RESIDENCY IN PRIMARY EYE CARE – INDIAN HEALTH SERVICE
Kayenta Indian Health Service, Kayenta, Arizona
- Melanie Tarutani, O.D.
This one year clinical-based, primary care optometry residency was developed and is jointly directed by the Southern California College of Optometry (SCCO) and the Kayenta Service Unit of the United States Public Health Service (USPHS) Indian Health Service, Kayenta, Arizona.
SETTING OF THE RESIDENCY PROGRAM
Kayenta Service Unit consists of two multi-disciplinary outpatient clinics and four small field clinics on the Navajo Reservation in northern Arizona. These facilities provide outpatient health care to approximately 17,000 inhabitants. Outpatient services at Inscription House Health Center and Kayenta Health Center include optometry, adult medicine, pediatrics, prenatal care, dental, nutrition, substance abuse, mental health and community health programs. Periodic clinics are held by visiting consultants in obstetrics, surgery and cardiology. Kayenta Health Center provides 24 hour emergency room services. The nearest ophthalmological services are approximately 75 miles away.
Inscription House Health Center is a tiny community approximately 50 miles east of Page, AZ. The facility was built in 1984 with housing for the clinic staff adjacent to the health center. There are two small convenience store/gas station/trading posts within a few miles of the clinic. A post office is about 15 miles away. Other services are available about 50 miles away in Page or Kayenta, AZ.
Kayenta Health Center is located 48 miles east of Inscription House, (25 miles south of the Utah border). The facility was originally built in the 1950's and has been added onto several times. A major renovation of the facility was completed in late 1997. Businesses include a large grocery store, hardware store, post office, video rental outlets, several restaurants, three motels, and several gas stations.
A one bedroom apartment in the Public Health Service housing area is provided for the resident at a nominal fee.
The nearest metropolitan areas are (distances from Kayenta, AZ): Flagstaff, AZ 150 miles; Farmington, NM 130 miles; Gallup, NM 170 miles; Durango, CO 160 miles; Phoenix, AZ 300 miles; Albuquerque, NM 320 miles.
MISSION OF THE RESIDENCY PROGRAM
The mission of this training program is to give qualified postdoctoral optometry practitioners an educational experience that will nurture their development into skilled, caring clinicians with broadened general skills and additional specialized skills. This experience will be in a clinical setting striving to provide exceptional patient care to Native Americans of all ages. With the guidance of staff optometrists, the resident is trained to fully integrate his or her skills within a multi-disciplinary and public health care system. The residency program seeks to create an atmosphere that fosters a compassionate appreciation for the needs of patients from all backgrounds and a sense of duty to the Native American population the resident serves.
GOALS AND OBJECTIVES
Goal 1: Strengthen the resident’s primary eye care skills.
Objective 1: Provide the resident with an extensive primary care patient base.
Outcome: The resident will provide a minimum on 1,200 primary eye care exams during the course of the program.
Measure: Using the Southern California College of Optometry (SCCO) Patient Diagnosis Log and the Clinician Activity Record the resident will report total patient encounters quarterly.
Objective 2: Provide the resident with a variety of diverse, challenging, and complex optometric cases that would involve ocular disease, trauma, unusual refractive errors, and ocular manifestations of systemic disease.
Outcome: Due to the very nature of the service population of Kayenta Health Center, diverse clinical presentations in age, sex, and ocular conditions are ensured.
Measure: Using the SCCO Patient Diagnosis Log and the Clinician Activity Record the resident will report total patient encounters quarterly including age, sex, and diagnosis.
Goal 2: Provide advanced optometric clinical training in a multi-disciplinary, public health oriented health care setting.
Objective 1: The resident will work within and develop an understanding of the role of optometry in the multi-disciplinary health care environment; to promote the resident’s consultations of providers in other health care disciplines (ophthalmology, medicine, community health nursing, mental health, etc.), and to integrate them into the treatment plan.
Outcome: The resident will serve as a source of complete optometric primary eye care for the medical staff and health care team of Kayenta Health Center, which is composed physicians, dentists, counselors, and nurses. The resident will attend Medical Staff meetings, Pharmacy and Therapeutics Committee meetings, and Diabetic Committee meetings.
Measure: The resident will consult with referring staff verbally and/or written report on referral forms. Conversely, the resident will verbally and/or by written request refer patient to the appropriate provider when the patient requires such evaluation. This will be recorded in the patient records. Staff meeting minutes and the resident’s SCCO Patient Diagnosis Log and the Clinician Activity Record will also document these activities.
Objective 2: The resident will develop an understanding of the support services that are available within a medical health care system.
Outcome: The resident will learn to properly order pharmacy medications, laboratory studies, and imaging studies.
Measure: Program faculty will supervise the resident’s initial support service request for accuracy and completeness.
Goal 3: To further develop the resident’s knowledge base and to provide the experience necessary to expand into other facets of optometry:
application of research, enhancing presentation skills, and precepting students.
Objective 1: To instruct and advise the resident in the preparation of clinical presentations.
Outcome: The resident will prepare and present at least one continuing education lecture to the Kayenta Health Center Medical Staff; at least one case report or other lecture to the Navajo Area Optometrist of another optometric group; and monthly lectures to the eye clinic staff and optometry student.
Measure: This will be recorded in the SCCO Clinician Activity Record log and will report quarterly.
Objective 2: To educate the resident on the process of manuscript preparation and require that the resident meet SCCO’s mandated deadlines.
Outcome: A manuscript of publishable quality must be prepared as part of the requirement for the completion of the residency program. The required will be successfully met.
Measure: The completion of a manuscript of publishable quality submitted to both SCCO and the residency coordinator. It may be on a case report of on original research done alone or as part of a team.
Objective 3: To expand the resident’s health care and optometric knowledge base.
Outcome: The resident will attend the Medical Staff’s CME programs and be an active participant in the Navajo Area optometry journal club, attending at least 3/4 of those meetings.
Measure: Using the SCCO Resident Activity Log and the Resident Reading Log the resident will report residency activities and reading quarterly.
Objective 4: The resident will develop an understanding of an experience the responsibilities of an optometric educator.
Outcome: The resident will be provided the opportunity to serve as a clinical preceptor for the optometry interns rotating through Kayenta Health Center.
Measure: Using the SCCO Resident Activity Log the resident will report residency activities.
Direct Patient Care
Approximately 70-80% of the resident’s time is spent in direct patient care.
- The emphasis of the program is clinical assessment and management of patients of all ages in a multi disciplinary outpatient setting. The resident primarily provides care in the optometry clinics at Inscription House Health Center and Kayenta Health Center, but may occasionally evaluate patients in the Emergency Room or Outpatient Department.
- Within the scope of their current practitioner privileges within the service unit, the resident will provide prescription of appropriate refractive correction, topical and/or oral medications, perform non-invasive therapeutic procedures including foreign body removal, and order indicated laboratory testing and imaging studies.
- The resident seeks and integrates consultation with appropriate optometric, ophthalmological or medical providers as required by the level of privileging and sound clinical judgment.
- The resident provides consultation to other health care specialties and participates in the co-management of health conditions with ocular or visual implications.
- A didactic curriculum includes daily case reviews and clinical discussions, journal club participation, giving lectures as outlined under Goals and Objectives, attendance at educational lectures as previously outlined, and individual study.
- The resident spends time in ophthalmology settings to observe surgery, pre and post operative care, and clinical care. These experiences are offered at Tuba City Indian Medical Center, Northern Navajo Medical Center, Gallup Indian Medical Center or private ophthalmology practices.
- The resident rotates through clinics of several other disciplines during the program, including the Emergency Room, primary care specialties and diabetes clinic.
- A publishable paper suitable for submission to a refereed professional journal is a requirement for completion of the residency program. Preparation for the paper is done with guidance from the Director for External Programs.
CRITERIA FOR RESIDENCY COMPLETION
- The resident is required to deliver patient care services at a level deemed satisfactory to those responsible for supervision of the residency program.
- The resident is expected to deliver patient care services in a professional manner and to display behavior and courtesies that are consistent with the rules, regulations, and bylaws governing SCCO and Kayenta Service Unit of the Indian Health Service.
- The resident is required to keep a detailed log of all program activities which will be reviewed by the SCCO Dean of Academic Affairs, the Director for External Programs, and the Residency Program Coordinator at KSU. It should include all patients examined, other clinical experiences, lectures presented or attended, meetings attended, and other activities.
- The resident is required to write a paper based upon original research, literature review, or a clinical case(s) suitable for publication in a refereed professional journal. The initial draft of the paper is due to the Director for External Programs by April 15.
- The resident is evaluated quarterly regarding their clinical and didactic performance level and informed of recommendations and suggestions in order to enhance their learning experience.
LENGTH OF THE RESIDENCY PROGRAM
The program is one calendar year in length: July 1 - June 30, inclusive.
STIPEND AND BENEFITS
- The stipend is $30,000 for the 12-month program, paid through SCCO’s payroll system.
- Government housing at Kayenta Health Center for which nominal rent is charged.
- Employee related health immunizations are required and available to the resident at no charge.
- Malpractice insurance is provided by SCCO.
- The resident is responsible for obtaining his or her own health insurance. SCCO will reimburse the cost of health insurance up to $1000.
- Approved continuing education and travel funding is available through SCCO up to $500.
- As a member of the KSU Medical Staff, on-site continuing medical education is available at no cost.
- The resident is allowed 12 days of paid leave. The leave may be used in any combination as annual leave or sick leave. Annual leave (except in case of an emergency) must be requested far enough in advance that it does not create a hardship to scheduled patients. Approved CME conference days are not considered as leave.
In addition to the 12 days of leave, the resident also receives the following paid holidays:
- New Year’s Day, January 1
- Martin Luther King Jr.’s birthday, third Monday in January
- President’s Day, third Monday in February
- Memorial Day, last Monday in May
- Independence Day, July 4
- Labor Day, first Monday in September
- Columbus Day, second Monday in October
- Veteran’s Day, November 11
- Thanksgiving Day, fourth Thursday in November
- Christmas Day, December 25
Projected work hours are below. In general there will be 40 hours scheduled each week. No on-call hours, however the resident may be called upon after clinic hours to assist in the ER as needed. Variations will be made to meet patient care demands of the clinics, available personnel, and the program goals of the residency.
Monday through Friday: 8 am to 5 pm – Kayenta Health Center
- Applicants must have earned an OD degree from a school or college of optometry accredited by the Accreditation Council on Optometric Education, before the start of the residency program.
- If the applicant is a citizen of a country other than the United States, that applicant may not be eligible.
- The applicant must have taken and passed parts I and II of the National Board of Examiners in Optometry.
- The applicant must apply through the Optometric Residency Matching Services, Inc.(ORMS) and follow the application guidelines. The deadline for application submission is February 1.
Through the application form supplied by ORMS, the following must be received by the program coordinator in order to be considered for a residency position:
- Name, address, and phone number
- Curriculum vitae
- Transcripts of NBEO scores
- Transcripts of optometric education
- Three letters of recommendation
- Brief statement regarding desire to complete this residency program
- A personal interview is required.
- Applicants should send application matching materials to the Optometric Residency Matching Services, Inc. (ORMS).
- All residency applicants will be evaluated without regard to sex, race, color, creed, age, national origin, or non-disqualifying physical disabilities.
- If accepted, the applicant must provide official NBEO and official transcripts of their optometric education and submit them to the Director for External Programs and SCCO.
FOR FURTHER INFORMATION CONTACT:
Dr. Melanie Tarutani
Residency Program Director
Kayenta Indian Health Center
PO Box 368
Kayenta, AZ 86033
Judy W.H. Tong, O.D.
Assistant Dean of Residencies
Southern California College of Optometry
2575 Yorba Linda Blvd.
Fullerton, CA 92831-1699