VA San Francisco Medical Center

Student Extern Director: Sandra Harpster, O.D Sandra.Harpster@va.gov

Residency Program Coordinator: Andrew Mick, O.D. andrew.mick@med.va.gov ,

Program Faculty: Heather Jones, O.D. Heather.Jones3@med.va.gov ,

Type of Practice: Department of Veterans Affairs Medical Center

The San Francisco VA Medical Center (SFVA) is an acute care medical/surgical facility providing primary thru tertiary health care to veterans of Northern California as part of the San Francisco VA Health Care System that includes seven additional community based clinics located in Eureka, Ukiah, Clearlake, Santa Rosa, Oakland, San Bruno, and downtown San Francisco. The SFVA has a 124-bed inpatient hospital, 120-bed Community Living Center and active outpatient clinics in all subspecialties of medicine (except pediatrics) that provide over 120,000 patient care encounters annually. It has the largest research funding in the VA system and has an institutional affiliation with the University of California, San Francisco (UCSF). Therefore, all medical-surgical staff are UCSF faculty and all medical or surgical residents are from UCSF. In addition, there are program affiliations with schools and colleges of nursing, pharmacy, dentistry, physical and occupational therapy, speech pathology, psychology, social work, medical administration, and optometry where each year over 1,500 trainees in 35 health care fields participate in clinical education programs.

The SFVA offers a clinical rotation in optometry exclusively to fourth year students from the affiliated University of California, Berkeley, Herbert Werthheim School of Optometry and Vision Science. The program is designed to provide a rich clinical experience, enhancing the clinical skills and expertise of the student. Primarily through direct patient care and supplemented with seminars and grand rounds, the student should significantly improve in competency and confidence in the areas of vision care, diagnosis and patient management. The eye clinic is staffed by optometry and ophthalmology residents who provide direct patient care under the supervision of three staff optometrist and ten UCSF subspecialty ophthalmologists (Cornea, Glaucoma, Ocular Oncology, Oculoplastics, Ophthalmic Pathology, Retina, Uveitis). The eye clinic has over 14,000 patient visits per year.

Demographics

• Predominantly middle-aged to elderly males.
• High incidence of ocular disease and ocular complications of systemic disease.
• The most common diagnoses are cataract, glaucoma, age-related macular degeneration, diabetic retinopathy, and other retinal vascular disorders.
• Students will have 200-300 patient encounters during their rotation.

Prerequisites for Student Interns

• Please see Externships Documentation and Immunization Requirements page for requirements.

Patient Services Provided

• Primary optometric eye/vision care

Educational Objectives

This rotation emphasizes learning through direct patient care with the following goals and objectives.

• This rotation emphasizes learning through direct patient care with the following goals and objectives:

  • Goal I – To enhance the student’s proficiency and competency in providing high quality primary eye/vision care for the patients of this medical center under the supervision of experienced practitioners.
    1. To improve the students’ ability to provide vision care and prescribe appropriate visual aids.
    2. To improve the students’ skills in the diagnosis and management of ocular disease and the ocular manifestations of systemic disease through patient care encounters.
    3. To improve the students’ ability to interpret the results of advanced diagnostic technologies including anterior segment imaging, ocular coherence tomography (OCT), OCT-angiography, ultrasonography, and perimetry.
    4. To improve the students’ confidence in the use of topical and oral pharmaceuticals in the management of ocular disease.
  • Goal II – To develop the students’ understanding of optometry’s role as member of the health care team through participation in a multi-disciplinary health delivery system.
    1. To provide vision care, evaluate for ocular disease, the ocular complications of systemic disease and ocular complications of pharmaceutical agents for patients referred by primary care medical practitioners.
  • Goal III – To stimulate the students’ scholarly development and knowledge of clinical eye care.

Student Responsibilities

• Students have direct patient care responsibilities under faculty supervision four and one-half days per week
• Provide prompt, high quality eye/vision care to patients under faculty supervision
• Complete accurate patient records in computer system and obtain faculty co-signature on all notes
• Provide continuum of care to patients when indicated
• Review pathophysiology and treatment of disorders seen in clinics and presented in seminars
• Deliver case presentations once a month during weekly seminars
• Bring hand-held lenses (+78D or +90D, and a +20D)

Faculty Responsibilities

• Supervise all aspects of student provided patient care
• Provide feedback on examination techniques, clinical findings, assessment and treatment plans
• Identify strengths and weakness in knowledge of clinical eye care and suggestions for improvement
• Provide seminars and journal clubs to improve clinical diagnosis, management, and understanding of clinical eye care
• Give formal evaluation at end of rotation of clinical judgment, knowledge, technical skills, humanistic qualities, professional attitudes, behavior and patient management
• Evaluation will be based upon direct observation of performance, patient satisfaction, review of treatment plans, and case presentation
• Please know that there are many providers at this site other than the members of the optometry clinical faculty. Students work primarily with the optometry faculty, but will also collaborate with the ophthalmologists and providers from other specialties of medicine.

College Affiliations

• Three ocular disease optometry residents affiliated with the UC Berkeley, Herbert Wertheim School of Optometry and Vision Science
• Three UCSF Department of Ophthalmology residents (1st, 2nd, and 3rd year) along with surgical interns and medical students

Miscellaneous Information

• Normal patient care clinic hours are Monday through Friday from 8 a.m. to 4:30 p.m., although urgent care, patient care responsibilities, and note completion may occasionally involve a later departure.
• Four hours per week are spent in attendance at the weekly optometry seminar, two journal clubs, and UCSF Department of Ophthalmology Grand Rounds
• Park in employee lots and structures on the West side of campus. Students may not park in patient, visitor, or volunteer lots. The Eye Clinic is located in Building 200 (Ambulatory Clinics) on the first floor (one up from the ground floor).
• Journal access and significant online educational resources are available through the SFVA library on all clinic computers