OPHU-4021 SJ - Clinical Ophthalmology at St. Joseph Medical Center in Houston

OPHU-4021 SJ - Clinical Ophthalmology at St. Joseph Medical Center in Houston

Elective Title: Clinical Ophthalmology at St. Joseph Medical Center in Houston
Course Number: OPHU-4021 SJ
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of Internal Medicine or Surgery clerkships. Submit C form to Fran Dawe.
Responsible Faculty Director: Keith A. Bourgeois, MD Periods Offered: 1, 3, 4, 6-11 including holiday period 8 
Coordinator: Other Faculty:
Location to Report on First Day:
St. Joseph Medical Center

The goals of the course are determined by the needs of each student. Emphasis may be placed on the type of eye problems likely to be encountered in the type of practice anticipated by the student, i.e., the future Neurologists will want to see nerve and field problems, and primary care doctors need to be exposed to the various common and simple ophthalmological problems seen in a general practice. Another goal is to learn about common disorders of the vitreous and retina that causes vision loss and how to treat them either with medication or surgery. The surgeries can either be done in the office or in the operating room.

1. Elicit and evaluate the history in a patient with ocular complaints (including those complaints that may signify systemic disease).

2. Perform a thorough eye examination (excluding refraction and sophisticated field testing).

3. Evaluate the common causes of red inflamed eyes and be able to differentiate conjunctivitis, keratitis, uveitis, acute glaucoma, and foreign body trauma.

4. Perform a neuro-ophthalmological examination including evaluation of the papillary reflexes, ocular muscle balance, confrontation field testing, and evaluation of the optic nerve head.

5. Evaluate and manage most types of minor ocular trauma (foreign bodies, minor lid lacerations, etc.), and recognize and initiate emergency measures for major eye trauma (hyphema, major lacerations of canaliculus or lid margin, etc.).

Description of course activities
Activities consist of rounds, assignment one-on-one to advanced faculty for observation leading to participation in the clinic, attendance of conferences, observation of surgery in the O.R., plus all lectures and conferences directed to residents and students by faculty.

Type of students who would benefit from the course
Students planning on a career in Ophthalmology, Primary Health Care, Internal Medicine, Pediatrics, Family Medicine and Emergency Room Medicine.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8:30 5:00
Tuesday 8:30 5:00
Wednesday 8:30 5:00
Thursday 8:30 5:00
Friday 8:30 5:00

 Average number of patients seen per week: 100
 Call Schedule: None for students

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time 40
Self-Directed Study 4

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Keith A. Bourgeois, M.D.
  B. Frequency / Duration of Presentation(s)?
    1-2 hours weekly
  C. Format - What guidelines are set for the student's presentation?
    Students review cases found in Case Studies for Ophthalmology, answer questions and present to faculty. Students are also asked to present a patient as well as a short presentation about the patient''s diagnosis. Students interested in Ophthalmology will be given the opportunity to make a presentation at Grand Rounds for the residents and faculty
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
  B. Format - What guidelines are set for the student's written work?
    Verbal instruction.
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Relate to patients seen in clinic.
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.
    Standard elective grade form completed by supervising faculty. No exam. Log of cases seen in clinic and/or O.R. and weekly patient presentations with Directors of Medical Student Education.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.