’s circle of care.
3. Present cases to the Supervisor(s).
4. Preparation of ePortfolio/Reflection(s) with emphasis on the Communicator role.

The outcomes of the learning opportunities will be measured using these assessment tools:

1. ITER(s) each term.
2. Direct observation by Supervisor(s) with feedback in the Low Vision clinic.
3. Review of ePortfolio/Reflections (including consult reports and letters) with emphasis on the Communicator role.

Goal 3 - Collaborator Role: To function effectively within inter-professional environments, demonstrate an understanding of the role of other professionals and be able to communicate and collaborate with other professionals to assure that appropriate resources are utilized for well-coordinated patient care.

Objectives: You will be able to:

3.1  For low vision service provision, communicate effectively with school representatives, other low vision rehabilitation providers, ophthalmologists, and family physicians:

1. Demonstrate an ability to advocate for the patient at the individual level.
2. Demonstrate the ability to recognize when referral to additional service agencies is appropriate and complete necessary documentation (Vision Loss Rehabilitation Ontario, Ontario Disability Support Program (ODSP), Disability Tax Credit).

The learning opportunities provided to meet these objectives include:

1. 1.    Assigned reading (as part of the LVR Residency Reading List) on Health Advocacy.
2. 2.    Patient care in the Low Vision Clinic, Primary and Acute Care clinics and External Geriatric outreach clinic.
3. 3.    Preparation of ePortfolio/Reflection(s) with emphasis on the Collaborator role.

The outcomes of the learning opportunities will be measured using these assessment tools:

1. ITER(s)each term
2. Direct observation by Supervisor(s) with feedback in the Low Vision clinic.
3. Review of ePortfolio/Reflection(s) on advocacy and Ccollaboration.

Goal 4 - Professional Role: To conduct yourself as a professional, showing integrity, ethical behaviour and the ability to continuously improve patient care through self-assessment and quality assurance.

Objectives: You will be able to:

4.1  Show the ability to self-assess strengths and weaknesses and develop a learning plan through the use of the ePortfolio/Reflections.

1. Demonstrate improvement in self-assessment and reflection over time.
2. Demonstrate compassion and integrity in clinical work.
3. Demonstrate an ability to deal effectively with an ethical dilemma.
4. Participate in ongoing quality assurance.

The learning opportunities provided to meet these objectives include:

1. Self-assessment and improvement planning as part of each ITER.
2. Patient care in the Low Vision clinic, Primary and Acute Care clinics and External Geriatric outreach clinic.
3. Preparation of ePortfolio/Reflection(s), some with emphasis on the Professional role.

The outcomes of the learning opportunities will be measured using these assessment tools:

1. ITER(s) each term
2. Review of ePortfolio/Reflections and self-assessments

Goal 5 - Scholar Role: To master, apply, and advance your knowledge by analyzing the best scientific information and integrating this knowledge into patient care through evidence-based clinical decision making. You will promote and disseminate knowledge through scholarly activities such as lectures, presentations, publications, poster or research.

Objectives: You will be able to:

5.1 Demonstrate an ability to use the five steps of evidence-based practice (Ask, Find, Appraise, Integrate, Evaluate)

5.2 Apply evidence-based health care in practice.

1. Show an ability to use evidence-based practice by preparing an article for publication.
2. Educate colleagues in Grand Rounds style or continuing education presentations.
3. Use effective teaching skills to teach undergraduate optometry students procedures and supervise patient care.

The learning opportunities provided to meet these objectives include:

1. Presenting four oral presentations in the year. These will be two short rounds, one Grand Rounds and one open-style oral presentation (Grand Rounds, seminar or continuing education lecture). The open style presentation is presented at the Vision Science Graduate Research conference. The Grand Rounds and open-style oral presentations will be graded by audience (Supervisors, Faculty, other Residents and/or graduate students) using a written evaluation.
2. Preparing an article in writing suitable for publication. This may be based on the same case or topic as one of the oral presentations or research project.
3. Attending/presenting at conferences/meetings when available/applicable e.g. Envision, CIVRC, the American Academy of Optometry, WOVS Continuing Education weekend, the Canadian Optometry Schools Research Conference, the Vision Science Research Seminar Series, the Vision Science Graduate Conference.
4. Participating in the Evidence-Based Medicine/Journal club, a directed reading class in which papers are critically analyzed with an emphasis on evidence-based medicine and clinical statistics (Fall and Winter terms)
5. Participating in a series of workshops to prepare and develop your skills for supervising undergraduate optometry students (as part of the Resident’s didactic curriculum). Many workshops are offered through the University's Centre for Teaching Excellence.
6. Teaching/assisting with OPTOM 387 (Gerontology and Low Vision) laboratory
7. Supervising in the Low Vision clinic.
8. Patient care in the Low Vision clinic, Primary Care and Acute Care clinics and External Geriatric outreach clinic.
9. LVR Residency Reading List
10. Scheduled Independent Self-Study time (some of this will be used for classes, workshops, rounds, meetings).

The outcomes of the learning opportunities will be measured using these assessment tools:

1. ITER(s)each term.
2. Assessment of presentations (graded) and paper (feedback).
3. Review of students’ teaching assessments of the Resident. (Regarding clinical supervision, the Resident will receive teaching evaluations from the optometry interns in the clinic).
4. Review of ePortfolio/Reflection(s) with emphasis on the Scholar role.

You will be supervised by Dr. Shamrozé Khan and Dr. Tammy Labreche in the Low Vision clinic. Dr. Khan will act as your main mentor and teacher. If Drs. Khan or Labreche are unavailable either in person or by phone, any other clinician in the Low Vision clinic may be approached if immediate consultation is required.

The Residency program will provide opportunities for competency development through the provision of educational experiences of increasing complexity over time.

Clinical responsibilities start with observation in the Low Vision Clinic due to the increased patient complexity and optometric skill level required in this clinic. Direct patient care in the Primary Care (PC) clinic occurs from the start of the Residency under supervision by a PC supervisor in case of any unforeseen delays with registration/licensure. By October, you will move to direct patient care in the Low Vision clinic, under the direct supervision of the Low Vision Supervisor(s). This graduated level of independence will be guided by your attainment of a set of basic low vision competencies outlined in advance. A combination of direct and indirect patient care (i.e. supervision of optometry students) occurs by January.

Every effort is made to ensure that the patient population scheduled increases in complexity throughout the year.  During the Fall term, whenever possible, only established elderly patients are scheduled in Low Vision.  This provides you with the opportunity to discuss the case with the Supervisor(s) prior to initiating the assessment. This progresses to the scheduling of new patients, including children and adults, by the second term, and eventually to those with multiple co-morbidities.

The numbers of patients booked increases throughout the year. At first, you will be scheduled only 2 patients per day in Low Vision and 4 patients per day in Primary Care. By the end of the Residency, you will be scheduled a maximum of 4 patients per day in Low Vision, and 7 patients per day in Primary Care.

You may also be scheduled to be on-call and there may be a requirement to participate in Saturday or evening clinics.

Formal:

1. Attend the Envision Conference and/or the biannual Canadian Interdisciplinary Vision Rehabilitation Conference (CIVRC) and the AAO meeting (3 days for the Envision conference (timing is variable); 2 days for the CIVRC (Spring), 4 days (Fall) for the AAO).
2. Attend lectures and seminars at WOVS whenever possible (e.g. research lectures, CE lectures) (Timing = various).
3. Submit ePortfolio/Reflections based on a patient encounter and/or teaching situation in which s/he will reflect on experiences gained, knowledge and skills learned, and changes to implement for improvement (ongoing).
4. Prepare written self-assessments and improvement-planning as part of each ITER (ongoing).
5. Participate in the Evidence-Based Medicine/Journal club, a directed reading class, to develop skills in the critical analysis of papers with an emphasis on evidence-based medicine and clinical statistics (Fall and Winter terms).
6. Attend/Participate in Rounds sessions by other Residents and Faculty (Fall, Winter and Spring terms).
7. Opportunity to participate in a research project.

Informal:

1. Case consultation with Supervisor(s) including feedback based on direct observation and Chart Stimulated Recall (monthly meetings one direct supervision has been completed).
2. Independent self-study; some of this scheduled time will be used for classes, workshops, rounds, meetings  (half-day per week for 12 months).
3. LVR Residency Reading List.

Formal:

1. Present four oral presentations in the year. These will be two short rounds, one Grand rounds and one open-style oral presentation (Fall, Winter and Spring terms).
2. Present when possible (poster, scientific paper, continuing education) at relevant conference/meetings (AAO, Envision, CIVRC, WOVS Doctor of Optometry programme Low Vision Special Interest Group).
3. Prepare a written article on a case report, topic or research project suitable for publication in a peer-reviewed journal (Spring term).
4. Participate in a series of workshops on writing skills, oral communication skills and case study development as part of the Residency’s didactic curriculum (Fall, Winter and Spring terms).
5. Participate in a series of workshops to prepare and develop the Resident’s skills for supervising undergraduate UW optometry students as part of the Residency’s didactic curriculum (Fall and Winter terms).

Informal:

1. Supervise in Low Vision, Primary Care (Winter term)

1. In-training evaluation reports.
2. Chart-stimulated recall (monthly, once direct supervision is completed).
3. Direct observation by Supervisor(s) with feedback in LV clinic.
4. Evaluation of ePortfolio/Reflections.
5. Grade on presentation. The grand rounds and open-style oral presentations will be graded by audience (Supervisors, Faculty, other Residents and/or graduate students) using a written evaluation.
6. Feedback on draft version of paper for style and content.
7. Regarding clinical supervision, the Resident will receive teaching evaluations from the undergraduate students in the clinic.