VAMC Iowa City Rotation Requirements

First Year – VAMC Iowa City

Goals: 

• During the first year, the resident will rotate through the VAMC Iowa City for a 10 week continuous rotation. One of the primary goals of this rotation is to develop basic surgical and clinical skills as part of the team of residents caring for our valued veteran patients. The first year will help to teach the family medicine residents and medical students rotating through the VAMC in Iowa City.

Patient care

• Manage basic clinical problems with faculty and senior resident supervision.
• Reach “beginner” level skills in cataract surgery (see cataract thread)
  • Develop surgical skills with Wet Lab program
  • Complete simulator “beginner” course.
• Assist attending and senior resident surgery.
• 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.
• Enhance refraction skills.
• Learn to interpret visual field tests.

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 anterior segment surgery including routine cataract surgery.

Practice-based learning and improvement

• Wet lab and simulator formative feedback leading to improvement in wound construction, anterior capsulotomy, nucleofractis, and IOL insertion using the VA wet lab, video, and reading.
• Participate in Journal Club.
• Participate in cataract morbidity conference.

Interpersonal and communication skills

• Develop patient communication techniques with faculty supervision.
• Teach medical students rotating through the clinic.
• Develop appropriate communication and interaction with clinic staff.
• Improve with feedback from healthcare professional providing 360 degree feedback.
• 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.

Professionalism

• Develop teaching skills.
• Develop skills at public speaking and scientific presentation by presenting in morning rounds.
• 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 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.
• Management of the non-surgical low vision patient including assessment of patient needs, refraction of complex cases, referral to rehabilitative agencies.
• Use information technology to support pre-operative and post-operative patient decisions and patient education.
• 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 (see e-value form).
• Faculty Wet lab cataract surgery evaluation, pre test, and post test (see forms)
• Scores on “beginner” Simulator Course (50% on each section to pass).
• Professionalism evaluation from VA clinic manager (see e-value form).
• Professionalism evaluation from VA OR nurses (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.

Second Year – VAMC Iowa City

Goals: During the second year, the resident will rotate through the VAMC Iowa City for a 10 week continuous rotation. One of the primary goals of this rotation is to develop beginning level surgical skills, enhance laser skills, and help to lead the clinic. The second year will help to teach the first year ophthalmology resident, family medicine residents, and medical students rotating at the VAMC in Iowa City

Patient care

• Manage clinical problems with little faculty supervision.
• Reach “advanced beginner” level skills in cataract surgery (see cataract thread).
• Perform minor surgical procedures (e.g. TA biopsy, lid biopsy, focal laser, panretinal photocoagulation, capsulotomy, etc.).
• Manage ophthalmic emergencies via urgent care coverage.
• Manage medical/laser retina care of VA patients with faculty supervision.
• 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.
• Postoperative management of glaucoma filtering procedures, both medical and interventional procedures (e.g. management of failing bleb, Tenon's cysts, hypotony, bleb leaks),

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.
• Know and apply basic laser operation and safety principles with argon and YAG lasers.
• Evaluation and management of complications of anterior segment surgery including cataract surgery and glaucoma.

Practice-based learning and improvement

• OR formative feedback leading to improvement in wound construction, anterior capsulotomy, nucleofractis, and IOL insertion using the VA wet lab, video, and reading. Participate in cataract morbidity conference. Use the feedback from surgery and self assessment to develop plans for improvement including the use of the simulator, wet lab, videos, and reading. 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

• Perform cataract consent with observation by nurse manager with written feedback.
• Teach medical students and first year residents rotating through the clinic.
• Improve with feedback from healthcare professional providing 360 degree feedback.
• Communicate effectively with operating room staff and anesthesia staff.
• 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.
• Teach first year residents in the wet lab.

Professionalism

• Develop teaching skills.
• 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 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.
• Management of the non-surgical low vision patient including assessment of patient needs, refraction of complex cases, referral to rehabilitative agencies.
• 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 (see e-value form).
• Faculty formative cataract surgery evaluation (see form).
• Scores from simulator “advanced beginner” course (75% to pass).
• Communication evaluation from VA nurse manager with observed consent (see form).
• Faculty summative professionalism evaluation (see e-value form).
• Professionalism evaluation from technicians (see e-value form).
• Professionalism evaluation from OR nurses (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.

Third Year – VAMC Iowa City

Goals:  During the third year, the resident will rotate through the VAMC Iowa City for a 10 week continuous rotation. One of the primary goals of this rotation is to develop leadership and teaching skills as the leader of a team of three ophthalmology residents, family medicine residents, and medical students at the VAMC in Iowa City. 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 anterior segment and oculoplastic 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 complex surgical procedures (e.g. trabeculectomy, shunting procedures, oculoplastic procedures, scleral buckles, etc.).
• 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.
• Postoperative management of glaucoma filtering procedures, both medical and intervention treatments (e.g. management of hypotony, bleb leaks, Tenon's cysts, failing blebs).

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 and glaucoma.

Practice-based learning and improvement

• Lead cataract Morbidity conference.
• OR formative feedback leading to improvement in wound construction, anterior capsulotomy, nucleofractis, and IOL insertion using the VA wet lab, 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.
• Teach medical students and junior residents rotating through the clinic.
• Improve with feedback from healthcare professional providing 360 degree feedback.
• Communicate effectively with operating room staff and anesthesia staff.
• 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.
• Teach junior residents in the wet lab.

Professionalism

• Develop teaching skills.
• 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 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.
• Management of the nonsurgical low vision patient including assessment of patient needs, refraction of complex cases, referral to rehabilitative agencies.
• 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 (see e-value form).
• Faculty formative cataract surgery evaluation (see form).
• Professionalism evaluation from technicians (see e-value form).
• Professionalism evaluation from OR nurses (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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Other Video Presentations

• Please see the Rounds and Conferences Videos on the Video server

 

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Clinic Information

Secretaries:

Valerie Bell (Greenlee) 356-3938

Andrea Hager (Abramoff) 384-5833

Peg Harris (Syed) 335-7095

Laura Pitlick (Kirschling, Oetting) 353-8585

Ramona Weber (Kardon, Longmuir) 356-1951

Pager Numbers:

Dr. Abramoff: 6677

Dr. Greenlee: 8009

Dr. Kardon: 7021

Dr. Kirschling: 7211

Dr. R. Longmuir: 5887

Dr. Oetting: 7312

Dr. Syed: 2438

Days of Clinic:

Information Needed here

Surgery Days:

Information Needed here

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