pacific university graduate program clinical skills ... clinical... · skills assessment candidate...

Pacific University Graduate Program Clinical

Skills Assessment

Candidate Name:

Proctor Name:

Date:

Skills being tested (check all that apply):

o Entrance Skills

Basic Proficiency YES NO

o Refraction


o Phorometry


o Biomicroscopy


o Tonometry and Gonioscopy


o Contact Lenses


o High Plus and BIO


Entrance Testing Entrance Skills Yes No

NPC:

Did the candidate explain the purpose of the procedure to the patient?

Did the candidate select an appropriate near fixation target?

Did the candidate provide proper instruction to the patient (including keeping the target clear)?

Did the candidate provide proper room illumination?

Did the candidate bring the target in from approximately 10-15 degrees below primary gaze at a

reasonable speed?

Did the candidate find break and recovery values and record them in cm?

Did the candidate perform the procedure in a smooth and efficient manner?

Confrontation fields:


Did the candidate select an appropriate fixation target and distance?

Did the candidate provide proper instructions to the patient?

Did the candidate provide proper room illumination?

Did the candidate appropriately display target in 8 meridians?

Did the candidate occlude the respective eyes of both patient and examiner?

Did the candidate test OD and OS separately?

Did the candidate correctly interpret the result and reasonable record the findings?


Near CT:


Did the candidate select an appropriate near fixation target to control accommodation (<20/40

letters)?

Did the candidate provide proper instructions to the patient (including keeping the target clear)?

Did the candidate place the target at 40cm in the primary positon of gaze?

Did the candidate utilize the occluder properly to detect the potential presence of strabismus

(unilateral CT)?

Did the candidate utilize the occlude properly to detect the potential presence of heterophoria

(alternating CT)?

Did the candidate properly neutralize any motion with prism, or confirm ortho using prism bar

and accurately state the obtained findings?


EOMS:


Did the candidate select a proper fixation target (penlight or transilluminator)?

Did the candidate provide proper instructions for the patient?

Did the candidate evaluate all 6 cardinal positions of gaze (up right, right, down right, up left,

left, down left) and accurately state the obtained findings?


PUPILS:


Did the candidate provide proper instructions to the patient, including appropriate fixation?

Did the candidate properly measure and state the pupil size OD under bright conditions?

Did the candidate properly measure & state the pupil size OS under bright conditions?

Did the candidate properly measure and state the pupil size OD under dim conditions?

Did the candidate properly measure and state the pupil size OS under dim conditions?

Did the candidate properly perform the direct pupillary light response OD and OS?

Did the candidate accurately state the obtained direct pupillary light response OD and OS?

Did the candidate properly perform the consensual pupillary light response OD and OS?

Did the candidate accurately state the obtained consensual pupillary light response OD and OS?

Did the candidate properly perform the swinging flashlight test?

Did the candidate properly evaluate the near response OD and OS?

Did the candidate accurately state the obtained near pupillary response OD and OS?

Do you feel the candidate possesses basic competency in this skill?

Comments:

Refraction Yes No

General Station Items: Did the candidate greet the patient?

General Station Items: Did the candidate properly wash his/her hands and dry them completely?

RETINOSCOPY:


Did the candidate position the patient properly?

Did the candidate align and level the phoropter properly?

Did the candidate provide proper illumination (dim)?

Did the candidate choose an appropriate fixation target for the patient (>20/100)?

Did the candidate give adequate instructions to the patient?

Did the candidate perform retinoscopy positioned such that the patient's fellow eye was able to

view the fixation target?

Did the candidate repeat retinoscopy OD to counteract potential effects of initial inadequate

fogging of the patient?

Did the candidate accurately determine the correct sphere power, OD?

Did the candidate accurately determine the correct cylinder power, OD?

Did the candidate accurately determine the correct cylinder axis, OD?

Did the candidate accurately determine the correct sphere power, OS?

Did the candidate accurately determine the correct cylinder power, OS?

Did the candidate accurately determine the correct cylinder axis, OS?

Did the candidate accurately state the obtained findings OD (sphere power, cylinder power,

cylinder axis)?

Did the candidate accurately state the obtained findings OS (sphere power, cylinder power,

cylinder axis)?

Did the candidate obtain reasonable results using a reliable clinical technique?


Comments:

DISTANCE MONOCULAR SUBJECTIVE REFRACTION:


Did the candidate provide proper illumination (moderate)?

Did the candidate provide adequate instructions to the patient?

Did the candidate provide an appropriate fixation target (20/40)?

Did the candidate determine an appropriate working sphere power (unfog to best VA)?

Did the candidate accurately determine the sphere power, OD?

Did the candidate accurately determine the cylinder power, OD?

Did the candidate accurately determine the cylinder axis, OD?

Did the candidate accurately determine the sphere power, OS?

Did the candidate accurately determine the cylinder power, OS?

Did the candidate accurately determine the cylinder axis, OS?


cylinder axis)?


cylinder axis)?

Did the candidate accurately state the monocular distance VA OD?

Did the candidate accurately state the monocular distance VA OS?

Did the candidate obtain reasonable results using a reliable clinical technique?


Comments:

PRISM DISSOCIATED BLUR BALANCE:


Did the candidate place 6Δ to 8Δ vertical prism in the phoropter?

Did the candidate fog both eyes to 20/40 blur?

Did the candidate balance the patient's eyes accurately and properly?

BINOCULAR BEST SUBJECTIVE:

Did the candidate properly determine an appropriate binocular endpoint (binocular difference

tolerance of ±0.50 D)?


cylinder axis)?


cylinder axis)?

Did the candidate accurately state the obtained binocular visual acuity?

DISTANCE SUBJECTIVE REFRACTION: Did the candidate obtain reasonable results

using a reliable clinical technique?


Comments:

Phorometry Near Testing:

ACCOMODATION TESTING


Did the candidate set the phoropter to the patient's near PD?

Did the candidate increase the illumination to a level comfortable for reading?

Did the candidate select an appropriate target (>20/40 letter / line)?

Did the candidate provide proper instructions to the patient (looking for first sustained blur)?

Did the candidate change lenses simultaneously before the patient's eyes at an appropriate rate?

Did the candidate properly and accurately measure NRA?

Did the candidate properly and accurately measure PRA (stop if measurement exceeds -3.00

D)?

Did the candidate accurately state the obtained PRA finding relative to the patient's near base

(distance subjective refraction or FCC)? (if measurement exceeds -3.00 D, state "PRA is greater

than 3 diopters")

BINOCULAR CROSS-CYLINDER TESTING:

Did the candidate reduce the illumination to an appropriate level?


Did the candidate properly and accurately perform the procedure (crossed cylinders oriented

with minus axes at 90°)?

Did the candidate accurately state the obtained finding relative to the distance subjective

refraction (e.g., +0.25 D or plano)?

HETEROPHORIA TESTING:


Did the candidate provide proper illumination (moderate)?

Did the candidate select an appropriate distance fixation target (<20/40 letter / line)?

Did the candidate provide proper instructions to the patient (ensuring fixation with the eye

viewing through dissociating prism)?

Did the candidate properly perform the horizontal phoria measurement and accurately state the

obtained findings, including magnitude and direction (e.g., "4 exo" or "2 eso")?

Did the candidate properly perform the vertical phoria measurement and accurately state the

obtained findings, including magnitude, direction, and eye (e.g., "1 hyper OD")??

Did the candidate perform the procedure in a smooth, efficient, and effective manner (moving

prisms smoothly and at an appropriate rate)?

HORIZONTAL VERGENCE AT NEAR:


Did the candidate properly perform the BI vergence measurement (break, recovery) and

accurately state the obtained findings (magnitude and direction)?

Did the candidate properly perform the BO vergence measurement (blur, break, recovery) and

accurately state the obtained findings (magnitude and direction)?

Did the candidate perform the procedure in a smooth, efficient, and effective manner (moving

prisms smoothly, simultaneously, and at an appropriate rate)?

Phorometry STATION:


Comments:

Biomicroscopy Yes No

Did the candidate greet the patient?

Did the candidate properly wash hands and dry them completely?


Did the candidate prepare the biomicroscope correctly (focus eyepieces, set up the illumination

system, magnification)?

Did the candidate position the patient properly in the biomicroscope (appropriate head position,

chin adjustment for proper eye height)?

Did the candidate properly examine and accurately describe the lids, lid margin, and lashes

(diffuse white illumination, wide parallelepiped beam)?

Did the candidate properly examine and accurately describe the bulbar

conjunctive/episclera/sclera?

Did the candidate properly examine and accurately describe the inferior palpebral conjunctive

(including lower lid eversion)?

Did the candidate properly examine and accurately describe the super palpebral conjunctiva

using upper lid eversion?

Did the candidate properly examine the entire cornea (scan using white illumination with a

parallelepiped and optic section)?

Did the candidate accurately describe the cornea (epithelium, stroma, endothelium)?

Did the candidate properly assess the temporal anterior chamber angle using the Von Herick

technique and accurately describe the findings?

Did the candidate properly assess the anterior chamber for cells and flare (dark room

illumination, high magnification, short parallelepiped, illumination beam angle approximately

45 degrees)?

Did the candidate properly examine and accurately describe the iris?

Did the candidate examine the ocular tissues in a smooth, efficient, logical sequence?

Did the candidate properly instruct the patient throughout the procedure?


Slit Lamp Comments:

Tonometry and Gonioscopy Goldmann Tonometry Yes No


Did the candidate instill topical anesthetic/fluorescein properly in one eye as indicated by the

examiner?

Did the candidate adjust the biomircoscope illumination system properly (cobalt filter,

magnification, wide beam, wide angle of illumination)?

Did the candidate position the patient properly in the biomicroscope?

Did the candidate provide proper instructions to the patient, including a fixation target?

Did the candidate assess the cornea for staining using cobalt filter prior to tonometry?

Yes No

Did the candidate assess and describe the quality of the tear film?

Did the candidate properly position the tonometer and align the probe?

Did the candidate set the pressure on the probe at an appropriate level (8-12mmHg)?

Did the candidate applanate the cornea in a safe and efficient manner?

Did the candidate adjust the biomicroscope so that the fluorescein semicircular patterns are

symmetrical and centered?

Did the candidate accurately align the tonometer mires of appropriate width?

Did the candidate safely retract the tonometer?

Did the candidate obtain an accurate IOP reading, (+/- 2 mm Hg)?

Did the candidate accurately state AND record the obtained findings?

Did the candidate assess the cornea for staining using cobalt filter following tonometry?

Did the candidate perform tonometry in a safe manner? One hand needs to remain on SL joystick at all times, One hand needs to be on GAT dial prior to going behind SL Too much time or movement on the cornea compromises safety of cornea Staying on cornea after getting the reading or letting go of SL. Pressing too hard on the cornea and not realizing it.


Comments:

Gonioscopy Yes No


Did the candidate prepare the gonioscopy lens properly?



Did the candidate insert the gonioscopy lens in a safe and efficient manner?

Did the candidate obtain and maintain a clear view?

Did the candidate perform a systematic examination of ONE anterior chamber angle quadrant

that the proctor indicates?

Did the candidate accurately identify the most posterior visible angle structure in the viewed

quadrant?

Did the candidate accurately describe the configuration of the iris approach into the viewed

angle (flat, concave, or convex)?

Did the candidate remove the gonioscopy lens in a safe and efficient manner?

Did the candidate observe and state the corneal integrity through the biomicroscope at the

conclusion of the procedure?

Did the candidate properly record the findings in the patient chart?


Comments:

Contact Lens Examination Yes No


Did the candidate properly wash hands and dry them completely?

Soft Contact Lens:

SCL preparation: Did the candidate inspect the lens for any damage?

Did the candidate determine that the lens is not inside-out?

Did the candidate apply an appropriate multipurpose contact lens solution to prepare the lens

for application?

Did the candidate instruct the patient regarding eye fixation position for applying the lens?

Did the candidate immobilize the patient’s lid properly without patient discomfort?

Did the candidate safely and properly apply the lens?

Did the candidate release the lid properly after lens application?

Soft Contact Lens Evaluation:

Did the candidate use white light to evaluate the SCL?

Did the candidate examine and accurately describe the fit of the SCL (centration, coverage,

movement with blink)?

Did the candidate examine and accurately describe the movement of the SCL in appropriate

position of gaze (primary, vertical)?

Did the candidate state if the fit was acceptable for dispensing?

GPCL:

Did the candidate inspect the lens for any damage?

Did the candidate apply an appropriate multipurpose solution to prepare the lens for

application?

Did the candidate instruct the patient regarding eye fixation position for applying the lens?

Did the candidate immobilize the patient’s lid properly?

Did the candidate apply the lens properly (without the use of any additional topical anesthetic)?

Did the candidate instruct the patient properly after completing lens application (blinking,

position of gaze)?

Did the candidate properly prepare the biomicroscope (magnification, moderately wide beam)?

Did the candidate properly instill fluorescein onto the conjunctiva of the eye with the GPCL?

Did the candidate properly position and instruct the patient within the biomicroscope?

Did the candidate utilize the cobalt filter?

Did the candidate accurately describe the fluorescein pattern of the GPCL (location of pooling

or baring; flat, steep, or alignment fit)?

Did the candidate accurately describe the position of the GPCL?

Did the candidate examine and accurately describe the movement of the GPCL in the primary

position of gaze?

Did the candidate state if the fit was acceptable for dispensing?

Contact Lens Removal:

Did the candidate properly wash/sanitize his/her hands and dry them completely?

Did the candidate instruct the patient regarding eye fixation position?

Did the candidate remove the SCL safely and efficiently?

Did the candidate remove the GPCL safely and efficiently?

Did the candidate clean, rinse, and store the GPCL in a case using an appropriate solution

(excluding water)?

Did the candidate assess the cornea for staining with the cobalt filter after removal of the

GPCL?

Did the candidate maintain proper hygiene throughout the station?


Comments:

High Plus and BIO BIO Yes No

Did the candidate greet the patient?

Did the candidate properly clean forehead and chin rests on biomicroscope?


Did the candidate adjust the BIO properly (headband, PD, oculars, light source)?

Did the candidate adjust the light level of the BIO to provide adequate illumination and

minimize patient discomfort?

Did the candidate position the patient properly (supine or upright)?

Did the candidate position the condensing lens properly (more convex side toward candidate)?

Did the candidate obtain full views of the designated retinal sectors?

Did the candidate properly examine and accurately describe posterior pole (including optic

nerve and macula), and describe any remarkable pathology and/or normal variations?

Did the candidate properly instruct the patient throughout the procedure?

Did the candidate conduct the procedure in a smooth and efficient manner?

Comments:

High Plus


Did the candidate prepare the biomicroscope correctly (focus eyepieces, illumination system 0-

10)?


Using the biomicroscope without the non-contact fundus lens, did the candidate properly

examine and accurately describe the crystalline lens (parallelepiped beam and

retroillumination)?

Using the biomircoscope without the non-contact fundus lens, did the candidate properly

examine and accurately describe the retrolental area/anterior vitreous?

Did the candidate position the non-contact fundus lens properly (alignment, centration,

distance)?

Did the candidate examine and accurately describe the posterior vitreous?

Did the candidate examine the optic nerve?

Did the candidate accurately describe the optic nerve (color, rim integrity, elevation)?

Did the candidate accurately state the C/D ratio?

Did the candidate examine & accurately describe (including vasculature) the peripapillary area?

Did the candidate examine and accurately describe (including vasculature) the posterior pole?

Did the candidate examine and accurately describe the macula?

Did the candidate conduct the procedure in a smooth and efficient manner?

Did the candidate maintain proper hygiene throughout the station?


Comments:

pacific university graduate program clinical skills ... clinical... · skills assessment candidate...

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