PGY-3 Goals & Objectives

(In addition to PGY·2 Level goals)

1)  Medical Knowledge

• Fundamentals:  to describe and demonstrate understanding of:

• Advanced retinal anatomy and physiology

• Diagnostic Studies:  to describe the principles behind and indications for:

        o   fluorescein/indocyanine green (ICG) angiography as applied to retinal vascular and other diseases (e.g., phases of the angiogram, indications)

                    o   ocular coherence tomography

                    o   8-scan ultrasonography

                    o   basic electrophysiological tests (e.g., electroretinogram [ERG], electro-oculogram [EOG], visual evoked potential (VEP), dark adaptation).

• Peripheral Retinal Disease: to describe and demonstrate basic understanding of the signs of and treatment for:

• peripheral retinal disease and vitreous pathology (e.g., vitreous hemorrhage, retinal breaks).
• peripheral retinal degenerations:  lattice degeneration, pavingstone degeneration and indications for prophylactic treatment
• various types of retinal detachment (e.g., exudative, rhegmatogenous, tractional)
• retinoschisis (e.g. juvenile, senile)
• choroidal detachment

• Macular Disease:  to describe and demonstrate basic understanding of the signs of and treatment for:

o   age-related macular edema

o   Choroidal neovascularization (e.g., ARMD, histoplasmosis)

o   High myopia

o   Macular dystrophies

o   Macular pucker (e.g., epiretinal membrane)

o   Macular holes

o   Cystoid macular edema

o   Central serous Choroidopathy (retinopathy)

o   Optic pit and secondary serous detachment

o   Parafoveal telangiectasia

• Retinal Inflammatory Diseases: to describe and demonstrate basic understanding of the signs of and treatment for:

• Serpiginous Choroidopathy
• AMPPE
• Birdshot Choroidopathy
• PIC
• Multifocal choroiditis
• Retinal vasculitis

•    Retinal Infectious Diseases: to describe and demonstrate basic understanding of the signs of and treatment for:

o   ARN

o   Toxoplasmosis

o   Acute Bacterial Endophthalmitis

o   Fungal Endophthalmitis

o   Syphilis

• Hereditary Retinal and Choroidal Diseases: to describe and demonstrate basic understanding of the signs of and treatment for:

• Gyrate atrophy
• Choroideremia
• Retinitis pigmentosa
• Cone dystrophies
• Stargardt's disease
• Best's disease
• Congenital stationary night blindness

• Hereditary Retinal and Choroidal Diseases: to describe and demonstrate basic understanding of the signs of and treatment for:

o   Phenothiazine

o   Hydroxychloroquine/chloroquine toxicity

                        o   Tamoxifen

• Retinal Vascular Diseases: to describe and demonstrate basic understanding of the signs of and treatment for:

• Arterial and venous obstructions
• Diabetic retinopathy
• Hypertensive retinopathy
• Peripheral retinal vascular occlusive disease
• Acquired retinal vascular diseases
• Ocular ischemic syndrome
• Sickle cell retinopathy

• Principles of surgery: to describe indications for and complications of:

• retinal detachment repair (e.g., pneumatic retinopexy, scleral buckling, vitrectomy).
• surgical vitrectomy (e.g., mechanics, instruments, indications, and technique).
• special vitreoretinal techniques
• Macular hole repair
• Epiretinal membrane peeling
• Complex vitrectomy for proliferative vitreoretinopathy
• Use of heavy liquids and intraocular gases (e.g., perfluorocarbons)
  • laser photocoagulation for conditions including
• diabetic macular edema
• diabetic retinal neovascularization
• other causes of retinal neovascularization
• retinal tears

• Major studies in retinal diseases:  describe the findings of studies including:

• Diabetic Retinopathy Study (DRS)
• Early Treatment of Diabetic Retinopathy Study (ETDRS)
• Macular Photocoagulation Study (MPS)
• Diabetes Control and Complications Trial (DCCT)
• o Branch Vein Occlusion Study (BVOS)
• Central Vein Occlusion Study (CVOS)
• Comparison of AMD Treatment Trials (CATT)
• Standard Care Versus Corticosteroid for Retinal Vein Occlusion (SCORE)
• Collaborative Ocular Melanoma Study (COMS)
• Diabetic Retinopathy Vitrectomy Study (DRVS)
• Endophthalmitis Vitrectomy Study (EVS)
• Age-Related Eye Disease Study (AREDS)
• Anti-VEGF Antibody for the Treatment of Predominantly Classic Choroidal
  • Neovascularization in AMD (ANCHOR)
• Minimally classic/occult trial of the Anti-VEGF antibody Ranibizumab In the treatment of Neovascular AMD (MARINA)

2)  Patient Care:  To perform:

o   indirect ophthalmoscopy with scleral indentation

o   ophthalmoscopic examination with contact lenses, including pan-funduscopic lenses

o   interpretation of fluorescein and ICG angiography

o   interpretation of retinal imaging technology (e.g., ocular coherence tomography)

o   interpretation of basic ocular imaging techniques (e.g., B-scan echography, nerve fiber layer analysis)

o   fundus drawings of the retina, showing complex vitreoretinal relationships and findings

o   surgical assisting with scleral buckling

o   surgical assisting with vitrectomy

3)  Professionalism

                  • To treat patients with respect and compassion at all times

• To treat clinical and administrative staff with respect

• To treat medical students with respect and strive to create an atmosphere conducive to education

• To arrive on-time for clinical experiences

• To prepare in advance for surgical experiences

• To work to become part of the clinical team

o   To work with the faculty, staff, fellow and other residents on the service to determine your responsibilities

o   To remain flexible and offer to help out with the responsibilities of others when you can

        • To remain visible and available to participate in clinical care throughout the clinical session.  When you leave the clinical care area make sure that other members of the service know where you are and why

• answer your pager within 10 minutes of being paged.

4)  Interpersonal and Communication skills

• To communicate your name and role on the service to patients and their families.

o    "Hello, I'm Dr. Resident; I'm a resident working with Dr. Attending today. I will start

your eye exam for Dr. Attending, and enter some notes in the computer. Dr. Attending will join us."

• To present patients to the attending in a succinct but complete way

• To enter data from the history and physical examination into the electronic medical records. As the "Progress Note" of the EMR is formatted to become the report sent to the referring MD, it should be composed with good grammar, and not contain abbreviations.

• a fluorescein angiogram or an OCT is available for interpretation, the resident is expected to enter their interpretation of the study into the EMR.

• To talk when you should be talking, listen when you should be listening

5)  Practice-Based Learning and Improvement

• To learn to recognize feedback from faculty, fellows, fellow residents, patients and students

• To accept that feedback constructively and work to improve based on it

• To accept your role as a teacher as well as a learner. Work to educate students, fellow residents, faculty, staff and patients

• To read on a daily basis, and when queried, to be prepared to discuss the previous days reading. The reading should include the above listed topics, and may include topics from interesting cases seen in clinic. Reading material should include the BCSC book and supplemented from "The Retina" textbook for which an on-line version can be made available to you.

6)  Systems Based Practice

• To work for the benefit of your patients to communicate with other health care provider

• To act as an advocate for your patient within the health care system

• To become aware of the costs of diagnostic and therapeutic interventions. Consider these costs as you recommend and prescribe these interventions.