Inpatient Consult Service Educational Goals and Objectives
Overall goals
Medical Knowledge
To establish good reading habits early. Plan to read every day. Stick to your plan.
To Apply your what you've read as you talk to, examine, diagnose and treat your patients.
When you are exposed to a new diagnosis in a clinical situation, read about it as soon as possible.
Patient Care
To take complete histories in an efficient, respectful manner
To perform thorough examinations in an efficient manner
To think through and formulate possible differential diagnoses
To develop an appropriate management plan; in appropriate circumstances initiate it
To demonstrate appropriate hygiene by washing before and after every patient contact
To identify the key examination techniques and management of basic and most common medical problems in the subspecialty areas of glaucoma (e.g., primary open angle glaucoma), cornea (e.g., dry eye, microbial keratitis), orbit and oculoplastics (e.g., common lid lesions, ptosis), retina (e.g., macular disorders, retinal detachment, diabetic retinopathy), and neuro-ophthalmology (e.g., optic neuropathy, ocular motor neuropathy, pupillary abnormalities, visual field defects).
To perform the basic anterior segment (e.g., , slit lamp biomicroscopy) and posterior segment examination skills (e.g., dilated fundus examination, use of magnification and lenses, Hruby lens, 90 Diopter lens, three mirror Goldmann contact lens) and to understand and use basic ophthalmic instruments (e.g., tonometer, lensometer).
To triage and manage ocular emergencies (e.g, central retinal artery occlusion, giant cell arteritis, chemical burn, acute angle closure glaucoma, endophthalmitis, traumatically open globe).
To perform minor external and adnexal surgical procedures (e.g., chalazion excision, corneal foreign body removal, use of foreign body corneal drill for removal of a rust ring, conjunctival biopsy, corneal scraping).
To recognize the most common ophthalmic histopathology findings and to recognize basic histopathology of common ocular lesions (e.g., retinal detachment, pterygium, corneal button removed at keratoplasty).
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 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 available to participate in clinical care throughout the day.
To answer your pager within 10 minutes of being paged.
Interpersonal and Communications Skills
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."
present patients to the attending in a succinct but complete way
maintain timely and legible medical records
talk when you should be talking, listen when you should be listening
Practice Based Learning and Improvement
learn to recognize feedback from faculty, fellows, fellow residents, patients and students
accept that feedback constructively and work to improve based on it
accept your role as a teacher as well as a learner. Work to educate students, fellow residents, faculty, staff and patients
Systems Based Practice
work for the benefit of your patients to communicate with other health care provider
act as an advocate for your patient within the health care system
become aware of the costs of diagnostic and therapeutic interventions. Consider these costs as you recommend and prescribe these interventions.
In addition, to these goals please see the topic and level specific medical knowledge and patient care goals below.
Neuro-ophthalmology related Goals
Medical Knowledge
To describe the neuro-anatomy of the visual pathways.
To describe the neuro-anatomy of the cranial nerves.
To describe the pupillary and accommodative neuro-anatomy.
To describe ocular motility and related neuronal pathways.
To describe the typical features, evaluation, and management of the most common optic neuropathies (e.g., demyelinating optic neuritis, ischemic optic neuropathy [arteritic and nonarteritic], toxic or nutritional optic neuropathy, Leber’s hereditary optic neuropathy, ethambutol toxicity, neuroretinitis, and compressive, inflammatory, infiltrative, and traumatic optic neuropathies).
To describe the typical features, evaluation, and management of the most common ocular motor neuropathies (e.g., third, fourth, sixth nerve palsy).
To describe the typical features of cavernous sinus and superior orbital fissure syndromes (e.g., infectious, vascular, neoplastic, inflammatory etiologies).
To describe the typical features, evaluation, and management of the most common causes of nystagmus (e.g., congenital motor and sensory, downbeat, upbeat, gaze-evoked, drug-induced).
To describe the typical features, evaluation, and management of the most common pupillary abnormalities (e.g., relative afferent pupillary defect, anisocoria, Horner syndrome, third nerve palsy, Adie’s tonic pupil).
To describe the typical features, evaluation, and management of the most common visual field defects (e.g., optic nerve, optic chiasm, optic radiation, occipital cortex).
To describe the epidemiology, clinical features, evaluation, and management of ocular myasthenia gravis.
To describe the epidemiology, clinical features, evaluation, and management of carotid-cavernous fistula.
To describe the epidemiology, differential diagnosis, evaluation and management of congenital optic nerve abnormalities (e.g., optic pit, disc coloboma, papillo-renal syndrome, morning glory syndrome, tilted disc, optic nerve hypoplasia, myelinated nerve fiber layer, melanocytoma, disc drusen, Bergmeister’s papilla).
Patient Care
To perform a basic pupillary examination
To describe indications for and perform basic pharmacologic pupillary testing for Horner syndrome, pharmacologic dilation, and Adie’s tonic pupil.
To list the differential diagnosis of anisocoria (e.g., sympathetic or parasympathetic lesion “physiologic”).
To describe, detect, and quantitate a relative afferent pupillary defect.
To list the causes for light-near dissociation (e.g., Argyll-Robertson pupils, diabetic neuropathy, tonic pupil).
To perform a basic ocular motility examination
To assess ocular alignment using simple techniques (e.g.. Hirschberg, Krimsky).
To describe and perform basic cover/uncover testing for tropia.
To describe and perform alternate cover testing for phoria.
To perform simultaneous prism and cover testing.
To perform measurement of deviations with prisms.
To describe the indications for and apply Fresnel and grind-in prisms.
To describe the indications for and to perform forced duction and forced generation testing.
To perform an assessment of saccade accuracy and pursuit and optokinetic testing.
To perform a measurement of eyelid function (e.g., levator function, lid position).
To describe the indications for visual field testing and to perform and interpret perimetry studies
To perform confrontational field testing (static and kinetic, central and peripheral, red and white targets).
To perform and interpret a tangent screen test.
To describe the indications for and perform basic Goldmann perimetry, and interpret results.
To describe the indications for and perform basic automated perimetry, and interpret results.
To perform basic direct, indirect, and magnified ophthalmoscopic examination of the optic disc (e.g., recognize optic disc swelling, optic atrophy, neuroretinitis).
To describe the anatomy and indications for, order appropriately, and interpret basic radiology studies of the brain and orbits, demonstrating the ability to communicate with radiologists in order to maximize both choice of proper diagnostic test and accuracy of interpretation.
To describe the indications for and interpret basic echography of orbits.
Oculoplastics related Goals
Medical Knowledge
To describe basic eyelid, lacrimal, and orbital anatomy and physiology (e.g., eyelid, orbicularis,orbital structures, meibomian glands, lacrimal glands, glands of Zeiss, Whitnall’s ligament,Muller’s muscle, Lockwood’s ligament. canaliculi, puncta, orbital bones, orbital foramina, paranasal sinuses, annulus of Zinn, arterial and venous vascular supply, lymphatics, nerves, extraocular muscles).
To describe basic mechanisms and indications for treatment of eyelid, orbital, and lacrimal trauma.
To recognize simple orbital trauma (e.g., orbital foreign body, retrobulbar hemorrhage).
To recognize and treat simple trichiasis.
To recognize blepharospasm and hemifacial spasm.
To identify normal orbital anatomy on imaging studies (e.g,, magnetic resonance imaging, computed tomography, ultrasound).
To describe the differential diagnosis of proptosis in children and adults.
To describe techniques and complications of minor operating room procedures (e.g., incision and drainage of chalazia, excision of small eyelid lesions).
To describe typical features of orbital cellulitis.
Patient Care
To describe indications for and to perform the basic office examination techniques for the most common oculoplastic and orbital abnormalities.
To identify indications for and to perform the basic assessment of the eyelids (e.g., eversion, double eversion) and eyebrows (e.g., margin to reflex distance, lid crease, levator function, eyelid/brow malpositions).
To identify indications for and to perform the basic lacrimal assessment (e.g., dye testing, punctal dilation, lacrimal probing, canalicular probing, lacrimal irrigation).
To identify indications for and to perform the basic assessment of the orbit (e.g., Hertel exophthalmometry, inspection, palpation, auscultation).
To identify indications for and to perform the basic socket assessment (e.g., types of implants, socket health).
To perform minor lid procedures (e.g., removal of benign eyelid skin lesions, chalazion curretage or excision, conjunctival biopsy, full thickness lid lacerations).
To treat complications of minor operating room procedures (e.g., incision and drainage of chalazia,excision of small eyelid lesions).
To perform punctal plug insertion or removal.
To recognize and treat trichiasis (e.g., epilation, cryotherapy, surgical therapy).
To perform a simple enucleation or evisceration under supervision.
To describe the indications for, describe the steps of and perform temporal artery biopsies
To recognize and treat orbital trauma (e.g., intraorbital foreign body, retrobulbar hemorrhage, fracture).
