RESIDENCY HANDBOOK
For
Southern College of Optometry
Residency Programs
2014-2015
MISSION STATEMENT
The Mission of SCO Residency Programs is to advance the clinical training of
graduate optometrists as an instrumental part of Southern College of
Optometry’s Mission to educate the best possible healthcare providers.
Introduction
This handbook provides guidelines for residents enrolled in programs at or
affiliated with Southern College of Optometry.
It is intended to serve as a
resource for residents by providing information on policies and procedures that
affect individuals participating in the College’s residency programs. It is reviewed
periodically by the Director of Residency Programs and the Residency
Committee, and may be revised with due notice to reflect changes in policy and
enhancements or additions to our programs.
This handbook is organized as follows: subjects germane to all of the programs
are covered in the handbook itself.
Residents are also provided a second
document consisting of the program description and, if necessary, additional
documents specific to their program.
Additional documentation concerning policies and procedures may be provided
by the residency program site.
Adopted by the Southern College of Optometry Residency Committee
January 1995
Amended: February 1998
March 2003, March 2009, March 2011, March 2012, March 2013, March 2014
ii
Table of Contents
Introduction ........................................................................................................... ii
GENERAL EXPECTATIONS ................................................................................ 1
Information for Entering Residents........................................................................ 5
Orientation ......................................................................................................... 5
Patient Care Philosophy ....................................................................................... 7
Resident Evaluation .............................................................................................. 7
Absences .............................................................................................................. 7
Counseling, Remediation, and Grievance Policies ............................................... 8
Remediation and Dismissal .................................................................................. 9
Residency Completion ........................................................................................ 10
Information for departing residents ..................................................................... 12
Resident Activity Reports .................................................................................... 13
Getting Registered on the System................................................................... 13
Instructions for using the activity logging system............................................. 17
Evaluation Forms ................................................................................................ 24
Summary of Forms to be Submitted by Residents ....................................... 33
iii
GENERAL EXPECTATIONS
This section contains the general expectations and responsibilities of each
position associated with the residency programs.
RESIDENTS
Residents in each residency program sponsored by or affiliated with Southern
College of Optometry shall:
1.
Strive to accomplish at the highest level in all components of the residency
program as stated in the program description for respective residency
programs.
2.
Maintain, at all times, the highest level of professional behavior.
3.
Provide reports of their activities and evaluations of the program and
residency faculty to the Director of Residency Programs as instructed.
4.
Meet with their supervisor on a quarterly basis to review their program and
the resident's performance.
FACULTY SUPERVISION OF RESIDENTS
Faculty members providing direct supervision to residents shall:
1.
Provide orientation program(s) for residents designating goals,
expectations, educational standards, policies, etc.
2.
Provide appropriate supervision to all resident activities.
3.
Assist the resident in the development and completion of the required
paper.
4.
Determine and implement appropriate educational activities for the
resident's continuance and satisfactory completion of each residency
program.
5.
Ensure that programmatic goals and objectives are appropriate for initial
and continuous accreditation.
6.
Make recommendations to the Director of Residency Programs and/or
Residency Committee regarding residency programs and residents.
1
DIRECTOR/ASSISTANT DIRECTOR OF RESIDENCY
PROGRAMS
The Director of Residency Programs shall be responsible for the following
functions:
1.
Publicizing residency programs through appropriate media.
2.
Coordinating the compilation of all admission materials.
3.
Scheduling applicant interviews with the Residency Committee at SCO for
in house programs.
4.
Corresponding with prospective residency applicants.
5.
Coordinating the orientation of residents regarding activity logs,
evaluations, and generalized program policies.
6.
Preparing a yearly report of the College's residency programs.
7.
Chairing the meetings of the Residency Committee
8.
Assisting each program in maintaining full accreditation by the
Accreditation Council on Optometric Education.
RESIDENCY COMMITTEE
The Residency Committee consists of the Vice President for Academic Affairs,
the Director of Residency Programs, and the Faculty Supervisor of each of the
existing residency programs located at or affiliated with the College. The Vice
President for Clinical Programs serves as an ex-officio member. The functions of
the Residency Committee shall include:
1.
Establishment of general criteria for each residency program and
determination of conformance with the requirements of the Accreditation
Council on Optometric Education for accreditation of residencies.
2.
Consideration of general qualifications applicants must have for
admissions into residency programs at or affiliated with the College.
3.
Monitoring the selection process for residency applicants and making
recommendations regarding changes in the selection process.
2
4.
Interviewing and ranking of applicants and formulation of admission
recommendations.
5.
Assisting in the development of an adequate applicant pool for all
residency programs at the College.
6.
Assisting in authoring of informational documents for appropriate
announcements of residency programs.
7.
Developing curriculum guidelines for residency programs and providing
procedures to ensure adequate faculty supervision, patient loads,
facilities, etc.
8.
Establishing appropriate guidelines for the residents' research projects or
case reports for subsequent publication.
9.
General supervision of the evaluation processes for residency programs.
10.
Determination of the need for residency programs in the College's clinical
educational programs.
11.
Making recommendations to the Vice President for Academic Affairs
regarding enhancement of existing residency programs.
12.
Providing assistance to the Vice President for Academic Affairs regarding
residency programs when requested.
VICE PRESIDENT FOR CLINICAL PROGRAMS
The Vice President for Clinical Programs shall have the following responsibilities
pertaining to the College's residency programs:
1.
The Vice President for Clinical Programs shall monitor and assist the
Director of Residency Programs and the supervisor of each program
located in a College-operated clinic with the development and
implementation of clinic policies amenable to the achievement of the goals
and objectives of each program.
2.
The Vice President for Clinical Programs shall serve as an ex-officio
member of the Residency Committee.
3.
The Vice President for Clinical Programs shall monitor and assist the
Director of Residency Programs and the supervisors in devising and
implementing specific enhancements to the clinical portion of Collegebased programs to achieve compliance with Accreditation Council on
Optometric Education accreditation report recommendations.
3
VICE PRESIDENT FOR ACADEMIC AFFAIRS
Certain responsibilities with respect to residency programs offered at or affiliated
with Southern College of Optometry should be coordinated with the Office of the
Vice President for Academic Affairs for efficiency. The Office of the Vice
President for Academic Affairs will be responsible for:
1.
Assisting the Residency Committee to ensure that all residency programs
offered by or affiliated with SCO are accredited and to monitor all
programs to ensure the continuance of appropriate accreditation.
2.
Assisting the Residency Committee in the development of additional
residency programs offered at or affiliated with SCO.
3.
Implementing recommendations made by the Residency Committee which
have received administrative approval.
4
Information for Entering Residents
We welcome you to our residency programs. Your supervisor will provide a
detailed orientation concerning specifics of your program. This section is
intended to provide Memphis area Residents with a list of items that all entering
residents need to address at the start of the program. Please feel free to contact
the Director of Residency Programs at cervin@sco.edu or (901) 722-3201 if you
have any questions regarding these items.
Entering Resident Checklist
Item
Location
SCO ID**, Keys*, Parking Physical Plant
Decal**
Department
Clinic Jackets*
Administrative Suite, The
Eye Center
Weekly VisionNet
Library - 5th floor
Reading List**
Tax Forms, etc*.
Accounting Dept. - 11th
floor
I-9 & general info sheet*
Human Resources - 10th
floor
Schedule
Your clinic
Orientation
Your clinic; Southern
College of Optometry **
*In-house residents only
**Memphis area residents
Individual to Contact
Stacy Knight
Lynne Boyd
Leslie Holland
Kathryn Melonas
Ann Fields
Your supervisor
Your supervisor, Dr.
Cheryl Ervin
Orientation
The Director of Residency Programs will provide an orientation, either verbal,
written, or both to entering residents that covers items common to all SCOaffiliated residency programs. Such items include: activity and patient encounter
reporting, evaluation form submission, and general residency policies, among
5
others. This orientation will be provided prior to the beginning of the residency if
possible or as soon as possible after the beginning of the program.
The program supervisor will provide an orientation covering items specific to his
or her residency program. This will include items such as resident scheduling,
clinical practice protocols, infection control, facility safety policies, other policies
specific to the site, and any other information that the supervisor considers
appropriate. This orientation will be provided prior to the beginning of the
residency if possible or as soon as practicable after the beginning of the
residency.
6
Patient Care Philosophy
As health care providers, it is the responsibility of every resident to ensure that all
clinical services delivered are of the highest caliber and in the best interest of the
patient. Medical records are to be complete, accurate, and signed by the
resident and other professional staff if appropriate. Patient confidentiality is to be
maintained. Remarks regarding care rendered by other providers should not be
made in the presence of patients. Residents should always treat patients with
respect and address them with a professional demeanor.
Resident Evaluation
Residents are evaluated by their supervisor. The supervisor will complete a
written evaluation of each resident in their program three times during the year
and at the end of the year.
Absences
Absences are described as occurring with or without leave. Each program has a
specific leave policy as stated in its Program Description in the supplement to
this handbook. Absences without leave are considered a serious breach of
policy. Repeated violations of this policy may lead to termination from the
residency program without certification.
Absences which occur outside of the allotted number of leave days (as specified
in the Program Description) that are due to exigencies (e.g., bereavement,
extended illness, etc.) will be dealt with on a case by case basis by the
Supervisor in consultation with the Director of Residency Programs. Such
7
instances will be dealt with in a manner consistent with maintaining the
educational integrity of the program.
Counseling, Remediation, and Grievance Policies
Residents are expected to follow “chain of command” with all issues related to
their residency program. The Supervisor should always be the first individual
contacted when the resident feels there is a problem that the resident alone
cannot solve. If and only if consultations with the Supervisor do not resolve the
issue(s) of concern the resident should contact the Director of Residency
Programs.
A grievance is an official complaint from a resident that results from a
misapplication or failure to follow policy that adversely affects the resident’s
educational program. If there is no violation of policy, then a grievance is not
warranted. If a resident wishes to file an official grievance, it must be signed by
the resident and sent in written form to the Director of Residency Programs within
10 working days of the alleged violation of policy. The Director of Residency
Programs will review the validity of the grievance and respond to the resident in
writing within 10 working days of receipt of the grievance. If the Director of
Residency Programs considers the grievance valid, he/she will convene a
meeting of the Residency Committee within 20 working days of receipt of the
written complaint to consider the grievance. The Committee will consider the
statements of those involved and recommend a course of action. If the resident’s
supervisor is involved in the grievance, that individual will not sit on the
8
Committee during consideration of the grievance. In the event that the Director
of Residency Programs is involved in the grievance, the Vice President for
Academic Affairs shall fill the previously described role of the Director of
Residency Programs, and the Director of Residency Programs will not sit on the
Residency Committee during consideration of the grievance.
If the resident feels that the decision of the Residency Committee did not follow
established policy, he/she may appeal the Committee’s decision to the President
of the College. The President will choose whether or not to consider the appeal.
If the President chooses to consider the appeal, he/she may recommend either
that the Committee’s decision stand, or that the decision be overturned. In all
instances the President’s decision will be final.
Remediation and Dismissal
A resident may be dismissed for violations of policy, including failure to perform
at expected levels of competence and professionalism. Certain violations are
more serious than others, and this will be taken into consideration when cases
involving possible dismissal are being considered. For purposes of example,
repeated tardiness, if uncorrected, could be grounds for dismissal; a single
substantiated case of intentionally recording false findings in a patient’s chart
could be grounds for dismissal. These examples are for illustrative purposes and
are certainly not all-inclusive.
If the resident is in danger of dismissal, the supervisor may consider remediation
if the resident is deemed capable of correcting the issues in question. Such
remediation is considered an extraordinary step and represents a serious
9
deficiency in the resident’s performance. If remediation is judged to be
appropriate, the supervisor will develop the plan in consultation with the Director
of Residency Programs. The supervisor will be responsible for implementation of
the plan. The plan will have specific goals and outcomes that can be assessed,
and will include a specific time frame for completion. The supervisor will report
on the resident’s progress to the Director of Residency Programs and to the
Residency Committee.
Residency Completion
Completion of the residency occurs at the end of the period specified in the
residency contract or letter of intent and when the resident has successfully
completed all requirements set forth in the contract, residency handbook, and
handbook supplement. The supervisor will notify the Director of Residency
Programs in writing when the resident has met those requirements under the
Supervisor’s responsibility. The Director of Residency Programs will verify that
the resident has completed all requirements under the Director’s responsibility.
The Director will then notify the Southern College of Optometry Records and
Admissions office to release the resident’s certificate.
All published requirements (e.g., residency paper, activity logs, evaluation
forms, etc.) must be completed and submitted by the end of the residency
as defined in the resident’s contract or letter of intent. Failure to submit all
required items by this date may result in permanent forfeiture of certification.
Extensions to this deadline for extenuating circumstances must be requested in
writing by the resident no later than one week prior to the deadline. Approval, if
10
granted, must be in writing from both the resident’s supervisor and the Director of
Residency Programs. The program Supervisor may set earlier deadlines for
completion of some requirements (e.g., the paper) if considered necessary for
review of the items prior to the end of the residency program. The activity log
and evaluations are to be kept current and submitted according the
instructions provided in the relevant sections of the Residency Handbook.
11
Information for departing residents
This section provides a list of items that must be addressed before completing
your residency program. It is intended to include those items common to all
programs. Your supervisor may have discussed additional items with you that
are not on this list. Because of this, the list is not intended to be all-inclusive.
Resident Exit Checklist
Action
Turn in keys* & Southern College of
Optometry ID card
Return all Library materials
Exit interview with supervisor
Forwarding address
Residency Paper
Remaining Patient Logs
Final Program Evaluation
Final Supervisor Evaluation
Residency Certificate
Individual to Contact
Location
Stacy Knight
Physical Plant
Department
Library personnel
Library
Your supervisor
Your clinic
Dr. Ervin
SCO Room 1008
Dr. Ervin
SCO Room 1008
Dr. Ervin
SCO Room 1008
Dr. Ervin
SCO Room 1008
Dr. Ervin
SCO Room 1008
Velma Dickson
Records &
Admissions
*If any were issued
12
Resident Activity Reports
Residents are required to maintain complete and current records of their
activities. These records serve as patient encounter logs and as a method for
reporting other activities such as meetings attended, presentations given, etc.
Instructions for maintaining these records follow.
Getting Registered on the System
We use electronic means to submit all activity logs and evaluations. Step by step
instructions for establishing a user account on our system are as follows:
1. Go to this website, http://residencyadministration.sco.edu/, where you will see
the following screen:
13
2. Click on the words “Resident Registration”. That will take you to this screen:
3. Click on the word “register”, which is below the orange “submit” button. That
will take you to this screen:
14
4. Complete each of the fields. Assign yourself a username and password.
Keep your username and password confidential; we consider them an electronic
signature for your activity logs and evaluations. They must only be used by you.
Please enter an email address that you check regularly. Email is our most
frequently used method of communication.
5. After completing all of the fields click the Submit button. If your registration is
successful, you will see the following screen:
6. Click on “Proceed to login page” and log in. That will take you to a page that
looks like this:
15
7. Verify that your information is correct. If you need to make changes, click on
“Edit” in the upper left hand corner. This will take you to the edit screen:
Make any changes necessary and click Save. This is also the screen that you
will use to complete your forwarding address information at the end of your
residency.
16
7. After you submit your information, it will be verified by the Director of
Residency Programs who will “unlock” your account so that you can use the
activity log and evaluation sites. This verification is an additional safeguard to
ensure that only authorized users can access our system. Because the
verification is done manually, please complete the registration process well in
advance of your start date (typically July 1) so that your account on the system
will be ready for use when you start your residency.
Instructions for using the activity logging system
This section contains instructions for using the electronic activity log. This log is
to be kept current and will be used to track how well your residency
program is doing at providing the experiences set forth in its goals and
objectives.
Tracking your activities is very important. The Accreditation Council on
Optometric Education, the body that determines the accreditation status of all
optometric residencies, requires that this information be tracked and included in
annual reports and self-study documents. Also, our own residency committee
evaluates this information quarterly in an effort to identify any potential problems
with each resident's clinical experiences. Your supervisor will receive monthly
reports so that he/she can address any issues that may adversely impact your
educational program. The accurate and timely entry of your activities is,
therefore, quite important -- certainly not just "busywork"!
The web-based form that you will use is used by all of our residents, with a
special section (“Objective-related Encounters”) that is customized for your
program. For this reason, there are some categories that you may never need.
For example, an ocular disease resident may not do any contact lens fittings. Do
not worry if you never have any patients for some categories. That is
unavoidable with standardized forms.
The web-based log is very straightforward, as described in the step-by-step
instructions below:
The first task is to complete your account setup (see the section above on
Getting Registered on the System). When your account information is verified by
the Director of Residency Programs, your account will be unlocked and you will
be notified by the Director of Residency Programs that your account is ready to
be used.
To use the Activity Log, go to this web address:
http://residencyadministration.sco.edu/
17
Use your username and password to log in to the site. This should take you to
the List page:
18
To add a log entry, click on Add new.
This will take you to the following page:
1. The first step is to select your residency program. Doing so will populate
the Objective-Related Encounters, which are specific to each residency.
2. Next, enter the date. The current date is automatically entered for you; if you
are entering the record on a later date, you can easily replace the current date by
typing over it or clicking on the small icon beside the field which opens a
calendar.
3. Enter the patient initials. This is optional; initials are not required and should
not be entered if your residency site prohibits entry of initials.
4. Enter the patient age. This should be done for all entries except non-patient
encounter activities and vision screenings. If the patient is an infant under 1 year
of age enter the age as a decimal fraction of 1 year (e.g., 6 months = 0.5)
5. Select the patient gender.
6. Select the Involvement Level. The purpose of this field is to track the level of
your participation in each patient encounter. “P” stands for primary involvement:
you were the doctor responsible for the patient’s care who had the most direct
involvement in examining, diagnosing, counseling, and treating the patient. “S”
stands for supervisory involvement: this is a special classification reserved for
patient encounters obtained while supervising students. In this category, you
19
had the same responsibilities as in the “P” classification, but you supervised an
optometry student who worked with the patient. Residents in clinics with no
students will, obviously, not use this classification. Finally, “O” stands for
observational involvement: this refers to patient encounters that you obtained by
observation only; you were not involved in the examination or decision making
process for the patient. For example, your supervisor calls you in to see an
unusual condition. You observed the condition, you learned from it, but you were
not the doctor responsible for diagnosis and treatment.
7. Enter the Diagnoses. Do NOT leave this blank.
8. Enter the Plan. Do NOT leave this blank.
The amount of information entered for both steps 7 and 8 above is up to you but
each field is limited to about 250 characters.
9. Select the Encounter Type:
There are 17 encounter types to choose from. Most should be self-explanatory.
The “Comprehensive” type sometimes leads to questions as to the definition of
a comprehensive exam. If you take a standard case history, VA, refraction,
tonometry, assess external and internal ocular health then for our
purposes you have performed a comprehensive exam.
The last two types also deserve some clarification. The type “Other activity –
20
non patient care” refers to any non-clinical educational activities in which
you are involved. Examples include presentations given, continuing
education attended, etc. Enter activities separately, e.g., if you participate
in a journal club on 7/15/2013 and again on 7/22/2013 that would be two
entries, one for each date. Enter the description of the activity at the very
end of the form:
The type “Special Visit” refers to patient activity that is specialized and does not
necessarily fit into any of the standard categories above it. Use this type if you
have some unusual venue or role in which you see patients. In most cases it will
not be needed. If you do use this encounter type, then you must enter a
description of the Special Visit in the Special Visit Description field that is
located immediately below the encounter type field. Otherwise, leave the
Special Visit Description field blank.
Vision Screenings are the only encounter type that is NOT logged with a
separate entry for each patient, for obvious reasons. If you have encounters of
this type to record, enter the total number of patients screened in the VISION
SCREENING TOTAL field.
10. From this point forward, the log record entry page consists of check boxes for
the various conditions/procedures that we track. Simply work down the form and
check all that apply. Related conditions are grouped together. You must check
21
all appropriate boxes – entering the diagnoses in step 7 does not replace
checking the appropriate boxes in this step.
11. The referrals and follow-up section allows us to determine if your residency is
providing you with opportunities to interact with other health care providers.
Often, our ocular disease residents have questions concerning this category.
Obviously, any patient you refer for retinal consult, internal medicine consult, etc.,
should be counted. However, patients "referred" back to the practitioner who
referred them to you do NOT count as Optometry referrals, since this would
include virtually all of your patients. In your case, an optometric referral would
need to be for treatment of a condition that you discovered and would not treat at
your center. It is understood that this is not always easy to define, given the
special relationship of co-management centers and the referring optometrists;
you will need to use your judgment and common sense.
This section also tracks follow-up visits that you perform. This feature is included
because of the importance of determining if residents are getting the benefit of
following their patients after the initial visit. A Follow-up visit is defined as one
where you are seeing a patient that you have previously examined, for the
purpose of evaluating a condition that you previously diagnosed.
12. When you reach the bottom of the form, click Save if you are ready to save
the record. If you click Save and discover that you made a mistake, return to the
List page, locate the record, click on Edit, and make any necessary corrections.
The system will detect and notify you of common data entry errors, such as
missing information. PLEASE CORRECT THESE ERRORS. Do not
leave erroneous patient entries in your log; this will cause discrepancies when
your activity totals are tabulated. Follow the instructions in the error message
and edit the defective log entry to correct the error.
Keeping track of all this information may seem intimidating, but it is easy once
you have used the system a few times. You are required keep the activity log
current - take a few minutes at the end of each day (or during the day) to log
your patient encounters. This is much easier than trying to remember and enter
multiple days’ worth of work at a later time. There may be occasions when some
residents rotate through clinics that don’t have computer access; these
encounters should be entered as soon as possible. To assist in with this, a
sample paper log form is included in this handbook.
Please feel free to contact the Director of Residency Programs if you have any
questions concerning this important part of your residency.
22
Southern College of Optometry Resident Patient Encounter Log
Resident____________________________________________________
Log period:
Patient
initials
Date
Age
From
_____________
Involvement
Level (P, S, O)
Encounter
Type
Through_____________
Page _______ of _______
Diagnoses
• Columbia VA
• Memphis VA
• Mountain Home VA
• CCL & Refractive Surg SCO
• Vision Therapy/Rehab SCO
• Pediatrics /VT SCO
• Primary Eye Care SCO
• Salisbury VA
• Family Practice WTE
• Salem VA
• ____________________
Management
 Encounter Types
1 - Comprehensive
2 - Brief Visit
3 – Soft Contact Lens Fitting
4 - Soft Contact Lens PE
5 - GP Contact Lens Fitting
6 - GP Contact Lens PE
7 – Other Contact Lens Fitting
8 – Other Contact Lens PE
9 – VT Vergence Problem
10. – VT Accom. Prob
11. – VT Strabismus
12. – VT Oculomotor Dys
13. – VT Amblyopia
14. – VT Vis. Percept.
15. – Vision Screening
16. – Other activity non-p
17. – Special Visit
23
Evaluation Forms
Regular assessment of each residency program is an integral part of our overall
outcomes evaluation for residency education. This assessment is accomplished
by interviewing residents, reviewing patient encounter data, and through written
evaluations of the supervisor and the program completed quarterly by each
resident.
All evaluations are recorded electronically. For your reference, copies of the
evaluation forms used by the resident and supervisor are included on the
following pages. You will complete the forms on the following web site:
http://residencyadministration.sco.edu/. Two forms are used by the resident
for evaluation: the Quarterly Program Evaluation and the Quarterly
Supervisor/Faculty Evaluation. The resident must complete both of these
forms each quarter. A separate Supervisor/Faculty Evaluation form must be
completed for the supervisor and for each faculty member that the resident
works with on a weekly basis. The submission dates for each quarter’s forms
for 2014-2015 are as follows: Fall, October 1, 2014; Winter, January 7, 2015;
Spring, April 1, 2015; Final, June 30, 2015. The supervisor will also complete
the resident evaluation form each quarter. The resident will sign this form
electronically after it has been reviewed.
Instructions for using the on-line Evaluation forms
Go to this web site: http://residencyadministration.sco.edu/ . Log in using your
username and password. You will see this screen:
24
Choose the evaluation that you wish to complete, either Program Evaluation or
Supervisor and Faculty Evaluations. The choice labeled Resident Evaluation
Review and Sign-off is used by you to electronically sign the evaluations of
your performance that your supervisor completes. When your supervisor
completes entry of your evaluation into the system, he/she will notify you. After
review of the evaluation and discussion with your supervisor you will need to sign
off on the evaluation electronically. To sign off on the evaluation, log into the
evaluation system as directed. Click on “Resident Evaluation Review and
Sign-off”. The evaluations that you have received will be listed along the
right hand side of the screen; scroll to the one you need to sign off and
click on the word “Edit” (not the small box next to the word). On the next
screen that appears, review the evaluation to ensure that there it is as
discussed with your supervisor. At the bottom are three fields. Enter your
username, password, and the current date. Click on “Save” (If you make a
mistake with the username and/or password the system will warn you and will not
save the sign-off).
25
Southern College of Optometry Affiliated Residency
Quarterly Program Evaluation
Quarter: Fall 
Winter 
Spring 
Final 
Resident _______________________ Program ________________________
Date
_______________________
Select one of the following responses for each statement listed below:
4
Strongly agree
3
Agree
2
Disagree
1
Strongly disagree
N/A Does not apply
Clinical Education
The program:
1.
provides an appropriate number of patient
encounters
2.
provides quality patient encounters
3.
provides quality clinical supervision
Didactic Education
The Program:
1.
provides adequate literature review
opportunities
2.
provides adequate rounds experience
3.
provides special lectures or CE courses to
attend
4.
provides adequate discussions and presented
topics to supplement clinical education
Resident Teaching
Experience
The resident:
1.
serves as a clinical instructor to optometry
students
2.
presents lectures to optometry students
3.
presents CE lectures to optometrists and/or
other health care professionals
Research /
Scholarly Activity
1.
Ample research/scholarship opportunities are
provided for the resident.
2.
Ample research/scholarship guidance and
supervision are provided to the resident.
Southern College of
Optometry:
4
3
2
1
N/A
___
___
___ ___ ___
___
___
___
___
___
___
___ ___ ___
___ ___ ___
___ ___ ___
___
___
___ ___ ___
___
___
___
___
___ ___ ___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___
___
___ ___ ___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
26
1.
2.
3.
Provides adequate support for library and
audio visual support
Provides ample support for the resident’s
educational development
Adequately addresses administrative
questions/concerns of the resident
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
Please comment on the following:
1. Program strengths
2. Program weaknesses
3. Suggestions for improvement
4. Additional comments
Signature
_________________________________________
Date
_________________________________________
27
Southern College of Optometry Affiliated Residency
Program Quarterly Supervisor/Faculty Evaluation
Quarter: Fall 
Winter 
Spring 
Final 
Resident _______________________
Program ___________________
Supervisor/faculty ______________________ Date
___________________
Select one of the following responses for each statement listed below:
4
Strongly agree
3
Agree
2
Disagree
1
Strongly disagree
N/A Did not observe, don’t know, does not apply
The supervisor (or faculty member):
1.
is available in the clinic to provide supervision
2.
is skilled in clinical techniques, diagnosis, and
management of patients
3.
is knowledgeable about recent developments
in the field
4.
is able to accurately asses the resident’s
strengths and weaknesses
5.
demonstrates techniques to the resident when
appropriate
6.
discusses the interpretation of signs,
symptoms, and data with the resident
7.
provides adequate clinical experiences and
challenges for the resident
8.
is approachable for suggestions, questions,
and requests for help
9.
provides appropriate feedback to the resident
in a timely manner
10. provides criticism to the resident in a
constructive manner away from the patient
11. is open to other points of view
12. displays a genuine interest in helping
residents become better doctors
13. Guides the resident in making referrals and
seeking consultation when appropriate
14. has a good working relationship with
colleagues and other clinic personnel
15. conveys a sense of professionalism
16. is a good role model for residents
4
___
___
3
___
___
2
1
N/A
___ ___ ___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___
___
___ ___ ___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___
___
___ ___ ___
___ ___ ___
28
Additional comments:
In reference to the working relationship with your supervisor/faculty member,
please indicate what you liked best, what you liked least, and what
recommendations you would offer to improve the working relationship.
29
Southern College of Optometry Affiliated Residency
Quarterly Resident Evaluation
Quarter: Fall 
Winter 
Spring 
Final 
Resident _______________________ Program ________________________
Supervisor ____________________ Date
_______________________
Select one of the following responses for each statement listed below:
4
Strongly agree
3
Agree
2
Disagree
1
Strongly disagree
N/A Does not apply
Technical Skills
The resident:
1.
is able to perform tests and procedures
expected for current level in program
2.
reliably obtains accurate data
3.
understands purpose of tests being utilized
4.
recognizes need for specialized ancillary tests
and procedures
5.
works aggressively to correct all apparent skill
deficits
Organizational Skills
The resident:
1.
uses an examination sequence appropriate for
current level in program
2.
obtains an organized problem-oriented case
history and clearly defines the reason for visit /
chief complaint
3.
analyzes clinical data in a logical sequential
manner
4.
produces orderly, sequential, legible clinical
records and related documentation
5.
completes examinations and procedures within
an appropriate amount of time for current level
in program
4
3
2
1
N/A
___
___
___ ___ ___
___
___
___
___
___
___
___ ___ ___
___ ___ ___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
30
Diagnosis and
Assessment
The resident:
1.
exhibits appropriate diagnostic capabilities for
current level in program
2.
develops diagnoses consistent with clinical
data
3.
consults with supervisory faculty when
appropriate
Management and
Treatment
The resident:
1.
exhibits appropriate management capabilities
for current level in program
2.
develops treatment plan consistent with
diagnosis
3.
consults with supervisory faculty when
appropriate
Communication
The resident:
1.
establishes and maintains good rapport with
patients
2.
establishes and maintains good rapport with
faculty
3.
makes an appropriate case presentation
consistent with current level in program
4.
effectively communicates findings and
treatment plan to patient
5.
Professionally controls patient encounters and
provides patients with instructions that promote
compliance with treatment plans
Attitude and Work
Habits
The resident:
1.
accepts constructive criticism in a mature
manner
2.
conveys a sense of professionalism
3.
demonstrates a desire by his/her actions to
maximize the quantity and diversity of patient
encounters
4.
is conscientious in follow-up of patients
5.
enthusiastically seeks new knowledge
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___ ___ ___
___
___
___
___
___ ___ ___
___ ___ ___
___
___
___
___
___ ___ ___
___ ___ ___
31
Academic Activities
The resident:
1.
regularly consults periodicals and textbooks to
enhance knowledge and patient care
2.
regularly attends meetings and conferences
3.
demonstrates an acceptable level of progress
on scholarly activity requirements
___
___
___ ___ ___
___
___
___
___
___ ___ ___
___ ___ ___
Signature of Supervisor
_________________________________________
Date
_________________________________________
Signature of Resident
_________________________________________
Date
_________________________________________
Use space below for comments
32
Summary of Forms to be Submitted by Residents
Document
Resident Activity Log
Frequency of
Submissions
Continuously
updated
Program Evaluation
Quarterly
Supervisor/Faculty
Evaluation
Quarterly
Purpose
Summarizes patient encounters
and other activities. Used to track
and document progress toward
meeting program objectives as
required by accreditation
standards.
Resident opportunity for feedback
on program as required by
accreditation standards.
Resident opportunity for feedback
on supervisor and other faculty
as required by accreditation
standards.
Submission
Method
Electronic
submission
Electronic
submission
Electronic
submission.
Separate form
for each
individual
evaluated.
33