By Pamela Martineau
Marshall B. Ketchum University’s Southern California College of Optometry boasts an impressive network of residency sites. The depth and breadth of its program, which focuses on exceptional resident training, is highly regarded throughout the country.
The size, depth and breadth of SCCO’s residencies is only a small part of what makes it remarkable. The individual residency programs themselves are unique in that they are designed to train residents in the latest evidence-based theories and advanced clinical procedures embraced by SCCO and American Optometric Association’s guidelines while focusing on training in interprofessional education and collaborative teamwork. Program settings range from Indian reservations to private practices to the Department of Veterans Affairs.
The majority of programs are offered in California, but there are affiliated programs in Washington, Arizona, Nevada, New Mexico and Utah as well.
Supervisors at four of the residency programs offered by SCCO spoke to Ketchum Magazine about what makes their programs unique. See firsthand why these programs are so imperative.
INDIAN HEALTH SERVICE CHINLE, ARIZONA
Residency Director, Brandon Runyon, OD Chinle Comprehensive Health Care Facility Residency in Ocular Disease
Amid the red rock of the Colorado Plateau, the Chinle Service Unit Optometry Residency Program offers residents training in primary eye care and ocular disease management in a hospital facility serving approximately 35,000 Navajo Indians. Residents practice in a multidisciplinary environment where they are fully integrated with practitioners in various medical disciplines ranging from emergency medicine to pediatrics, internal medicine and rheumatology.
“Over the course of the year, (the residents) really gain a lot of confidence in communicating and co-managing patients with other medical disciplines,” says Residency Coordinator Dr. Brandon Runyon, OD, FAAO.
Dr. Runyon says residents gain experience in managing complicated optometric cases including eye trauma, uveitis, glaucoma, diabetic retinopathy and ocular complications of systemic disease. Residents in this program will care for Native American patients of all ages, from neonates to elderly patients. “The youngest patient I’ve cared for at this facility is a 3-day-old neonate, and the oldest is 105 years old,” says Dr. Runyon.
Dr. Runyon adds that uveitis—an inflammatory complication of autoimmune diseases—is encountered with more frequency at this clinic than most other primary eye care clinics in the nation. Native American populations have a higher frequency of autoimmune diseases.
In addition to focusing on the integration and multidisciplinary care, the residency program seeks to provide an added cultural experience as medical care at Chinle Hospital commonly integrates Navajo cultural beliefs with Western medicine and treatments. Three native healers work at the hospital, and residents have an opportunity to spend time observing with the healers to further understand traditional cultural beliefs and healing methods.
Dr. Runyon said the healers once invited him to their “hogan” – the traditional Navajo home (now more commonly used for ceremonies) – which is located at the hospital. They were interested in learning how diabetes impacts the eyes for the purpose of educating their patients about the disease using a culturally sensitive approach. However, not all patients seek the help of the native healers. “Every patient is different in how traditional their beliefs are,” he says.
One more unique aspect of the residency training program is the optometry minor procedures clinic that provides the residents with experience in advanced optometric procedures such as eyelid lump and bump removal, chalazion incision and curettage, entropion repair by suture and others. The program includes a minor procedures education series and hands-on learning lab that provides dedicated time for education and practice performing these procedures. These additional services have been provided locally for several years now, which has significantly decreased the patients’ burden of travel given the isolated location.
“That’s something that’s not available at many other sites across the country,” says Dr. Runyon, when asked about the advanced procedures training.
Because the facility is located on an Indian reservation, those who are not members of the tribe are unable to own land in the local area. As a result, all medical providers and some hospital staff live in federally owned housing in a small community adjacent to the hospital.
“We work together and we play together,” says Dr. Runyon, adding that the medical staff and residents frequently hold yoga classes, movie nights and other recreational activities such as ultimate Frisbee to foster a stronger personal and working relationship amongst the providers.
The nearest airport is three-and a-half hours away by car and the nearest super store is 95 miles away. The remoteness of the location and immersion in the culture of the patients attracts a special kind of resident, says Dr. Runyon. When asked about the remoteness of Chinle, “I like to say – ‘It’s not the middle of nowhere. It is the center of everything,’” he adds.
“(Our program attracts) people who come in knowing hard work is in front of them and that it’s not going to be easy, but they are interested in growing both professionally and culturally,” he says. Ultimately, after a rewarding year of cultural immersion and significant professional growth, a good portion of the residents end up working for the Indian Health Service or at a tribal facility following completion of the program.
SEATTLE AND TACOMA SITES, WASHINGTON
Residency Director, Stuart Frank, OD
Residency in Primary Care Optometry
The Kaiser Permanente campuses in Seattle and Tacoma serve a diverse group of patients from multiple ethnicities and socioeconomic strata. This diversity makes for a rich residency experience, says Residency Coordinator Dr. Stuart Frank, OD.
Residents at both the Seattle and Tacoma facilities work with each of the full-time staff optometrists. The residents rotate each day among the doctors. Most of our staff doctors spend their day managing ocular disease cases and doing primary eye care, while a few specialize in seeing contact lens cases.
Our residents have a mixed schedule that includes urgent care and ocular disease cases, contact lenses, low vision and primary eye care. The residents initially see about eight patients a day, but may build up to 14 to 16 patients a day by the end of the year.
“Each patient encounter has the opportunity to teach the resident something,” says Dr. Frank. “We want our residents to appreciate each patient and each patient encounter. Our hope is that the residents will have an enjoyable educational experience that they can reflect back upon and say – ‘Yes, I got something unique out of this program overall.’”
Each doctor has special interests – such as retina, glaucoma, anterior segment disorders and neuro-ophthalmic disease – which they enjoy sharing with the residents. Dr. Frank emphasizes that working with five different doctors allows residents to view different styles and ways of interacting with patients and colleagues.
“They really have the opportunity to dig into each of our practices and see how our styles are different,” says Dr. Frank. “Eventually they can adopt a style of their own.”
“We have five doctors who, combined, have more than 100 years of experience,” adds Dr. Frank. “The residents can look to any one of us at any time with questions.”
In addition to the diversity of patients seen, Dr. Frank says the medical collegiality among doctors at Kaiser is extraordinary and truly collaborative. “The residents who come to our program will be part of the patient’s medical team. We take a cooperative approach where the patient, the resident and other care providers are all involved in shared decision-making with regard to the patient’s care.”
Dr. Frank says the optometrists at Kaiser make and receive multiple referrals and are required to work with various specialties including doctors in family practice, internal medicine, neurology, ophthalmology, rheumatology and other areas of medicine. This approach is consistent with the interprofessional education – or IPE – approach embraced at SCCO and endorsed nationally by several medical associations. The idea is that training residents to work as part of a clinical team makes for better doctors and optimal health outcomes for patients.
“You really feel like you are part of a medical team and your responsibility is to add to that team – to offer your expertise,” says Dr. Frank.
Dr. Frank says he enjoys working with the residents whom he typically finds to be “very forward-thinking … they are looking to make themselves better doctors for their patients.”
CENTER FOR VISION DEVELOPMENT OPTOMETRY, INC.
Residency Director, Derek Tong, OD, ’98
Residency in Pediatric Optometry & Vision Therapy/Neuro-Optometry
Residents at Dr. Derek Tong’s private practice – the Center for Vision Development Optometry in Pasadena, Calif. – receive advanced clinical training in the growing field of neuro-optometry. The field specializes in vision disorders caused by brain injuries such as stroke and concussion.
The CDC estimated that there are about 800,000 new cases of stroke and 2 million new cases of traumatic brain injury each year. As awareness of these conditions grows, so does the need for optometrists with the training to diagnose and treat the vision disorders associated with these conditions.
“There are very few residency programs that provide training in neuro-optometry,” says Dr. Tong. Neuro-optometry treatment may involve prescribing therapeutics prism lenses and weekly vision therapy sessions where patients work on visual tracking, eye coordination, depth perception and many other issues. Residents in Dr. Tong’s practice become adept at performing these vision therapy techniques.
Dr. Tong also focuses on pediatric optometry, giving residents an opportunity to learn how to cater their examination to meet the needs of children of all ages, including those who are not able to read the letters on the standard eye chart. “Sometimes we need to make it like a game to get them involved,” he says of the young patients. Often, various eye charts with pictures will be used.
Dr. Tong also provides services to many children with autism who present with vision problems such as poor eye contact or eye-hand coordination. He says residents learn how to adapt the vision therapy sessions to meet the needs of the patients in terms of the communication style.
“Some patients may need more direction, more prompting or support from parents,” he says. “Our residents use a reward system of vision therapy dollars to keep the patients motivated.” One resident designed a chart with princesses as its target, while another developed a chart for those who like games such as Minecraft. “They bring in a lot of cool ideas,” Dr. Tong proudly says of his residents.
Dr. Tong has expanded his residency program beyond the development of clinical skills. He also trains his residents on practice management. He teaches them how to effectively operate a vision therapy clinic in a private practice setting and communicate with referral sources regarding their patients through written reports and electronic communications. The residents learn how to do outreach and marketing, including providing lectures and in-services so that educators and other professionals will become aware of how to identify vision problems in children.
Dr. Tong also encourages his residents to attend national and local optometric conferences and present case reports. Several of his residents’ papers have been published in peer-reviewed journals. His residency program currently provides the highest amount of travel reimbursement to help residents cover their costs of attending these conferences.
The physical proximity of this residency program to MBKU’s Southern California College of Optometry allows the residents to attend the monthly Vision Therapy Journal Club and interact with SCCO faculty.
All told, the residency program at the Center for Vision Development Optometry is an excellent fit for residents whose career goals include starting or joining a private practice that specializes in pediatric optometry, vision therapy or neuro-optometry.
“Our residency program provides a highly concentrated advanced training in 12 ½ months in a friendly and positive environment,” says Dr. Tong. “If the newly licensed optometrist were to try learning on their own without such residency training, it would probably take them as many as five years to reach the same level of clinical expertise.”
SOUTHERN ARIZONA VETERANS AFFAIRS HEALTH CARE SYSTEM
Residency Director, Amy L. Grimes, OD, R ’99
Residency in Primary Care/Low Vision Rehabilitation
Launched in 1995, the optometry residency program at the Southern Arizona Veterans Affairs Health Care System embraces what Amy Grimes, OD, Chief of Optometry, calls the “full circle concept.”
“Since all urgent patients are seen by the optometry chief resident, our residents have the experience of triaging patient complaints and then examining the patient, which allows a full circle concept,” says Dr. Grimes.
“Our residents also get the opportunity to work alongside ophthalmology and hand off cases requiring surgical intervention such as retinal detachments, macular edema, macular holes, perforated corneas, and obviously, cataracts,” she adds.
The chief resident position is unique to this residency program. The four residents who participate in the program rotate in three-month blocks spending nine months in the eye clinic where they serve a three-month stint as chief resident and also spend three months in the multidisciplinary blind rehabilitation center examining end-stage disease incorporating low vision. As chief resident, they triage and examine urgent cases which “serves them well when they complete the program and are working independently,” says Dr. Grimes.
The majority of the veterans seen at the clinic are male, with the average age being 65. Dr. Grimes adds, however, that women veterans are the center’s fastest-growing population. The most common cases seen are glaucoma, macular degeneration and diabetic retinopathy. However, residents get their fair share of anterior segment including corneal diseases, dry eye, herpetic complications and uveitis. The location of the eye clinic on the VA campus allows residents the opportunity to co- manage patients with rheumatology, endocrinology and neurology.
Eye clinic residents examine roughly 12 to 18 patients a day, while those working in the blind rehabilitation center work at a slower pace immersed in low vision with a small component of vision rehabilitation associated with traumatic brain injury. These residents may see about 3 to 6 patients a day. Friday afternoons are reserved for didactic educational activities such as lectures, grand rounds, journal clubs, case presentations and chart review. Fostering this collaboration among residents aligns with the educational approach at SCCO where clinical team skills training is encouraged. A vast amount of research indicates that complex issues are best addressed by teams of doctors, especially interprofessional teams.
Six optometrists work with the residents, providing what Dr. Grimes calls a “nurturing environment” for the residents. Residents working in the blind rehabilitation center “are able to hone their advanced examination skills … with state-of-the-art equipment and one-on-one interaction with an attending optometrist,” says Dr. Grimes.
Dr. Grimes says residents also are encouraged to join optometry associations.
“We foster involvement in professional optometry associations,” she says. “We promote lifelong learning.”
Overall, residency programs offer invaluable experience, says Dr. Grimes, who is the Chair of the American Academy of Optometry Resident’s Day Committee and serves on the Accreditation Council on Optometric Education Residency Committee. “I don’t think anything could replace that year – exclamation point!” she says.