Ophthalmology Elective/Clerkship Course Description

Elective Title:

Clinical Ophthalmology

Elective Description:

This elective is designed to meet the educational needs of all medical students regardless of ultimate choice of specialty. The rotation is suitable as an introduction to ophthalmology or as an advanced course for a student planning a career in ophthalmology. In addition to attending daily didactic conferences, the student will engage in clinical activities under the supervision of ophthalmology residents. The extent of participation in patient care is determined by the skill level, motivation and initiative of the student. Emphasis is placed on the ability to perform a good general eye exam in order to detect common abnormalities of the eye and visual system. Students will develop and refine skills in the use of the penlight, ophthalmoscope and slit lamp. Students will also have ample opportunity to observe a variety of ophthalmic surgical and laser procedures.

Rotation Supervisor:

Komal B. Desai, MD
   Eye Foundation of Kansas City
   2300 Holmes St.
   Kansas City, MO 64108
   (816) 404-1780

Institution:

Eye Foundation of Kansas City / Truman Medical Center-Hospital Hill Eye Clinic

Availability/Length of Elective:

every month except July. This elective is one month long. Rotations of less than four weeks in length are not possible.

Open to:

UMKC Students: Year 5 or Year 6

Visiting Students: Year 4 (or second half of Year 3, pending application approval)

NOTE: Visiting students must submit an application for this elective at least one month in advance. An acceptance or denial decision will be made within two weeks.

Prerequisites:

None.

Days on Duty:

Monday - Friday.

Call:

Not required.

Housing/Meals:

Not provided.

Curriculum for the Ophthalmology Elective

Objectives

Cognitive Objectives - At the end of this elective, the student will:

  1. Understand the basic anatomy and physiology of the eye and visual system.
  2. Understand basic ophthalmic terminology and abbreviations.
  3. Understand the pharmacology, indications, contraindications and potential complications of commonly used ocular medications.
  4. Understand what information is needed when taking a general ophthalmic history.
  5. Understand the basic principles of performing a general eye exam.
  6. Achieve a basic understanding of the pathophysiology and clinical manifestations of important ocular disease states, including:
    1. Ocular manifestations of systemic diseases:
      • Diabetes
      • Systemic hypertension
      • Intracranial hypertension
      • Embolic disease
      • Migraine
      • Blood dyscrasias
      • Sickle cell anemia
      • Metastatic carcinoma
      • Connective tissue disorders
      • Thyroid disorders
      • Sarcoidosis
      • Myasthenia gravis
      • AIDS
    2. Glaucoma:
      • Primary open angle glaucoma
      • Angle closure glaucoma
      • Primary congenital glaucoma
      • Common forms of secondary glaucoma
    3. Diabetic retinopathy:
      • Nonproliferative retinopathy
      • Proliferative retinopathy
    4. The red eye and its causes:
      • Stye / Chalazion
      • Blepharitis
      • Cellulitis
      • Nasolacrimal duct obstruction / Dacryocystitis
      • Conjunctivitis
      • Subconjunctival hemorrhage
      • Dry eyes
      • Pingueculum / Pterygium
      • Episcleritis / Scleritis
      • Contact lens overwear
      • Keratitis
      • Iritis
      • Acute glaucoma
    5. Eye trauma and emergencies:
      • Chemical burns
      • Ruptured globe
      • Hyphema
      • Orbital trauma & fractures
      • Lid lacerations
      • Corneal abrasions & foreign bodies
    6. Strabismus
    7. Nerve palsies (Cranial nerves 3, 4, 6 and 7)
  7. Understand which ocular conditions can be treated by an internist or other primary care practitioner and which conditions require ophthalmologic consultation or referral.
  8. Understand what constitutes an ocular emergency.

Skill (Performance) Objectives - At the end of this elective, the student will:

  1. Demonstrate the ability to obtain an ophthalmic history:
    1. Elicit chief complaint.
    2. Obtain history of present illness.
    3. Perform review of systems.
    4. Obtain past, family and social history.
    5. Inquire about current medications and allergies.
  2. Demonstrate the ability to perform a general eye exam:
    1. Measure and record visual acuity, distance and near.
    2. Perform external exam.
    3. Test pupils to detect abnormal responses.
    4. Test for strabismus and abnormal eye movements.
    5. Perform confrontation visual fields.
    6. Examine anterior segment with penlight and slit lamp.
    7. Perform direct ophthalmoscopy to detect fundus abnormalities.
  3. Describe the steps required to evaluate a red eye.
  4. Describe the steps required to evaluate a traumatized eye.
  5. Demonstrate competence to initiate appropriate management and/or physician referral for detected or suspected abnormalities of the eye and visual system.

Educational Methods

Didactics -

  1. Departmental lectures and case presentations.
  2. Teaching sessions with faculty.

Clinical Experience -

  1. Examination of patients under the supervision of ophthalmology residents.
  2. Observation of ophthalmic surgical and laser procedures.

Independent Study -

  1. Slide-script programs.
  2. Videotapes.

Recommended Texts -

  1. General Ophthalmology by Vaughan, Asbury and Riordan-Eva. This is a good one to purchase.
  2. Basic Ophthalmology for Medical Students and Primary Care Residents by Frank Berson. This will be checked out to you.

Clinical Duties

All students are expected to be present in the TMC-HH Eye Clinic each day during normal working hours. UMKC students will be excused for their weekly Medicine Clinics. All other planned absences must be cleared in advance through the rotation supervisor. The rotation supervisor must also be notified personally of unexpected absences due to illness or other reasons.

While in clinic, students are expected to be working actively with the residents in seeing patients. Students are permitted to observe interesting resident surgical cases. Independent study materials may be reviewed when the clinic is slow.

Students are expected to attend departmental conferences and lectures, including Grand Rounds, as directed by the rotation supervisor.

Evaluation Criteria and Methods

Evaluation Criteria -

  • Attitude
  • Peer relations
  • Reliability
  • Clinical competence
  • Maturity
  • Patient rapport
  • Ingenuity
  • Conscientiousness - includes attendance in clinic and in conferences.

Evaluation Methods - The student will meet with the supervisor midway through rotation and upon completion.

Passing Grade

  1. Direct observation by ophthalmology residents with feedback to rotation supervisor. This is the primary source of your evaluation. Therefore, it is important to work with all of the residents.
  2. Direct observation by rotation supervisor.
  3. Written test.
  4. Paper or oral presentation.

Honors Grade

  1. In conjunction with the resident, write up a case report presented at Grand Rounds (or similar conference) which will be submitted for publication by the end of the rotation.