Year 3 & 4 Objectives

Learn more about General, Essential and Desirable Objectives for Years 3 & 4 of the MD Undergraduate Program.

The general objectives of the department are to teach medical students sufficient ophthalmology to enable recognition of common eye complaints and their etiology as well as recognition of less common but life or sight threatening emergencies presenting as eye findings.  The student should be able to take the appropriate action to safeguard the patient’s life, vision and overall function.

Given a presenting eye sign or symptom the student shall be able to:

  • Take an accurate History
  • Perform an appropriate Physical examination including use of the Slit Lamp and Ophthalmoscope
  • Be able to differentiate normal from abnormal eye findings
  • Outline a logical program of investigation and possible management

Skills

The student shall be able to:

  • Obtain a history of Eye disease from a patient or their guardian.
  • Measure and record Visual acuity at distance and at near both with and without correction and with pinhole where appropriate.
  • Examine pupil response (direct, indirect, accommodation)
  • Examine eye movements
  • Confrontation Visual Fields
  • Use of the corneal reflex to establish alignment
  • Use the slit lamp to examine the anterior segment.
  • Use the direct ophthalmoscope to check the red reflex, examine the optic nerve and macula.

Knowledge

The student shall:

  • Know the anatomy of the eye and orbit
  • Describe the meaning of and method to correct the refractive problems: emmetropia, myopia, hyperopia, astigmatism, presbyopia
  • Know the nature of the following Pupil Disorders/Findings: Horner’s Syndrome, Adie’s Pupil, Relative Afferent Pupil Defect and Argyll-Robertson Pupil
  • Describe the nature of Strabismus and Amblyopia and be able to explain these to a patient or parent of a patient. In particular, differentiate:
    • Esotropia
    • Exotropia
    • Hypertropia
    • Hypotropia
    • Ocular cranial nerve palsies – 3rd, 4th, 6th
  • List the main causes of leucocoria (white pupil) in children and understand the importance of each:
    • Congenital cataract
    • Retinoblastoma
    • Other media opacities
  • List the eye/visual findings associated with the following systemic diseases:
    • Diabetes Mellitus
    • Cerebrovascular Accident and TIA
    • Hypertension
    • Dysthyroidism
    • AIDS
    • Collagen Vascular diseases, arthritis, polymyalgia rheumatica etc
    • Visual pathway lesions ie tumours, inflammation
  • Be able to recognize the symptoms and signs of the following eye emergencies, to perform initial therapy appropriate to their ability and know when to refer:
    • Cornea foreign body, abrasion
    • Ultraviolet corneal burn
    • Corneal Ulcer
    • Chemical/Caustic Burns
    • Acute Angle Closure Glaucoma
    • Lid Laceration
    • Hyphema
    • Acute Retinal Vascular Occlusion
    • Retinal Detachment
    • Vitreous Hemmorrhage
    • Papilloedema
    • Globe perforation/penetration
    • Blunt injury of the eye
    • Orbital cellulitis/fracture
    • Herpetic infection
    • Uveitis
  • Be able to recognize the symptoms and signs of the following causes of chronic visual loss:
    • Cataract
    • Chronic open angle glaucoma
    • Age related macular degeneration
  • Assess the most common causes of red eye and eye irritation presenting to the primary physician. Be able to form a differential diagnosis
    • Conjunctivitis – viral, bacterial, allergic
    • Blepharitis
    • Chalazion/hordeolum
    • Dry eye
    • Trauma – abrasion, foreign body,
    • Subconjunctival hemorrhage
  • Describe disorders of ocular media clarity including: corneal scarring, cataract, vitreous hemorrhage, vitreous floaters (PVD)
  • Describe disorders of lacrimation
    • Congenital nasolacrimal duct obstruction
    • Dacrocystitis, dacryocele
    • Acquired nasolacrimal duct obstruction
  • Understand the indications, contraindications, ocular effect and systemic effect of the diagnostic topical medications: Tetracaine/alcaine, phenylephrine, tropicamide, cyclopentolate, atropine, cocaine, fluorescein
  • Understand the ocular effects of some systemic medications: topiramate, ethambutol, hydroxychloroquine, prednisone, sidenafil, tamsulosin
  • Know the definition of Legal blindness and be aware of community based services available to rehabilitate the visually handicapped.
  • Be aware of how to effectively communicate to an ophthalmic consultant

Knowledge

  • Understand how time course of presenting complaints influences differential diagnosis.

Skills

To perform a thorough ocular examination including:

  • Examine everted eyelids for disease and foreign matter
  • Having an understanding of the methods used to measure intraocular pressure
  • Measure relative anterior chamber depth with a flashlight
  • Use of the cover/uncover or the cross-cover test
  • Testing corneal sensation and orbicularis function
  • Instilling diagnostic eyedrops and use of fluorescein dye

Students are responsible for obtaining their Year 3 rotation "must do’s" and patient encounters "must see’s”. These things need to be logged.  By the end of Year 3, students must have performed 10 Ophthalmoscopic examination (direct) and 10 Slit Lamp examinations and be observed doing an ophthalmology history and ophthalmology physical exam.   Students must also see 1 patient with Amblyopia/Strabismus, 1 patient with Cataract, 1 patient with Red Eye and 1 patient with vision loss. 

Failure to see, perform, and log these objectives will lead to a failing grade in Ophthalmology and remediation will need to be completed prior to being promoted to Year 4.

Students are also recommended to have at least one patient encounter for each of the following conditions:

  • Age-related Macular Degeneration
  • Blepharitis
  • Chalazion
  • Corneal Foreign Body or Abrasion
  • Diabetic Eye Check
  • Open Angle Glaucoma
  • Posterior Vitreous Detachment
  • Preseptal or Orbital Cellulitis
  • Refractive Error
  • Toxic Conjunctivitis

If you have not seen these Patient Encounters by the end of the year, please let us know and we will try and make arrangements for you to see them. This is not a required encounter, but we highly recommend that you see it prior to your advancement into year 4.

Please note that these encounters can be from any of your rotations throughout the year and not specifically to your time in Ophthalmology. Our goal is for you to meet all these requirements during your time in Ophthalmology, however, that may not be possible.

Required: Harper, Richard A. Basic ophthalmology , 9 th ed. San Francisco, CA: American Academy of Ophthalmology, 2010.
ISBN: 9781615251230

***Textbooks are available at the administration office in the Eye Care Center   and can be loaned out for the duration of your clerkship rotation

Optional: Trobe, Jonathan D. The physician's guide to eye care , 3 rd ed. San Francisco: American Academy of Ophthalmology, 2006.  ISBN: 9781560556268

For more information on the Year 4 Electives Program, including deadlines and application procedures, please go to www.med.ubc.ca/electives.

Please note that acceptance into an Ophthalmology elective at UBC will neither help nor hinder a future application for residency.

Rev. 21-Feb-17