BVAMC Optometry Residency Program Description

The BirminghamVAMedicalCenter

Optometry Residency in Geriatric and Low Vision Rehabilitative Optometry

(2 Positions)

July 1stto June 30th

Affiliation: The University of Alabama at BirminghamSchool of Optometry

The Geriatric and Low Vision Rehabilitative Optometry Residency at the Birmingham Department of Veterans Affairs Medical Center is a 52-week post-graduate clinical education program that currently offers three positions. The optometry clinic at the Birmingham Veterans Affairs Medical Center was established in 1971, becoming the first Department of Veterans Affairs academically affiliated optometry student program. The residency program in Geriatric and Low Vision Rehabilitative Optometry at the Birmingham Department of Veterans Affairs Medical Center (BVAMC) was established in 1981. The first resident entered the program in 1982 and the program received its initial accreditation that year and has maintained accreditation to date. The program was so successful that with the help of our affiliate, the University of Alabama at Birmingham School of Optometry (UABSO), a second position was created in 1984, and a third position in 2008. The residency program was founded by Dr. Murray Fingeret, who served as clinic chief and residency supervisor until 1983, when Dr. Lyman Norden assumed oversight of the program as Optometry Section Chief. Steady program growth led to the creation of an Optometry Residency Program Director position in 2001, filled by former resident and full time staff optometrist, Dr. Patti Fuhr. Dr. Fuhr served as the Residency Supervisor until May 2013. The position is currently filled by former resident and research fellow, Dr. Bethany Martinez. Dr. Martinez is a full-time VA employee with a faculty appointment of Adjunct Assistant Professor at the University of Alabama at Birmingham School of Optometry. Her clinic and research specialty is Low Vision Rehabilitation. She is the Director of Low Vision Optometry and the primary Optometrist for the Blind Rehabilitation Center.

The optometry clinic has experienced significant growth through the years. We have grown from a clinic with a total of only 5 rooms, to a clinic which now contains 11 exam rooms and 7 special procedures rooms. Our annual patient encounters currently average approximately 14,000. This number of encounters affords each resident exposure to a variety of patients. The Optometry Low Vision Rehabilitation Clinic has grown from serving two patients per week to more than 300 outpatients per year. Patients with low vision are consulted from Visual Impairment Services Team Coordinators and eye clinics throughout the Alabama. Residents provide extensive low vision rehabilitation outpatient services to a wide variety of patients with visual impairments ranging from mild to profound. Resident rotations in the Southeastern Blind Rehabilitation Center (SBRC) afford the resident unparalleled opportunities to work with patients who suffer severe visual impairment. The SBRC is an exemplary multidisciplinary and interdisciplinary rehabilitation setting. The resident is responsible for primary eye and vision care of inpatients in the 24 bed rehabilitation program of the BRC, under the guidance of the attending O.D. The resident schedules each BRC patient appropriately for evaluations which include ocular health evaluation, low vision device evaluation, mid-term follow up evaluation, and discharge summary. When family members are able to visit the program, residents also provide family counseling and education with the legally-blind veteran’s significant others.

The Department of Veterans Affairs has also amended patient eligibility rules and its attitude toward delivering care which now emphasizes preventive health care. These changes have been very beneficial for the optometry clinic in that they have provided opportunities for continued growth and have increased opportunities for residents to interact with diverse and quality patient encounters.

Our academic affiliate is University of Alabama at Birmingham School of Optometry (UABSO).

Mission Statement, Program Goals and Residency Curriculum

The mission of the residency in Geriatric and Low Vision Rehabilitative Optometry at the Birmingham VAMC is to provide optometric residents with clinical experience in geriatric and rehabilitative optometry that goes beyond the general optometric four-year curriculum. The clinical training in the residency program will result in the resident’s attainment of advanced competencies in eye, vision, health and rehabilitation care. The residency’s comprehensive experience includes participation in the Birmingham VAMC Optometry Resident Clinic, Southeastern Blind Rehabilitation Center, Outpatient Low Vision Rehabilitation Clinic, and the UAB School of Optometry’s Residency Program. The residency’s advanced didactic training and strong clinical foundation allow residents upon completion of the program to pursue professional opportunities that require a high level of clinical expertise, such as specialized optometric practice or academia.

Criteria for Residency Completion

Satisfactory completion of the objectives as set forth in the BVAMC Residency Mission, Goals, and Objectives statements. Please note that the publishable quality paper is due prior to awarding of the residency certificate.

Clinical Activities

Goal I: Provide appropriately supervised clinical educational experiences with an emphasis in geriatric optometry and low vision rehabilitative optometry.

  1. The resident will be exposed to a high diversity of clinical conditions.
  2. The resident will have extensive opportunities for patient encounters with geriatric patients.
  3. The resident will have extensive opportunities for patient encounters with outpatient low vision rehabilitation patients.
  4. The resident will have extensive opportunities for patient encounters in comprehensive low vision/blind rehabilitation of profoundly visually impaired individuals during the Blind Rehabilitation Center (BRC) rotation.

Scholarly Activities

Goal II: Stimulate scholarly activity in the resident.

  1. The resident will be required to write a paper suitable for publication in a peer-reviewed ophthalmic journal.
  2. The resident will be encouraged to present a poster or paper at a continuing education or scientific meeting.
  3. The resident will be encouraged to participate in clinical teaching during the residency year.
  4. The resident will be active in critically reviewing ophthalmic literature. The resident will be required to select and present at least 2 articles in journal club.
  5. The resident will be required to recruit, research, and present at least 6 interesting patients (at least 3 patients 2 times per year) for grand rounds during the residency year.
  6. The resident will be required to present a lecture to other residents, faculty, or staff in the latter part of the program.
  7. The resident will be required to keep an activity log of clinical, scholarly, and didactic activities.

Didactic Activities

Goal III: Provide stimulating didactic activities for the resident.

  1. The resident will attend at least 5 Geriatric Noon Conferences or complete the Birmingham/Atlanta Geriatric Research, Education and Clinical Center (GRECC) self-study mini-course.
  2. The resident will be required to attend weekly Residency Conference covering core topics of broad interest and specialty topics in other areas of optometry.
  3. The resident will be provided with authorized absence to attend continuing education or scientific meetings.

Curriculum

The residency curriculum at BVAMC is multi-faceted and includes clinical, scholarly and didactic activities. Residents are involved in direct patient care on Monday, Tuesday, Thursday, and Friday from 7:30am to 4:00pm, and scholarly activities on Wednesday afternoon from 1:00 pm to 4:00pm. Each Wednesday morning, residents attend residency conference at our affiliate UABSO, where the majority of the didactic components of the program are addressed. Wednesday morning conferences include lectures and presentations, clinical procedures rounds, clinical grand rounds and journal club. The resident spends 40 hours per week in program-related activities but is expected to be available as needed for patient care. The residency is a 12 month (52 week) full-time training program.

Residency Conference

The Residency Conference schedule is presented Wednesday mornings, 8am – 12pm, from July through May in the UAB School of Optometry. During the first several weeks, topics of general interest are covered in order to achieve a relatively equal common knowledge base. In addition to these core topics, a series of topics germane to the various specialty areas is presented throughout the year. When residency conference ends in May, residents are expected to see patients on Wednesday morning.

Clinical Grand Rounds

It is required that the residents participate in grand rounds. Specifically, the resident is required to present patients periodically to students, residents, and clinical faculty. This aspect of the program rotates between UABSO, Birmingham VAMC, and Tuscaloosa VAMC.

Case Conference

Residents present interesting cases that are discussed with other residents and faculty. These cases may include unusual or problematic cases which the resident would like to share or seek a second opinion about. Case conference is similar to grand rounds without the patients physically present.

Journal Club

All residents are required to attend and participate in the journal club. In the journal club, residents select papers to be discussed in terms of the overall content, research design, and results. This serves to familiarize the residents with the current literature and various aspects of research methodologies. Please note that the publishable quality paper is due prior to awarding of the residency certificate.

Paper for Publication

All residents are required to write a paper suitable for publication in a refereed ophthalmic journal. This paper may be a unique or unusual case report, a case series, clinical review, or original research. This serves not only to teach residents the elements of research and paper writing but also to enrich the optometric literature.

Geriatric Noon Conference and GRECC mini-course

Each Thursday at noon throughout the year lectures on topics related to geriatric care are presented at the Geriatric Noon Conference. Residents are encouraged to attend these presentations on a regular basis. Resident attendance is recorded in the resident log. Residents are also often invited to present specific topics to the Geriatric Noon Conference attendees.

The GRECC mini-course provides Associated Health Trainees with specific training to prepare them for providing the best possible care to the growing population of geriatric patients in our care settings. Because our associated health trainees’ primary charge is to gain the hands-on clinical experience they need, this self-study course is made-up of a series of brief modules, which can be easily completed in short sittings. The goal of this program is to provide needed knowledge, tools and resources in a way that would work flexibly and in complement to preceptor and trainee needs.

Clinical Education

Schedule (Tour of Duty)

  • Normal Medical Center clinic hours are from 7:30 am to 4:00 pm Monday through Friday. The Optometry clinic begins seeing patients at 7:40 am. Residents begin at 7:30 am and end at 4:00 pm Monday, Tuesday, Thursday and Friday. Even though the tour of duty officially ends at 4:00 pm, the residents are expected to stay until all patients for the day are seen and notes for the day are completed.
  • Each Wednesday morning, residents meet for the didactic component of the program at the affiliate (UABSO). Conference begins at 8:00 am and concludes around 12:00 pm. Residents rotate between Resident Clinic from 12:40 to 4:00 pm and research/science or external rotations on Wednesday afternoons.
  • Lunch is from 11:40 am to 12:40 pm. The first afternoon patients are scheduled at 12:40 pm and must be seen on time. If your morning patients extend beyond 11:40 am your lunch period will be shorter.
  • The goal in our clinic is to see patients on time. Please be considerate of your patients’ time. Remember, too, that many patients will have multiple appointments on the same day and we need to be sure that we are not at fault if they are late for an appointment scheduled after ours. If you are tied up and have a follow-up come in and see that you will be a while before getting to them, please advise the staff so that we can help maintain flow and ensure that we do not make your patient wait beyond their scheduled time. Sometimes doctors get backed up with an emergency or a difficult case and get behind. Please be mindful of other doctors in the clinic. If you are ahead of schedule, or if you notice that another clinician is behind schedule, you may offer to help out. If you need help, please ask for it.

Optometry Resident Clinic (R)

The BVAMC Eye Clinic is located across 18th Street from the VA in the Callahan Eye Foundation Hospital, which is next door to the UAB School of Optometry. The VA Eye Clinic encompasses most of the 5th floor and includes the exam rooms and offices of both Optometry and Ophthalmology. The BVAMC Optometry Resident Clinic is dedicated to the care of our more elderly, multiple-impaired, complicated eye care patients. Exams are scheduled approximately every 30 minutes, 7:30 am through 4 pm, for each clinician, with overbooks as necessary.

Optometry Outpatient Low Vision Rehabilitation Clinic (LV)

The Optometry Low Vision Rehabilitation Clinic serves outpatients who are consulted from Visual Impairment Services Team Coordinators and eye clinics throughout the state of Alabama, including BVAMC & Central Alabama VA (CAVHS) Ophthalmology & Optometry, Tuscaloosa and Dothan Optometry clinics, retinal specialists, the School of Optometry, and practitioners throughout the state. We also receive referrals from Mississippi, Tennessee, and Georgia. The Clinic meets in the VA Low Vision Clinic in the Southeastern Blind Rehabilitation Center. Residents provide extensive low vision rehabilitation outpatient services to a wide variety of patients with visual impairments ranging from mild to profound. Residents perform a thorough functional low vision evaluation, evaluate and train the patient in the use of a wide variety of low vision devices, and prescribe and dispense those devices, much as will occur in private practice. Patients are scheduled on Monday, Thursday, Friday mornings (8:00 and 10:00 am) and Tuesday morning and afternoon allowing time for complicated low vision evaluation.

Blind Rehabilitation Inpatient Eye Clinic (BRC)

Resident rotations in the Southeastern Blind Rehabilitation Center (SBRC) afford the resident unparalleled opportunities to work with patients who suffer severe visual impairment. The SBRC is a multidisciplinary and interdisciplinary setting. The resident is responsible for primary eye and vision care of inpatients in the 24 bed rehabilitation program of the BRC, under the guidance of the attending O.D. The resident schedules each BRC patient appropriately for evaluations which include ocular health evaluation, low vision device evaluation, mid-term follow up evaluation, and discharge summary. When family members are able to visit the program, residents also provide family counseling and education with the legally-blind veteran’s significant others.

Each resident will go through an orientation to the Blind Rehabilitation Center, including a one-hour overview with a specialist in each area of Blind Rehabilitation. This includes; Low Vision, Communications, Activities of Daily Living, Manual Skills, Computer Access Technology, Psychology, Nursing, Social Work, and a general orientation by the Chief of the BRC, the Visual Impairment Services Team (VIST) Coordinator, and the Blind Rehabilitation Outpatient Specialist (BROS). The session with the Orientation and Mobility instructor includes a short course in sighted-guide to insure that each resident knows how to properly guide visually impaired patients. The residents also have an orientation with each Low Vision Instructor. This gives the resident an opportunity to get to know the instructors with whom they will work closely during the BRC rotation.

Residents work directly with Dr. Martinez, Dr. Snow and Dr. Keith during the first week of clinic, learning clinical practice procedures, with emphasis during the first week placed on information, access, and security available in the VA computer system, VISTA and CPRS, and Outlook. Desktops are set up for each resident and an overview of each system is delivered one-on-one. Residents are introduced to the employee menu for earnings and leave and to Outlook and VISTA for email communications. Introduction to CPRS, the VA’s Computerized Patient Record System, includes personalization of the menus for each resident, overview of progress notes, record retrieval and entry, templates, order menus, pharmacy issues, prosthetics issues, lab orders, medication orders, and electronic consults. Residents are introduced to VISTA Imaging Capture and Display as well as VistAWeb and remote access to data from other VA facilities. Residents are given an overview of all instrumentation used in the Optometry Clinics, including perimetry, OCT, pachymetry, and digital photography.

Clinical Teaching Experience

Each resident is encouraged to participate in clinical teaching during the residency year by serving as attending in the Optometry Extern Clinic. This should occur when the resident is comfortable in clinic and has reached Level 3 of independence in residency supervision (See Residency Supervision Guidelines below).