TVAMC Optometry Residency Overview

The Tuscaloosa VA Medical Center Optometry Residency 
in Ocular Disease with emphases in Primary Care Optometry and Retina

(2 Positions)

Affiliation: The University of Alabama at Birmingham School of Optometry

The Tuscaloosa VA Medical Center (TVAMC) is located in West Alabama where it is situated on a beautiful 125 acre campus with 25 major buildings.  TVAMC provides primary care, long-term health care and mental health care services to eligible veterans in the Veterans Integrated Service Network (VISN) 7.  Comprehensive outpatient services, as well as access to secondary and tertiary care services, are also available to eligible veterans.

The Optometry Clinic at the Tuscaloosa Veterans Affairs Medical Center was established in 1978. The following year the clinic accepted its first resident. The program was so successful that with the help of our affiliate, the University of Alabama at Birmingham School of Optometry (UABSO), a second position was created in 1980.  The optometry clinic has experienced significant growth through the years, having grown from a clinic with a total of only three rooms, to a clinic which now contains seven exam rooms, two special procedures rooms, a preliminary testing area/health technician office, staff office space, a breakroom , and a large waiting area.  Our annual patient encounters currently average approximately 7500.  This number of encounters affords each resident sufficient quality and quantity of patient encounters.  The Department of Veterans Affairs has also amended patient eligibility rules and its attitude toward delivering care, and now emphasizes preventive health care.  These changes in focus have been very beneficial for the optometry clinic in that they have provided opportunities for continued growth and increased the optometric education opportunities available at TVAMC. 

The Tuscaloosa VAMC has 3 optometrists on staff.  Optometrists provide primary eye care as well as manage ocular diseases and ocular manifestations of systemic diseases.  Each optometrist is a licensed practitioner, and is credentialed and privileged to practice full scope optometry, including the use of topical and oral medications.
 
The Tuscaloosa VAMC has a teaching program that trains fourth year optometry students from the University of Alabama at Birmingham School of Optometry (UABSO) and from the Illinois College of Optometry (ICO).  Currently, three to four students per quarter rotate through our program.  Although our primary goal is to provide high quality eye care to our nation's Veterans, our other emphasis is to provide a quality educational experience for our optometry residents and students.  As the residency year progresses, residents who have demonstrated an established level of clinical competence are allowed to precept students under the guidance of the clinic staff.  This affords additional opportunities for the resident's growth and educational experience.

Residents will perform routine eye examinations as well as be responsible for evaluating walk-in and emergency patients.  Based on our patient demographics, residents will encounter a high percentage of patients with glaucoma, macular degeneration, diabetic retinopathy, inflammatory eye disease, vascular occlusive disease and varied ocular manifestations of systemic diseases.  Residents have an opportunity to rotate through external clinical sites (subject to approval by the office of Academic Affiliations) including a private retinal specialist practice and a regional optometry / ophthalmology referral center.  The external rotations afford  them the opportunity to observe more complicated cases and procedures.

The Tuscaloosa VA Medical Center Optometric Residency in Ocular Disease is a one-year program which typically begins on July 1st and concludes June 30th of the following year.  Adjustments may be required by Human Resources related to the start dates and end dates based on when pay periods and the July 4th Federal holiday falls.  Regardless, the appointment is for one year and is reflected in the Residency Acceptance Letter signed by the accepted candidate

CONTACT INFORMATION:
Medical Center Toll-Free Number  1-
Optometry Clinic Main Number  1-
Optometry Clinic Fax Number  1-

MAILING ADDRESS:
Tuscaloosa Veterans Affairs Medical Center
Optometry Clinic (679/123)
3701 East Loop Road
Tuscaloosa, AL  35404  

Mission Statement

The mission of the Residency in Ocular Disease with emphases in Primary Care Optometry and Retina at the Tuscaloosa Veterans Affairs Medical Center is to provide a unique post-doctoral experience in a multidisciplinary setting with the intent of nurturing the residents’ development into exceptional optometric clinicians by broadening general skills and mastering additional specialized skills in the areas of ocular disease and primary care optometry through independent patient care while adhering to supervision guidelines.

OPTOMETRY RESIDENCY PROGRAM GOALS:

1. To solidify each resident’s patient care skills in the areas of ocular disease and primary care optometry.
2. To expand each resident’s knowledge base by delivering care to patients with a wide variety of ocular diseases, including retinal diseases, and systemic diseases.
3. To provide residents the opportunity to interact with providers outside of optometry and to help them understand how a health care team operates in a multidisciplinary health care system.
4. To develop and improve the resident's scholarly activity skills including those required for the preparation and presentation of lectures and the process of manuscript preparation.
5. To equip residents with the necessary knowledge base and clinical skills for careers in specialty service or clinical teaching.

OPTOMETRY RESIDENCY PROGRAM CURRICULUM: 

The educational objectives, learning activities, and expected outcomes of the Residency in Ocular Disease include the following:

Clinical Activities

1. Residents will manage at least 1000 patient care encounters.
2. The residents will be the primary provider, within residency supervision guidelines, for patients exhibiting a variety of ocular diseases (including retinal diseases) such as: diabetic retinopathy, glaucoma, cataracts, acute red eyes, vein occlusions, age-related macular degeneration, inflammatory eye disease , retinal lattice degeneration, and others.
3. Residents will interact with disciplines outside the medical center through external rotations.  
4. Residents will consult with regional VA and non-VA ophthalmic sub-specialties.                                                                                                 
5. Residents will interact with medical disciplines inside the facility by completing internal consult requests.
6. Residents will manage patients requiring specialized testing and perform tests on these patients in sufficient numbers and at a level of expertise that is acceptable to the clinical staff.

Scholarly Activities

1. Residents must prepare a manuscript of publishable quality.
2. Residents must research, prepare and present lectures at specific times during the residency year.
3. Residents will select and present articles in Journal Club.

Didactic Activities

1. Residents will attend the weekly Residency Conference at the affiliate (UABSO), which will cover core topics of broad interest and specialty topics in primary care optometry. 

Commensurate with The Department of Veterans Affairs Residency Supervision Guidelines, all residents who are trained in the VA system must be supervised by an attending staff doctor who is physically present in their respective clinics.  Residents are responsible for performing examinations, completing the electronic records, and collaborating with their attending clinic staff for each patient.  Graduated levels of supervision are granted during the course of the residency year as staff doctors become more familiar with and confident in a resident's clinical and case management skills.  In each instance, the attending with whom the resident worked will co-sign each patient note.

The TVAMC has developed three levels of supervision.  The clinic staff will make a final determination on the level of supervision based on the individual competency of each resident. 

 
Level 1 

This level represents the entry level for all residents.  At this level, residents will perform a complete ocular examination of their patient and formulate differential diagnoses and management strategies.  The attending doctor will verify the resident's findings to ensure the accuracy of the diagnosis and treatment plan.  It is anticipated that each resident will be prepared to progress to the 2nd level of supervision after one month of interaction with patients and the attending doctors.  

Of note: passage of all 3 parts of the NBEO examination is required before residents may proceed to Level 2 Supervision. If a resident has not passed all 3 parts of the NBEO examination within 2 months of the program start date, external rotations may begin but not the other components of level 2.  

Level 2 

This level of supervision permits residents to discuss routine cases without the physical examination of every patient by the attending staff.  More complex cases will require the staff to physically examine the patient.  Procedures such as foreign body removal will be performed with the attending present.  This level of supervision also permits residents to rotate outside into external sites. It is anticipated that each resident will be prepared to progress to the 3rd level of supervision by the time of the 1st quarter resident review. 

Level 3  

This level of supervision permits residents to supervise 4th year students.  All cases will continue to be reviewed and cosigned by the staff attending.  Advanced procedures will continue to be conducted with the attending present.

OPTOMETRY RESIDENCY ADMISSION CRITERIA

ADMISSION ELIGIBILITY CRITERIA

• Applicants must have earned a Doctor of Optometry (O.D.) degree, or will have earned such a degree, by the time of matriculation from an Accreditation Council on Optometric Education accredited school or college of optometry.
• Applicant should have a minimum cumulative grade point average in the optometry professional curriculum of 3.0 on a 4.0 scale.
• Applicants must have successfully completed parts I, II, and III of the National Board of Examiners in Optometry (NBEO).
• An interview by the TVAMC optometry staff with concurrence by the UABSO residency committee may be necessary.
• By congressional law, candidates must be citizens of the United States.
• The Tuscaloosa VAMC affirms that all residency applicants will be evaluated without regard to sex, race, color, creed, national origin, or non-disqualifying physical disabilities.

Program Application Deadline: February 15

Selection procedure

Interested candidates for the residency positions, including official ORMatch applicants, are directed to the TVAMC optometry residency web pages and are provided an electronic copy of the TVAMC Residency in Ocular Disease Handbook (or are sent a hard copy if needed).   Applicants may contact the Residency Director or the Residency Supervisor from the ORMatch website to obtain more information about the program. Dr. Schifanella usually corresponds with interested potential candidates via email and/or phone prior to and during the ORMatch application process.

The application process officially begins with the resident registering with ORMatch. The resident applicant registers with ORMatch by submitting agreement to compliance with ORMatch Rules, an Applicant Agreement, OE Tracker Number, and a registration fee. Once registered, the resident applicant will submit the following documents to ORMatch:

• A page of applicant contact, educational, and NBEO information
• Letter of intent
• Curriculum vitae
• Unofficial optometry school transcript
• Identification of 3 references who will submit letters of recommendation

In addition to the above documents, the program requires a copy of the NBEO score report (photograph or screen shot is acceptable). The applicant should upload a copy of the NBEO score report as supplemental information on the ORMatch application to the program. Official transcripts are required for all applicants and should be sent directly to Dr. Schifanella. Finally, the resident applicant should submit his or her ranking of residency program preferences to ORMatch by the ORMatch deadline.

Whenever possible for the applicants, the program coordinator and the staff optometrists interview qualified applicants. On-site interviews are strongly encouraged, as it gives applicants the opportunity to see the facility, meet the staff and coordinator, and become familiar with the clinic environment. Although each Ocular Disease resident candidate is strongly encouraged to visit TVAMC, a personal interview is not mandatory. Telephone interviews may be arranged if a visit cannot be scheduled. Dr. Schifanella is responsible for inviting resident candidates for interviews and for arranging the interview schedule for each candidate. The interview typically consists of the visiting candidate meeting with Dr. Schifanella, Dr. Whitaker, Dr. Prewitt, and the current residents. The candidate's meeting with Dr. Schifanella includes a one-on-one interview, a review of the residency requirements, and a tour of the TVAMC Optometry Clinic.

Following the interview, Dr. Schifanella requests input regarding the candidates from Dr. Whitaker, Dr. Prewitt, and the current residents. She then ranks the candidates and shares this ranking with Dr. Whitaker and Dr. Prewitt. Based on these discussions, the ranking may be modified. The final ranking list is reviewed and approved by the Residency and Fellowship Programs Advisory Committee and the Dean prior to the match. Finally, Dr. Schifanella enters the official ranking into the ORMatch system. Official notification of matches is sent to all parties by ORMatch one week after the matching deadline date. Following the match, Dr. Schifanella contacts the candidates and letters of acceptance are sent to the incoming residents.

Resident applicants who do not match will be informed of such by ORMatch. The names of residency programs which also did not match and the name of unmatched applicants will be available on the ORMatch website after the match. After official notification of non-matched status by ORMatch, interested parties can proceed with independent negotiation in filling residency programs.

United States citizenship is required to qualify for VHA appointment in a paid VA optometry resident position funded by the Office of Academic Affiliations.  Reference: VA Handbook 5005/57, Part II, Chapter 3, Paragraph 3.g.(1) & (5)(c), dated June 14, 2012.

The resident must obtain a license in at least one state.

Application Materials and Procedures Contact Information:

Lisa Schifanella, O.D., M.S.

Tuscaloosa Veterans Affairs Medical Center

3701 Loop Road East

Tuscaloosa, AL 35404

Lisa.Schifanella@va.gov

RESIDENCY COMPLETION CRITERIA

When a resident successfully completes the training program, the Director of Residency Programs recommends to the Dean of the affiliate (UABSO) the granting of a certificate. Criteria for residency completion are as follows:

• The resident is required to deliver clinical services at a level which is satisfactory to the clinic staff.
• The resident is required to write a paper based on original research, literature review, or a clinical case suitable for publication in a refereed ophthalmic journal.
• The resident is expected to perform in a professional manner in the delivery of patient care services and to observe those proprieties of conduct and courtesies that are consistent with the rules and regulations governing the clinic.
• The resident is required to participate in and complete the requirements set forth in the curriculum.

Contact Information

Lisa L. Schifanella, OD, MS

Optometry Residency Program Supervisor
Tuscaloosa VAMC Optometry Clinic
3701 Loop Road East
Tuscaloosa, AL 35404
Phone: 
Fax: 

RESIDENT HOURS

Normal Medical Center clinic hours are from 8:00am to 4:30pm Monday through Friday. The Optometry clinic begins seeing patients at 7:00 am. Residents begin at 7:30 am and end at 4:00 pm Monday, Tuesday, Thursday and Friday. Even though the tour of duty officially ends at 4:00 pm, the residents are expected to stay until all patients for the day are seen and notes for the day are completed.  There is no call duty. Each Wednesday morning, residents meet for the didactic component of the program at the affiliate (UABSO). Conference begins at 8:00 am and concludes around 12:00 pm. Wednesday afternoon is reserved for research and rotations through external sites such as a private practice retinal surgeon and a regional optometry/ophthalmology referral center  subject to approval by the VAMC Office of Academic Affiliations..

RESIDENT RESOURCES

The resident has access to current educational and informational resources.  The
following educational resources are available to each resident:

• Access to the VHA National Desktop Library internet library at the desktop in every exam room
• TMS online training library (eyecare and extensive non-eyecare holdings)
• Access to ophthalmology and optometry journal articles and texts online through the online holdings and subscriptions of the affiliate’s library – UAB Lister Hill Library of the Health Sciences
• On-site ophthalmic reference texts
• Physical access to Lister Hill Library of the Health Sciences at the affiliate (UABSO)

 
Since 2010, the TVAMC Education Department has been encouraging staff to use online databases that have been purchased by Veterans Affairs Central Office headquarters and the VISN 7.  This has increased the number of educational resources (journals and textbooks) that are available to staff and residents.  As an example, through the one of our databases, the following online materials are available:

• Review of Cornea and Contact Lens   (2006 to present)
• Review of Optometry   (2004 to present)
• Optometry and Vision Science  (1989 to present)
• Ophthalmology    (1998 to present)
• American Journal of Ophthalmology (2004 to present)
• Canadian Journal of Ophthalmology (2005 to present)
• Journal of Glaucoma   (1992 to present)
• Journal of Neuro-ophthalmology  (1994 to present)
• Survey of Ophthalmology   (1975 to 1994)
 

Residents may access the VHA National Desktop Library from their exam rooms.  The VHA National Desktop library (https://www.va.gov/library/) is an online medical library available to staff VA-wide that provides full-text access to clinical textbooks, journals, and databases.  Some of the resources in the Desktop Library will link to sites that are on the VA intranet and must be accessed through the VA network.  The extensive holdings in the VA National Desktop Library include over more than 50 databases. 

The VA Talent Management System (TMS) is the online VA education system.  The VA requires certain training sessions for residents to complete such as HIPAA, infection control, and environmental safety.  The residents have access to the entire library of trainings on TMS, including many medical, leadership, billing, and eye-related trainings.  The resident may search for a desired topic and assign the desired training to him - or herself. 

The resident’s examination room/office has space for the resident’s small personal library, and it contains a computer with internet, VHA National Desktop Library access, TMS access, and patient data (electronic health record) access.  Residents are welcome to use the small collection of reference books in the faculty office.  Other resources are available through the Lister Hill library associated with the affiliate UABSO.

Residents are advised by the Residency Director early in the Residency Program to complete the UAB process to become an unpaid volunteer in order to obtain library privileges through UAB. The Administrative Associate to the Residency Programs at UABSO and the Residency Director at UABSO assist the residents through the process. Once a resident has become an unpaid volunteer, the resident is given the same library privileges as faculty at the Lister Hill Library of the Health Sciences, located next door to the Henry B. Peters School of Optometry Building. This library is the largest biomedical library in Alabama, and occupies a space of approximately 90,000 square feet.  The optometry and vision science holdings are integrated into the health sciences library collection and are organized according to the National Library of Medicine classification scheme.  Currently, its collection contains electronic journals of more than 5000 titles for the health sciences; 104 of these are optometry and ophthalmology titles.  Students, residents, and faculty have access to over 300 databases and resources and 2,587 electronic books.  In total, the library’s print and media collection contains over 338,000 volumes in all formats, spanning seven centuries of knowledge with the rare collections of the Reynolds Historical Library and extending to the latest electronic journals and databases.  The library catalog, electronic journals, databases, etc. are accessible from an off-campus internet connected computer by the resident when he or she authenticates by entering his or her Blazer ID and password.  Librarians are available to assist the resident with databases and resources, literature searches, systematic reviews, grant preparation, and other research needs.  The School of Optometry is assigned a reference librarian to whom the residents may turn for help.  The Lister Hill Library web site is https://library.uab.edu/locations/lister-hill.