Des Moines VAMC Rotation Requirements

Third Year – Des Moines VAMC

Goals:  During the third year, the resident will rotate through the VAMC in Des Moines Iowa for a 10 week continuous rotation. The resident will also spend 2 half days a week in the Broadlawns County Hospital Eye Clinic. The third year residents at the VA will lead efforts to provide “state of the art” comprehensive ophthalmologic care to the many veteran patients of this clinic. The third year will do a large volume of cataract surgery under the direction of faculty.

Patient care

• Manage clinical problems of increasing complexity with little faculty supervision.
• Reach “proficient” level skills in cataract surgery (see cataract thread).
• Perform efficient cataract surgery.
• Perform medical retinal laser procedures with faculty supervision.
• Manage ophthalmic emergencies via urgent care coverage.
• Postoperative management of the cataract patient including: medications, astigmatism management, refraction, uveitis, CME, and ocular hypertension.
• Preoperative management of cataract patients including IOL power estimation.

Medical knowledge

• Development of a core knowledge base through attendance and participation in department morning rounds, use of the American Academy of Ophthalmology Basic and Clinical Science Course, and attendance at afternoon and clinical conferences.
• Know and apply the basic and clinically supportive sciences which are appropriate to ocular surgery including lens anatomy, physiology, and cataract pathogenesis.
• Evaluation and management of complications of anterior segment surgery including complex cataract surgery.

Practice-based learning and improvement

• Video tape surgery with feedback from UI and Des Moines faculty.
• OR formative feedback leading to improvement in wound construction, anterior capsulotomy, nucleofractis, and IOL insertion using the video and reading.
• Demonstrate an investigatory and analytic thinking approach to pre-surgical and surgical clinical situations for cataract surgery including appropriate patient selection, indications for surgery, and contraindications for cataract extraction.
• Gather essential and accurate (pre-operative) information about their patients.
• Make informed decisions about pre-operative diagnostic, intra-operative, and post-operative interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment.
• Develop and carry out an individual pre-operative, intra-operative and post-operative management plans.

Interpersonal and communication skills

• Fine tune patient communication techniques with faculty supervision.
• Improve with feedback from VAMC Chief of Optometry (see form).
• Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families in the pre-operative, intra-operative, and post-operative management of cataract surgical cases.
• Counsel and educate patients and their families pre-operatively and post-operatively including the management of complications of complex surgery.

Professionalism

• Develop and exercise clinical and ethical decision making abilities.
• Improve with feedback from healthcare professional providing 360 degree feedback.

Systems-based practice

• Work effectively as a member of the VA and Broadlawns medical care team.
• Demonstrate proficiency using the CPRS VA national computer system. Demonstrate ability to manage heath care team with complex patients that require interaction of other services, nursing, anesthesia, social services, and other parts of the VA health care team.
• Understand the VA regulations that apply to cataract surgery.
• Develop a productive relationship with the Des Moines VAMC optometry department.
• Use information technology to support pre-operative and post-operative patient decisions and patient education.
• Provide health care services aimed at preventing intra-operative problems, post-operative problems and general health maintenance such as correct site surgery and correct IOL surgery.
• Work with health care professionals, including those from other disciplines, to provide patient-focused care in the pre-operative and post-operative period.

Assessment

• Faculty summative evaluation including professionalism evaluation (see e-value form).
• Professionalism evaluation from VA Optometry Chief(see e-value form).

Resources

1. American Academy of Ophthalmology Basic and Clinical Science Course. (Full set)
2. The Wills Eye Manual, Office and Emergency Room Diagnosis and Treatment of Eye Disease, Second Edition. 1991, R. Douglas, Cullom, Jr., Benjamin Chang, eds., J.B. Lippincott Co.
3. Kim T, Oetting TA, Chang DF. Curbside consultation in cataract surgery. Thorofare, NJ: Slack, Inc., 2007.
4. Chang DF. Phaco chop: mastering techniques, optimizing technology, and avoiding complications. Thorofare, NJ: Slack, 2000.
5. Oetting TA. Cataract Surgery for Greenhorns. Coralville, IA: MedRounds Publications, 2005. [Available from: http://www.medrounds.org/cataract-surgery-greenhorns]
6. Nerad, JA. Oculoplastic surgery: the requisites in ophthalmology. St. Louis: Mosby, 2001.
7. Alward, WLM. Glaucoma: the requisites in ophthalmology, St. Louis: Mosby, 2000.

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Clinic Information

Secretary:

Name, phone, email

Clinical Technicians:

name, phone

Pager Numbers:

faculty

fellow

Days of Clinic:

Information Needed here

Surgery Days:

Information Needed here

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