(in addition to PGY-3 Level goals)
Medical Knowledge
- To describe the most advanced eyelid, lacrimal, and orbital anatomy and physiology.
- To evaluate and to treat simple and more advanced eyelid, orbital, and lacrimal trauma (e.g., full thickness lid laceration, chemical burns to the face).
- To perform pre-operative and post-operative assessment and coordination of care of patients with more advanced or complex oculoplastic disorders (e.g., systemically ill patient, multi-disciplinary procedures).
- To describe the etiology, evaluation, and medical and perform or assist with the surgical treatment of the following eyelid diseases
- Ectropion (e.g., congenital, paralytic, involutional, cicatricial, mechanical, allergic).
- Entropion (e.g., involutional, cicatricial, spastic, congenital).
- Myogenic ptosis (e.g., chronic progressive external ophthalmoplegia).
- Dermatochalasis (e.g., blepharochalasis).
- Benign, pre-malignant, or malignant eyelid tumors (e.g., papilloma, keratoacanthoma, seborrheic keratosis, epidermal inclusion cyst, molluscum contagiosum, verruca vulgaris, actinic keratosis, basal cell carcinoma, squamous cell carcinoma, sebaceous cell carcinoma, melanoma).
- Single or recurrent inflammatory lesions (e.g., recurrent chalazion or its mimics).
- Facial dystonia (e.g., blepharospasm, hemifacial spasm).
- Facial nerve palsy with exposure keratopathy (e.g. tarsorrhaphy, gold weights).
- Complex lid and orbital trauma cases.
Patient Care
- To describe the indications for and to perform more complicated and advanced “in office” examination techniques for the less common but important oculoplastic and orbital abnormalities.
- To perform preoperative and intraoperative assessment of the eyelids and eyebrows (e.g., intraoperative adjustments).
- To perform more advanced lacrimal assessment (e.g., intraoperative and postoperative testing, more complex trauma to lacrimal system).
- To recognize and treat more complex or difficult socket-related problems and complications (e.g.,extrusion of implants, anophthalmic socket complications).
- To perform more complicated lid procedures (e.g., larger benign, recurrent, or multiple skin lesions.
- To describe management of and treat lacrimal system abnormalities, including:
- More complex congenital disorders (e.g., canalicular stenosis)
- Complex moderate trauma (e.g., requiring lacrimal intubation)
- To recognize typical and atypical features and to describe the differential diagnosis, clinical features, and treatment of more complicated orbital disease, including:
- More complex orbital infections (e.g., preseptal and orbital cellulitis, mucormycosis, Aspergillosis)
- Congenital tumors (e.g., dermoid)
- Fibro-osseus disorders and tumors (e.g., fibrous dysplasia, osteoma, chondrosarcoma, osteosarcoma, Paget’s disease)
- Vascular tumors (e.g., capillary hemangioma, cavernous hemangioma, hemangiopericytoma, lymphangioma, Kaposi’s sarcoma)
- Xanthomatous tumors (e.g., xanthelasma)
- Lacrimal gland tumors (e.g., benign mixed tumor, adenoid cystic carcinoma, malignant mixed tumor, lymphoma)
- Neural tumors (e.g., optic nerve glioma/meningioma, neurofibromatosis, neuroblastoma)
- Rhabdomyosarcoma
- Orbital pseudotumor
- Lymphoid lesions (e.g., lymphoid hyperplasia, lymphoma, leukemia)
- Thyroid-related orbitopathy
- Metastatic tumors (e.g., from breast, lung, prostate, colon, melanoma)
- Trauma (e.g., orbital fractures, traumatic optic neuropathy)
- Anophthalmic socket – implant exposure, volume augmentation
- To describe, recognize the indications and complications, and to assist in surgery for the eyelid procedures listed below:
- Basic biopsy techniques
- Lateral tarsal strip
- Specialized lid suture procedures (e.g., Frost sutures)
- Medial spindle
- Levator advancement
- Eyelid laceration/margin repair
- Tarsorrhaphy
- Lateral canthoplasty (canthotomy and cantholysis)
- Blepharoplasty
- Facial nerve palsy – gold weight placement in the lid
- Simple eyelid reconstruction
- Orbital approaches and incisions (e.g., lid crease, brow, lateral canthus, transconjunctival, transnasal)
- To describe, recognize the indications and complications, and assist with orbital skills and procedures
- Anterior orbitotomy for tumor biopsy/excision
- Orbital floor fracture repair
- Lacrimal gland biopsy
- To describe the indications for and to interpret CT and MRI scans (e.g., orbital trauma, orbital lesions and tumors).
- To perform simple botulinum toxin injections (e.g., blepharospasm).
- To identify more advanced orbital pathology (e.g., complex orbital fractures, orbital tumors) on imaging studies (e.g, magnetic resonance imaging, computed tomography, ultrasound)
- To describe, recognize the indications and complications, and perform temporal artery biopsy
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
- To work with the faculty, staff, fellow and other residents on the service to determine your responsibilities
- 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. If 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 page.
Interpersonal and communication skills
- To communicate your name and role on the service to patients and their families.
- "Hello, I'm Dr. Resident, I'm a resident working with Dr. Attending today."
- To present patients to the attending in a succinct but complete way
- To maintain timely and legible medical records
- To talk when you should be talking, listen when you should be listening
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
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.