Expectations

All residents on the service are expected to
  • read and become familiar with the Educational Goals and Objectives for the rotation
  • arrive on time for clinical experiences.
  • provide courteous care to patients.
  • take thorough histories and perform complete examinations
  • complete timely, thorough and accurate documentation using the electronic health record
  • complete preliminary interpretations for all imaging studies performed on the service
  • review neuroradiology scans with UPMC neuroradiology team as scheduled during Monday and Friday reading times.
  • work as part of the neuro-ophthalmology service sharing work with each other and the technical staff as needed
  • work closely with medical students and other trainees rotating with the service
  • when necessary complete correspondence with patients’ other health care team
  • when necessary complete medical disability forms with pertinent exam findings as per medical records, then submit to attending for review and signature
  • treat the technical and administrative staff with courtesy and respect
  • when necessary, provide post encounter care for the patient by checking labs, filling out forms and corresponding with patients
  • read on a daily basis while on the service concentrating on topics brought to the forefront during clinical experiences

Clinic Logistics

  • ALWAYS record patient phone conversations or radiology reviews in EpiCare for documentation
  • All NEW NEURO patients
    • Please review and edit the tech's chief complaint and histories, which autocomplete from intake exam in the Neuro Hybrid letter for new patients.Review techs’ medical, family, social history
    • TECH: Autorefraction vision and pinhole if less than 20/20 
    • TECH Color vision  & contrast sensitivity with Ishihara 
    • TECH Near vision, best corrected, if complaining of any blurring before drops
    • Check pupils but DO NOT DILATE until asked by attending
    • Help keep track of patients at testing 
    • Nerve and macula 5 line raster OCT, Stereo disk photos 
    • PLEASE INTERPRET in ENTER/EDIT results EPICARE
    • Measure alignment if diplopic with Maddox if able, Cover testing, or Krimsky, if unable
  • RETURN NEURO patient
  • Copy previous HPI and Progress note in EpiCare, then make appropriate changes in visual acuity box (NEURO OPHTH GENERAL  SHORT), exam and plan
  • Neuroradiology Rounds - we regularly review studies from outside imaging centers with Dr Branstetter, Dr Rothfus, Dr Tsday.  It is helpful to email Dr Branstetter in advance to schedule 10-15 minutes to review 2-3 studies at his leisure.
  • Please notify Melissa Wyse and Attending of any post-call or time off  from clinic

     
  • Dr. Bonhomme is in clinic Tuesdays, Wednesdays, Thursdays and most Fridays
  • Dr. Mitchell is in clinic 2 Fridays each month (check Epic) (first priority for residents)
  • Radiology Review Friday after clinic, or as able
  • Temporal Artery biopsies, laser procedures, & op cases as able 

 

 
Recommended Reading Includes: 
  • BCSC Section 5: Neuro-ophthalmologyIn addition, Dr Bonhomme has made several neuro-ophthalmology and strabismus texts & review manuals available for use on site.
  • Beck RW. The optic neuritis treatment trial: three-year follow-up results. Arch Ophthalmol. 1995 Feb;113(2):136-7. PubMed PMID: 7864737.
  • The 5-year risk of MS after optic neuritis. Experience of the optic neuritis treatment trial. Optic Neuritis Study Group. Neurology. 1997 Nov;49(5):1404-13.PubMed PMID: 9371930.
  • Optic nerve decompression surgery for nonarteritic anterior ischemic optic neuropathy (NAION) is not effective and may be harmful. The Ischemic OpticNeuropathy Decompression Trial Research Group. JAMA. 1995 Feb 22;273(8):625-32. PubMed PMID: 7844872
  • Beck RW, et al; Optic Neuritis Study Group. High- and low-risk profiles for the development of multiple sclerosis within 10 years after optic neuritis: experience of the optic neuritis treatment trial. Arch Ophthalmol. 2003
  • Jul;121(7):944-9. PubMed PMID: 12860795.
  • Hayreh SS, Podhajsky PA, Raman R, Zimmerman B. Giant cell arteritis: validity and reliability of various diagnostic criteria. Am J Ophthalmol. 1997 Mar;123(3):285-96. PubMed PMID: 9063237.
  • Murchison AP, et al; Validity of the American College of Rheumatology criteria for the diagnosis of giant cell arteritis. Am J Ophthalmol. 2012 Oct;154(4):722-9. doi: 10.1016/j.ajo.2012.03.045. Epub 2012 Jul 17. PubMed PMID: 22809782

Additional Important Resources

  • Neuro-ophthalmology Virtual Education Library (Novel) - https://novel.utah.edu/  
  • Young Neuro-Ophthalmologist Committee (YONO) https://www.nanosweb.org/i4a/pages/index.cfm?pageid=3759
  • NANOS illustrated curriculum for neuro-ophthalmology http://pitt.idm.oclc.org/login?url=http://online.statref.com/Document.aspx?grpalias=UPHSLPIER&FxId=694

Neurology residents and neuro-otology will benefit from reading over the appropriate attached guidelines.

 

In addition, third year residents are expected to
  • take primary responsibility for the preoperative evaluation and postoperative care of operative patients
  • assist in the supervision of junior residents
  • when necessary, provide direction to medical students, junior residents and staff to assist with efficient patient flow