Internship Program

Doctor of Optometry (OD)

Name:
ID: _
Hospital:
Period of Training: __
_

Logbook for OD Interns

Table of
Contents
 I. Introduction

II. Internship program Goals and Objectives

III. Instructions on number of clinical case records to be entered in log book

IV. Rotation record

 Optometry rotation

 Cornea, External Eye diseases rotation

 Vitreo-Retina rotation

 Glaucoma rotation

 Pediatric Optometry/ Ophthalmology rotation

 Emergency rotation

V. Educational assignment

VI. Student intern feedback

INTERNSHIP LOGBOOK
 Introduction

The Internship Program

Doctor of Optometry (OD)
College of Applied Medical Sciences,
Qassim University

The Sixth year of the Doctor of Optometry (OD) program at College of Applied Medical
Sciences, Qassim University (CAMS,QU) the is devoted entirely to the clinical education
track and consists of a three clinical rotation system that requires student optometrists to
participate in external clinical site training with an option to choose a clinical rotation .

This experience provides students with a wide range of patient care opportunities. Each
student is required to complete three internship rotations of 4 months each. Between the
rotations, experiences in Low Vision, Contact Lenses, and Pediatrics will be obtained. Each
rotation will contain a primary care component.

The coordination and educational experience of the internal clinical education program is
managed by the Chairman for the Department, in addition to the internal site supervisors
at each location.

The internship year is a crucial period of transition from student to full registration as a
Doctor of Optometry (OD). The professional and personal skills that you develop during
the intern year will provide a platform for the rest of your career. This booklet provides
information to guide you through this exciting and demanding period.

At the end of your internship, you will need to obtain a Certificate of Experience from
the Dean of your college. This Certificate is an essential requirement for full registration
with the Saudi Commission for Health Specialties.

It is therefore important that you refer to this booklet on a regular basis, and fill the log in
it. You will need to complete some parts of it as you go through the year and other
sections after a period of experience or reflection. You have a duty of confidentiality to
your patients, and patient identifiers should never be used in the portfolio. You may wish
to photocopy the portfolio, or sections of it; but please return the original to your intern
supervisor at the end of each rotation.

The department of optometry wishes you a purposeful and fulfilling year and a
rewarding career in optometry.

INTERNSHIP LOGBOOK
 INTERNSHIP PROGRAM

Mission

To prepare Graduating Optometrists (OD) for lifetime service in the delivery of the
highest quality of eye and vision care to their patients.

GOALS:

 To provide students with an opportunity to strengthen optometry skills

 To apply their knowledge in various clinical practices

 To demonstrate competency in practical skill and procedure

 To facilitate the transition to professional role

OBJECTIVES:

Upon completion of internship program, the professional O.D. intern will:

 Be acquainted with hospital policies and procedures

 Apply theoretical knowledge into various clinical setting

 Enhance effective communication skill

 Develop professional relationships with patients and members of the

multidisciplinary health care providers

 Improve the ability to act independently and implement appropriate medical

intervention

 Utilize appropriate available resources in-patient care

 Ensure safe environment for patients, families and health care personnel

 Provide organized and quality patient care

INTERNSHIP LOGBOOK
 INSTRUCTIONS

 Familiarize yourself with the practice

 Recognize the limits of expertise and seek help appropriately

 Students must demonstrate adherence to ethical principles and commitment to

carrying out professional responsibilities in the best interest of the patient and

the community

 Use clinical reasoning processes to interpret data to derive a differential

diagnosis and develop a clinical management plan, including in the areas of

contact lenses, binocular vision, low vision, glaucoma, pediatrics, anterior and

posterior segment disorders

 Show commitment towards prevention of treatable blindness and other ocular

diseases to promote the health and wellbeing within the community

 The supervisor prior to final determination of the patient’s case shall review all

intern evaluations of any patient before the patient leaves the premises.

 Independent cases with management: Cases done by the individual should be

followed up with the consultant and the management plan should be detailed

as Comprehensive workups.

 Document the date, numbers of cases you have seen and get your supervisor’s signature

INTERNSHIP LOGBOOK

Number of clinical case records to be entered in log book

 In order to facilitate collection of clinical experience data, each intern is REQUIRED to
keep a log of patients seen in the clinic.

Use logbook to record the date, the site, supervisor’s name, patient’s gender, patient’s
age, type of examination, time with patient, diagnoses, and procedures.

Even though gender, ethnicity and time with patient are not required fields, the students
are expected to fill these areas in when the information is available.

The intern may wish to keep a personal record or copy of their summary statistics logs
for future reference.

Failure to comply with the requirement will result in appropriate disciplinary action.
Students will be required to make up any missed time in the clinic. A grade of “In-
Progress” will be assigned to any intern who fails to comply with this requirement.

Minimum Number of clinical case records to be entered in log book in each

rotation of 4 Months

Refraction- 100 Cases

Anterior Segment (Cornea/Lasik etc) – 20 cases
Posterior Segment (Retinal Diagnostics and Imaging) - 20 cases
Pediatric& Squint- 20 cases
Glaucoma (with Perimetry) - 10 cases
Binocular Vision anomalies - 10 cases
Contact Lenses (5 Rigid+5 Soft) – 10 cases
Emergencies 05 cases
Low Vision 05 cases
____________________ _____________

Total 200 cases (4 Months)

3 Rotations of 4Months (3 Hospitals) = 600 Cases (1 year)

Any student who fails to complete the patient logs within two weeks of the beginning
of the next rotation will receive “No Credit” for the previous rotation.

INTERNSHIP LOGBOOK
 Evaluation of Work

Hospital supervisors evaluation 50%

Internship logbook 25%

Department Exam (Viva + Practical) 25%

During the clinical training it will be case discussion by the supervisor and weekly

evaluation.

A final evaluation will be required for your internship year. This is including theory

and practical exam during the academic semester. These exams will be conducted at

the optometry and ophthalmology clinics in Qassim University.

Logbook Submission

When complete, review your work.

A ring binder with all the documents outlined above. Turn into internship supervisor

for grading at the end of the internship year.

Documents to Include:

a) The form of case details, completed

b) Completed hours worked signed by Site Supervisors

c) Details of continuous education, completed

INTERNSHIP LOGBOOK
 ROTATIONS RECORD

Internship rotations include the following clinical areas:

Clinics Category Description Period

. Refractive errors
Optometry Clinic . Contact lenses
. Color vision assessment
. Low vision aids (If available)
. Binocular vision assessment

Cornea, External Eye . Cornea diseases management

diseases Clinic . Cataract management

. Diabetic eye disease

. Hereditary retinal diseases
. Age-related macular degeneration
. Macular holes
Vitreo-Retina
Clinic . Ocular tumors
. Retinal detachments
. Retinal vascular diseases
. Vitreous degeneration and detachment

. Direct and indirect ophthalmoscopy

. Tonometry
Glaucoma Clinic
. Gonioscopy
. Visual field testing
. Optical Coherence Tomography (OCT)

. Visual acuity and refraction

. Amblyopia
Pediatric . Strabismus
Optometry/
Ophthalmology . Congenital anomalies
Clinic
. Tear duct disorders
. Retinopathy of prematurity
. Pediatric glaucoma
. Eye injuries and infections

. First aid, diagnosis and understand

Eye Emergency management options for ocular
Clinic emergencies

INTERNSHIP LOGBOOK
 OPTOMETRY CLINIC
(To be filled in by clinic supervisor)

Started from: / / To / /

Please evaluate the intern on the listed qualities, and any other that you may deem appropriate. Please input into
the Assessment box a grade using the following key:

Very Good (V.G), Good (G), Average (A), Poor (P), Not Applicable (NA)

NO. Of
Clinical skill task Cases Assessment
Observed Comments

1-Refractive errors

 Prescribe refractive correction for

different age groups and visual
needs
2-Contact lenses

 Pre-fitting evaluation and

prescribe Contact lenses
appropriate for different age
groups and visual needs
 Teach a patient to safely insert,
remove and care for contact
lenses
3-Low vision devices

 Prescribe Low Vision devices

appropriate for different age groups
and visual requirements
4-Color vision assessment

 Identify abnormal color vision

and to appreciate its
significance
5- Binocular vision assessment

 Binocular vision and

accommodative status are
assessed and needs for
treatment

Supervisor: / /

Name Signature Date

INTERNSHIP LOGBOOK
 Please print out this page for each case you have seen, and attach it to your portfolio

Posting: Refraction Date:

Supervisor name:

Patient Details:

 Additional Case paper format given in the last page can also be used in the log book.

INTERNSHIP LOGBOOK
 Please print out this page for each case you have seen, and attach it to your portfolio

Posting: Contact Lenses Date:

Supervisor name:

Other Details if Any:

INTERNSHIP LOGBOOK
 Please print out this page for each case you have seen, and attach it to your portfolio

Posting: Binocular Vision Date:

Supervisor name:

Patient Details:

Clinical Impression:

Diagnostic Procedures:

Management / Advice:

INTERNSHIP LOGBOOK
 Please print out this page for each case you have seen, and attach it to your portfolio

Posting: Low Vision Care Date:

Supervisor name:

Patient details:

Clinical Relevant History:

Clinical Diagnosis:

Requirements:

Trial Information:

Management / Advice:

INTERNSHIP LOGBOOK
 CORNEA, EXTERNAL EYE DISEASES CLINIC
(To be filled in by clinic supervisor)

Started from: / / To / /

Please evaluate the intern on the listed qualities, and any other that you may deem appropriate. Please input into
the Assessment box a grade using the following key:

Very Good (V.G), Good (G), Average (A), Poor (P), Not Applicable (NA)

Clinical skill task NO. Of Comments Assessment

Cases
Observed

1- Diagnose and understand

management for the
following:
 Conjunctivitis

 Corneal Dystrophies

 Corneal Ulcers

 Corneal Abrasions

 Keratoconus

 Dry Eye

 Pterygium &
Pinguecula

 Recurrent Corneal
Erosions
2- Cataract

 Assessment of pre
and post cataract care

Supervisor: / /

Name Signature Date

INTERNSHIP LOGBOOK

Please print out this page for each case you have seen, and attach it to your portfolio

Posting: Cornea, External Eye Diseases Date:

Supervisor name:

Demographic Data:

History:

Ocular Examination:

Slit Lamp:

Nature of Consultation (Diagnosis, Management and Prescribing Taken):

INTERNSHIP LOGBOOK
 VITREO-RETINA CLINIC
(To be filled in by clinic supervisor)

Started from: / / To / /

Please evaluate the intern on the listed qualities, and any other that you may deem appropriate.
Please input into the Assessment box a grade using the following key:

Very Good (V.G), Good (G), Average (A), Poor (P), Not Applicable (NA)

Clinical skill NO. Of Comments Assessment

Cases
Observed

Diagnose and understand

management for the following:

 Diabetic eye disease

 Hereditary retinal diseases

 Age-related macular
degeneration
 Ocular tumors

 Retinal detachments

 Inflammation of the middle

layer of the eye

 Retinal vascular diseases

 Vitreous degeneration
and detachment

Supervisor: / /

Name Signature Date

INTERNSHIP LOGBOOK
 Please print out this page for each case you have seen, and attach it to your portfolio

Posting: Vitreo-Retina Date:

Supervisor name:

Patient Details:

Fundus Drawing:

Diagnosis

Management

INTERNSHIP LOGBOOK
 GLAUCOMA CLINIC
(To be filled in by clinic supervisor)

Started from: / / To / /

Please evaluate the intern on the listed qualities, and any other that you may deem appropriate.
Please input into the Assessment box a grade using the following key:

Very Good (V.G), Good (G), Average (A), Poor (P), Not Applicable (NA)

Clinical skill task NO. Of Comments Assessment

Cases
Observed

Perform and interpret:

 Visual field testing

 Gonioscopy

 OCT

 Tonometry

Supervisor: / /

Name Signature Date

INTERNSHIP LOGBOOK
 Please print out this page for each case you have seen, and attach it to your portfolio

Posting: Glaucoma Date:

Supervisor name:

Patient Details:

IOP:

Visual fields:

Interpretation:

OCT Interpretation

Diagnosis

Management

INTERNSHIP LOGBOOK
 PEDIATRIC OPTOMETRY/ OPHTHALMOLOGY CLINIC
(To be filled in by clinic supervisor)

Started from: / / To / /

Please evaluate the intern on the listed qualities, and any other that you may deem appropriate. Please input into
the Assessment box a grade using the following key:

Very Good (V.G), Good (G), Average (A), Poor (P), Not Applicable (NA)

Clinical skill task NO. Of Comments Assessment

Cases
Observed

Diagnose and understand

management for the
following:

 Pediatric refraction and

prescription of glasses

 Strabismus

 Retinopathy
of prematurity

 Pediatric glaucoma

 Congenital anomalies

 Amblyopia

 Cataract tear
duct disorders

 Eye infections

Supervisor: / /

Name Signature Date

INTERNSHIP LOGBOOK
 Please print out this page for each case you have seen, and attach it to your portfolio

Posting: Pediatric Date:

Supervisor name:

Patient Details:

Clinical Information:

Diagnosis:

Management:

INTERNSHIP LOGBOOK
 EYE EMERGENCY CLINIC
(To be filled in by clinic supervisor)

Started from: / / To / /

Please evaluate the intern on the listed qualities, and any other that you may deem appropriate. Please input into
the Assessment box a grade using the following key:

Very Good (V.G), Good (G), Average (A), Poor (P), Not Applicable (NA)

No. Of
Clinical skill task cases Comments Assessment
observed

First aid, diagnosis and

understand management
options for ocular emergencies
including:

 Chemical eye injury

 Corneal erosion
and laceration
 Corneal, conjunctival and
intra- ocular foreign body
 Lid and globe laceration

 Traumatic hyphema
 Globe hemorrhage
and rupture
 Acute glaucoma
 Central retinal
artery occlusion
 Blow out fracture

Supervisor: / /

Name Signature Date

INTERNSHIP LOGBOOK
 Please print out this page for each case you have seen, and attach it to your portfolio

Posting: Eye Emergency Date:

Supervisor name:

Please print out this page for each case you have seen, and stable it to your portfolio.

Patient details:

Clinical Information:

Diagnosis:

Management:

INTERNSHIP LOGBOOK
 EDUCATIONAL ASSIGNMENTs

1- Presentation given by the intern (scientific meeting)

Topic name Date

2- Seminars, presentation or lectures attended by the intern

Topic name
Date

1-

2-

3-

Internship Supervisor: / /

Name Signature Date

INTERNSHIP LOGBOOK
 Center for International Education – Academic Purposes Only
Pennsylvania College of Optometry at Salus University

Group_________ Date of Participation _____/____/_____

DEMOGRAPHIC DATA Medications (Name/Amount/Frequency):

Name: _________________________________
DOB: _____/____/_____ Age: ______
Sex: ____ Race: ____ Occupation: ____________

CHIEF COMPLAINT:

Allergies:

OCULAR SYMPTOMS (Yes/No) HISTORY OF PRESENT ILLNESS (HPI):

Flashes Symptoms Instructor Notes:
Floaters Onset
Loss of vision Location
Diplopia Quality
Itch/burn/tear Severity
Headache Duration
Eye pain/strain Timing
Context
Modifiers

OCULAR HISTORY - Personal (Rx/CL Hx, Injuries, Surgery, Eyeturn, OCDX):_____________________________

_______________________________________________________________________________
_______________________________________________________________________________
DATE OF LAST EYE EXAM _____/____/_____ PREVIOUS DR. ___________________________

GENERAL HEALTH HISTORY & HEALTH STATUS (Yes/No/Describe)

Diabetes:
Cardiovascular:
Cholesterol:
Respiratory:
Gastrointestinal:
Genitourinary:
Musculoskeletal:
Dermatologic:
Ear, Nose, Mouth, Throat:
Neurological:
Psychiatric:
Hematologic/Lymphatic:
Endocrine:
Immunologic:
Infectious:
Cancer:
Smoking/Alcohol/Drugs:

DATE OF LAST PHYSICAL/MEDICAL EXAM _____/____/_____ BY WHOM ________________

FAMILY HISTORY (Blindness, Glaucoma, ARMD, Cancer, Diabetes, Heart, Hypertension) Yes/No/Who
_______________________________________________________________________________
_______________________________________________________________________________
 STUDENT INTERN FEEDBACK

Please answer the following questions:

 Which experience in this rotation was most valuable? Why?

 Which experience in this rotation was the least valuable? Why?

 How many patient you are assigned independently (patient load/shift) in the
rotation?

 Are you satisfied with this number? Explain.

 What suggestions would you make to improve the experience?

 Additional Comments: