To describe and perform the most advanced strabismus examination techniques (e.g., complicated prism cover testing in multiple cranial neuropathy, patients with nystagmus, dissociated vertical deviation, double Maddox rod testing).
To perform the most advanced techniques for assessment of visual development in complicated or non-cooperative pediatric ophthalmology patients (e.g., less common objective measures of visual acuity, electrophysiologic testing).
To apply the most advanced knowledge of strabismus anatomy and physiology (e.g., spiral of Tillaux, secondary and tertiary actions, spread of comitance) in evaluation of patients.
To describe clinical application of the most advanced sensory adaptations (e.g., anomalous head position, anomalous retinal correspondence).
To recognize and treat the most complicated etiologies of amblyopia (e.g., refraction noncompliance, patching failures, pharmacologic penalization).
To recognize and treat the most complex etiologies of esotropia (e.g., optical, prism-induced, postsurgical/consecutive).
To recognize and treat the most complex etiologies of exotropia (e.g., supranuclear, paralytic pontine exotropia, consecutive).
To recognize and treat the most complex strabismus patterns (e.g., aberrant regeneration, postsurgical, thyroid ophthalmopathy and myasthenia gravis).
To recognize and treat the most complex etiologies of vertical strabismus (e.g, skew deviation, postsurgical, restrictive).
To apply non-surgical treatment (e.g., patching, atropine penalization) of more complicated forms of amblyopia (e.g., non-compliant, patching failures).
To recognize, evaluate, and treat the most complex forms of childhood nystagmus (e.g., sensory, spasmus nutans, associated with neurologic or systemic disease).
To recognize and treat (or refer for treatment) complex retinopathy of prematurity (e.g., stages, treatment indications, retinal detachment).
To recognize and treat (or refer for treatment) uncommon etiologies and types of pediatric cataracts (e.g., congenital, traumatic).
To recognize and appropriately evaluate the more complex hereditary ocular syndromes (e.g., bilateral Duane syndrome, Mobius syndrome).
To recognize and treat (or refer for treatment) patients with complicated retinoblastoma (e.g., bilateral cases, monocular patient, treatment failure, pineal involvement).
To recognize and evaluate the less common congenital ocular anomalies (e.g., unusual genetic syndromes).
To apply the most advanced principles of binocular vision and amblyopia (e.g., physiology of binocular vision, diplopia, confusion and suppression, normal and abnormal retinal correspondence, classification and characteristics of amblyopia).
To recognize and treat complex pediatric retinal disease (e.g., inherited retinopathies, retinopathy of prematurity).
To recognize and treat complex pediatric glaucoma.
To recognize and treat complex pediatric cataracts and anterior segment abnormalities (including surgical implications, techniques, and complications).
To recognize and treat complex pediatric eyelid disorders (e.g., lid lacerations, lid tumors).
To recognize and treat (or refer) pediatric orbital disease (e.g., orbital tumors, orbital fractures, rhabdomyosarcoma, severe congenital orbital malformations).
Patient Care
To perform a more advanced extraocular muscle examination based on knowledge of the anatomy and physiology of ocular motility.
To assess more advanced ocular motility problems (e.g., bilateral or multiple cranial neuropathy, myasthenia gravis, thyroid eye disease).
To apply Hering’s and Sherrington’s laws in more advanced cases (e.g., pseudoparesis of the contralateral antagonist, enhancement of ptosis in myasthenia gravis)
To perform more advanced measurements of strabismus (e.g., double Maddox rod testing, Lancaster red green testing, synoptophore or amblyoscope).
To perform assessment of vision in more difficult strabismus patients (e.g, uncooperative child, mentally impaired, nonverbal or preverbal).
To perform basic extraocular muscle surgery
To exercise surgical judgement for the indications and contraindications for strabismus surgery
To perform pre-operative assessment, intraoperative techniques and to describe intraoperative and post-operative complications of strabismus surgery
To perform the following strabismus surgeries
Recession
Resection
Muscle weakening (e.g., tenotomy) and strengthening (e.g., tuck) procedures
Transposition
Use of adjustable sutures
To manage the complications of strabismus surgery (e.g., slipped muscle, anterior segment ischemia).
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 being paged.
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.
