Ophthalmic Surgeon

1. Entry Requirements

1. MRCSI (Ophth) or equilivant
2. Microsurgical skills course (if commenced training after July 2002)
3. Surgery – a minimum of 50 cataracts, 50 lasers and 50 miscellaneous procedures
4. Research programme
5. Publications - 2 abstracts in Irish Journal of Medical Science or equilivant (minimum)
   A publication in a peer review journal is desirable.
6. 24 months in recognised Basic Specialist Trainee posts

Comhairle na nHospideal approves the number of posts and the training programme is approved by the Royal College of Ophthalmologists in London.

The scoring system is available from the Irish College of Ophthalmologists

Interview panel will consist of the following:

1 x Representative from each Training Unit
1 x Representative from each University
1 x Speciality Representative - Chairman of the Training Committee
1 x External Assessor
Chairman

Each unit should have no more than three representatives.

2. Length of Training

The Continuum for Specialist Training is a 4½ year Comhairle approved higher surgical training programme for ophthalmology with a further optional six months.

Trainers

The training is carried out in rotation between the four recognised units.

The supervision of each trainee is the responsibility of the person to whom the trainee is allocated for that particular module.

The Chairman of the Manpower, Education and Research Committee of the Irish College of Ophthalmologists is responsible for allocating trainees to each module.

The number of continuum approved posts at present is:

3 in the Royal Victoria Eye and Ear Hospital and associated hospitals, (Our Lady’s Hospital for Sick Children.)
2 in the Mater Misericordiae Hospital and associated hospitals (Beaumont and Temple Street)
2 Cork University Hospital
1 Waterford Hospital

The number of training posts in each hospital is controlled by Comhairle na nHospideal with approval by the Royal College of Ophthalmologists in London who inspects hospitals for training facilities.

3. Rotations

• SpRs level of responsibility should increase progressively according to seniority of trainee and experience.
• Maximum of 2 years outside Dublin.
• Final six months can be used to do Fellowship abroad as long as prospectively agreed by Training Committee. - Fellowships during the four years are not encouraged.
• Additional six months is available to all trainees.

4. Weekly Programme

7 Clinical sessions maximum.
2 Research Teaching Session
1 Regional Teaching Session

Each clinical session should be appraised for its value as a training resource.
2 general clinics (maximum) - may include one casualty or primary care
2 special clinics (Minimum)
2 Theatre Sessions (Minimum)
1 Treatment Session e.g. Laser, minor ops

The remaining three sessions should include:

1 Protected research session
1 Study session
1 Postgraduate teaching session

5. Outpatients

5.1 The trainee should not see more than 15 patients during an out-patient session. In all clinics, SpRs should see selected new patients and should be able to present them to the consultant.

5.2 A special clinic is a clinic in which patients with a single diagnosis or group of related diagnoses are seen exclusively, and to which there are internal referrals. There should not be a mixture of patients in such a session, even if the bias is towards a particular subspecialty, because this dilutes the trainees' experience.

5.3 All clinics must be timetabled to be supervised by a consultant and it is important that a consultant must always be available, especially during designated laser and minor operations sessions, and casualty. The degree of supervision of SpRs must be judged according to their seniority, experience and competence.

Trainees must never be timetabled to do outreach clinics alone, although it is permitted for the SpR to attend outreach sessions with the consultant. It is not acceptable for a consultant doing an outreach clinic to leave the trainee undertaking unsupervised clinical sessions in the base hospital. No trainee should undertake timetabled clinical sessions, such as casualty or laser photocoagulation, which do not necessarily need direct supervision, without a consultant being available in the hospital at the time.

5.4 It is important that trainees should see the patients they operate upon pre- and postoperatively.

5.5 Preoperative assessment clinics are to be encouraged, but should largely be run by nurses, with only a minor input from SH0s and none from SpRs, as these sessions are not valuable as training, unless they are part of a ward round with the consultant present.

5.6 Laser photocoagulation should be fully supervised at the start of training, although thereafter, trainees can manage patients without supervision. SpRs should be able to see their patients both before and after treatment. An appropriate laser teaching attachment, such as a sidearm or video, must be available.

5.7 Additional experience is valuable, for all grades, in other hospital departments, notably neurology, neurosurgery, plastic surgery, immunology, maxillo-facial surgery, paediatrics, endocrinology and diabetes. SpRs should have access to radiological imaging facilities.

5.8 SpRs may see casualties, but usually no more than one weekly session of casualty or primary care should be timetabled. If a casualty session is included in the timetable, it should be substituted for a general clinic.
Senior supervision and advice must always be available. It is not necessary for eye casualty to be open throughout 24 hours to be approved for training.

6. Theatre

6.1 Surgical experience should be introduced to trainees according to their abilities and experience gained in BST. Thereafter, training in surgery is dependent upon the trainee's progress but should be in keeping with the curriculum.

6.2 The Training Committee guidelines for the minimum number of procedures to be personally performed by trainees are published in the curriculum.
It is recognised that trainees wishing to acquire sub-specialist knowledge and skills will be expected to undertake many more procedures in the field of their interest, usually through an advanced subspecialty training programme (clinical fellowship).

6.3 A log book must be kept and should be up to date and available for inspection at any time. It should contain an audit of complications of cataract surgery, as defined in the curriculum.

6.4 All junior trainees must be timetabled to be supervised by a consultant in every session, but in the later part of SpR training, one theatre session may be unsupervised in keeping with their progress, provided consultant assistance is available in an adjacent theatre or within the unit.

7. Out patient facilities

7.1 There should be a dedicated, fully equipped ophthalmic outpatient department.

7.2 Each trainee, whatever the grade, should have a room in which to examine patients, or a separate examination area where the layout is based on a modular system. Every trainee must have access to his/her own test type, slitlamp, direct and indirect ophthalmoscope, retinoscope and trial lenses and the necessary indirect lenses. There must be appropriate examination facilities for retinal diseases, such as a couch or reclining chair. There should be easy access to the consultant.

7.3 Teaching aids should be available wherever possible, such as sidearms or video cameras on slitlamps and lasers, and teaching mirrors or video cameras on indirect ophthalmoscopes.

7.4 Ancillary equipment which should be available should include:
Fields equipment, Fundus camera, Argon laser, YAG laser, Keratometer and A-scan ultrasound for biometry, Focimeter, Orthoptic instruments such as prism bar and Hess chart/Lees screen.

7.5 In a teaching hospital, it would be expected that additional equipment would include:
B-scan ultrasound, Anterior segment camera and Electrophysiology equipment.

8. Theatre facilities

8.1 In most cases the theatre will be dedicated to ophthalmology, but in small units, this may not be possible.

8.2 The layout and instrumentation must be designed with training in mind.

8.3 The equipment should include, as appropriate:
Operating microscope with teaching side arm and video camera and recorder Coaxial assistant's microscope Phakoemulsifier Vitrector (even in units in which no vitreous surgery is undertaken, to deal with complications of cataract surgery) Modern micro-instruments

9. Ward

9.1 It is expected that, with the exception of paediatrics, beds will be dedicated to ophthalmology.

9.2 There must be adequate examination facilities for trainees' use in a ward side room, equipped with a slitlamp, indirect ophthalmoscope, test type and trial lens set and, where not available in Outpatients, biometry equipment. The side room is often the site, in addition, for informal teaching and ward rounds.

10. Daycase unit

10.1 The advent of large-scale day case surgery should not be allowed to be a barrier to teaching in theatre, nor to SpRs' surgical experience. It is expected that SpRs will have gained the necessary preliminary training in most procedures carried out in day case units during BST and that consequently surgery under local anaesthetic will not be a bar to teaching.

11. Library

11.1 All trainees should have access to a medical library which is open outside weekday and daytime working hours. There should also be reference books available in the Eye Department.

11.2 The library should contain books that cover all the principal subspecialties, as well as major ophthalmic texts, and there should be a demonstrable active purchasing policy for new books.

11.3 Ophthalmic journals available on the rotation should include:

• British Journal of Ophthalmology
• Eye
• American Journal of Ophthalmology
• Archives of Ophthalmology
• Ophthalmology Survey of Ophthalmology
• Investigative Ophthalmology

This list should not be seen as prescriptive and, in large units, is frequently supplemented by specialist journals.

11.4 There should be access to computer search facilities.

11.5 Isolated eye hospitals should stock principal general medical texts.

12. Additional facilities

12.1 Trainees should have a room for study large enough for all those on the rotation, and should have access to a computer.

12.2 A surgical skills laboratory is a valuable ancillary training resource. Appropriate instrumentation and a microscope should be available, and trainees encouraged to use the facility.

13. On call

13.1 It is permissible for junior SpRs (in the first 2 years in the grade) to take part in the first on call rota. Senior SpRs (years 3-5) must be second on call.

13.2 On-call cover for neighbouring eye departments is allowed, but only to fulfill statutory limits on junior doctors' hours.

13.3 In ophthalmology, it is not mandatory for trainees to be resident when on call. However, when they do have to reside in the hospital, the on call rooms must be adequate and may be visited by Royal College inspectors.

14. Core Curriculum

Specialist Registrar Training should include attachments in the following specialities:

Paediatric Ophthalmology
Neuro - Ophthalmology
Orbital & Oculoplastic Surgery
Medical & Surgical Retina
Cornea & Anterior Segment

15. Exit

During the Continuum trainees will be assessed twice a year by an Assessment Panel appointed by the Irish College of Ophthalmologists. At one assessment each year an External Assessor appointed by the Royal College of Surgeons in Ireland will be present. These assessments will give trainees an opportunity to discuss any difficulties they may be encountering and will ensure that each module is providing the necessary training, with adequate time allocated to research. The trainees logbooks will be examined to ensure that they are being completed correctly.

There will be a final assessment on completion of the four-and-a-half year training, when the Irish College of Ophthalmologists will recommend that the ISPTC issue a Certificate of Completion of Continuum Training in Ophthalmic Surgery.

Relevant Courses in Ophthalmology

Information will be included shortly.