PRACTICAL SKILLS (PS)

From College of Ophthalmology of Eastern Central and Southern Africa
Jump to navigation Jump to search

Refractive assessment

Learning outcome Overview

PRACTICAL SKILLS (PS)
Learning Outcome Refractive assessment
Code PS1
Description All trainees must be able to assess a patient's refractive error. They must be able to assess a patient's spectacle lenses using neutralisation techniques and focimetry. They must be able to perform retinoscopy and an accurate subjective refraction and provide an appropriate prescription. They must be able to assess a patient's binocular co-operation and advise on whether this should be corrected optically. They must be able to perform an accurate cycloplegic refraction (especially on a child) and provide an appropriate prescription.
Assessment CRSret Refraction certificate Portfolio, end of year exams, COECSA Exams
Target Year of Achievement Year ¾
Related Learning Outcomes PM10 PM11 BCS5
Other Links Study Guide  3.5.1.2 below

Perform refractive assessment and optical prescription Study Guide

Think:

  • ·What are the principles of refraction?
  • ·How does refracting children differ from refracting adults?

Activity:

  • ·Ask your departmental or local optometrist to teach you to refract
  • ·Familiarize yourself with optical prescription documentation
  • ·Practice on colleagues, friends, secretarial staff and as many patients as you can get a senior colleague to observe and give feedback
  • ·Consider going on a Refraction Course

Resources:

Self-Assessment:

  • ·Optics and Refraction section www.mrcophth.com
  • ·Basic Sciences in Ophthalmology: A self-assessment Text by John Ferris, D.L. Easty
  • MCQS and OSCES in Optics and Refraction PDF Download at mrcophth.com

Ocular and periocular drug administration

Learning outcome Overview

PRACTICAL SKILLS (PS)
Learning Outcome Ocular And Periocular Drug Administration
Code PS2
Description Trainees must be able to administer drugs directly into ocular and periocular tissues. Specifically these include subconjunctival, sub-tenons, intraorbital, intracameral and intravitreal injections. They must know the indications, contraindications and risks associated with each route.
Assessment DOPS, Portfolio, end of year exams, COECSA Exams
Target Year of Achievement Year ¾
Related Learning Outcomes PM3, BCS7
Other Links Study Guide  3.5.2.2 below

Administer periocular and intraocular drugs STUDY GUIDE

Think:

  • ·What clinical anatomy is relevant to the administration of periocular drugs?
  • ·What are the methods of action and pharmacokinetics of these drugs?
  • ·What side effects should I be prepared for in the specific context of periocular and intraocular administration?
  • ·How do you constitute and administer intravitreal antibiotics? Remember this is often performed in an emergency situation out of hours
  • ·Has the drug been stored properly and is it within its expiry date?
  • ·Some more details on administering local anaesthesia
  • ·How do you constitute and administer intracameral drugs?

Activity:

  • Observe the administration in theatre
  • Assist and perform some administrations under supervision


Resources:

  • ·Kunimoto DY, Rapuano CJ, Friedberg MA, Maker M, Kanitkar KD. The Wills Eye Manual:Office and Emergency Room Diagnosis and Treatment of Eye Disease. 4th ed. Appendix 7. Technique for Sub-Tenons and subconjunctival injections. Lippincott Williams and Wilkins; 2004
  • ·Clinical Ocular Pharmacology. J.D. Bartlett, S.D. Jaanus. Butterworth Heinemann Elsevier. 5th Edition, 2008. Pg. 48-52
  • ·Duane's Ophthalmology DVD-ROM
  • ·British National Formulary

Diathermy/cautery

Learning outcome Overview

PRACTICAL SKILLS (PS)
Learning Outcome Diathermy/cautery
Code PS3
Description Trainees must be able to use diathermy. They must understand the principles of diathermy use and the risks involved.
Assessment DOPS, portfolio/logbook and end of year review/exams
Target Year of Achievement Year 3/4
Related Learning Outcomes PS1- PS14
Other Links Study Guide  3.5.3.2 below

Diathermy aND CAUTERY USE STUDY GUIDE

Think:

  • ·What are the principles of diathermy?
  • ·What is the difference between monopolar and bipolar diathermy?
  • ·What are the possible dangers of diathermy?
  • ·What alternatives are there to diathermy for achieving haemostasis and for making incisions?
  • ·What settings do you start with on your diathermy machine for intraocular and extraocular procedures?

Activity

  • Observe in theatre how the machine is set up and the instruments are connected.
  • Consult the senior theatre staff to teach you on handling of the diathermy.
  • Participate in using diathermy in theatre.

Resources:

  • Clinical Atlas of Procedures in Ophthalmic and Oculofacial Surgery edited by Daniel M Albert, Mark J Lucarelli 2nd Edition. Oxford University Atlas
  • Gonnering R S. Ch5. Physical Modalities and their Application. Monograph No 8 Surgery of the Eyelid, Orbit and Lacrimal System. American Academy of Ophthalmology; 1993

Cryotherapy

Learning outcome Overview

PRACTICAL SKILLS (PS)
Learning Outcome Cryotherapy
Code PS4
Description Trainees must be able to understand the indications and appropriate use of cryotherapy in various eye conditions.  They should understand the side effects and complications of cryotherapy and manage accordingly.
Assessment DOPS, portfolio/logbook and end of year review/exams
Target Year of Achievement Year 3/4
Related Learning Outcomes PS1- PS14
Other Links Study Guide  3.5.4.2 below

Appropriate AND SAFE USE OF CRYOTHERAPY STUDY GUIDE

Think?

  •                What are the indications of cryotherapy in ophthalmology?
  •                What are the principles of cryotherapy?
  •                What are the side effects or complications of cryotherapy and their management?

Activities

Observe senior colleagues perform cryotherapy procedures for retinal holes, retinal detachment surgery, intra-ocular tumours, scleral perforations, trichiasis, giant cobblestones etc.

Learn how to set up the cryotherapy machines in your department.

Resources

  • Find these: Medtube, Eyetube, AAO?
  • Clinical Atlas of Procedures in Ophthalmic and Oculofacial Surgery edited by Daniel M Albert, Mark J Lucarelli 2nd Edition. Oxford University Atlas
  • Top of Form
  • Bottom of Form
  • Ophthalmic Surgical Procedures, PS. Hersh, BM Zagelbaum, SL Cremers. Thieme, 2ndEdition. 2011.Pg. 175-179 & 346 – 348.

Assess tear Film

Learning outcome Overview                                                               

PRACTICAL SKILLS (PS)
Learning Outcome Assess tear Film
Code PS5
Description Trainees must be able to assess the tear film.  They must be able to perform and interpret qualitative and quantitative tests for tear production and stability, such as tear break up time, Schirmer I and II, rose Bengal and fluorescein tests.
Assessment DOPS, portfolio/logbook and end of year review/ COECSA Exams
Target Year of Achievement Year 1 – 2 yr program/ Year 3/4 yr program
Related Learning Outcomes PS1- PS14
Other Links Study Guide  3.5.5.2 below

Assess Tear Film Study Guide  

Think

  • How do you determine if your patient has a tear film disorder? What is the normal tear film structure?
  • Which layer is likely to be deficient in the particular case at hand?
  • What tests are appropriate for testing the suspected deficient layer?

Activity:

  • Observe seniors assess tear film disorders in the eye clinic.
  • Perform as many as possible under supervision and thereafter do many on you own.

Resources:

  • AAO BCSC External Disease and Cornea Chapter 4 pg 61-70
  • Anatomy and physiology of eye. A.K. Khurana, I. Khurana. CBS Publishers and Distributors. 2nd Edition. 2008. Pg. 390-393.
  • Adler’s Textbook of Ocular Physiology
  • Dry Eye Disease: The Clinician's Guide to Diagnosis and Treatment edited by Penny A. Asbell, Michael A. Lemp Chapter 5

Assess LACRIMAL DRAINAGE apparatus

Learning outcome Overview

PRACTICAL SKILLS (PS)
Learning Outcome

Assess Lacrimal  Drainage Apparatus

Code PS6
Description Trainees must be able to assess the patency and efficiency of the lacrimal drainage apparatus.  They must be able to dilate the lacrimal punctum.  Perform irrigation tests; perform probing safely so as to assess the patency of the canuliculi and naso-lacrimal duct.
Assessment

DOPS, portfolio/logbook and end of year review/ COECSA Exams

Target Year of Achievement Year 3/4 yr program
Related Learning Outcomes PS1- PS14
Other Links Study Guide  3.5.6.2 below

Lacrimal function assessment Study Guide

Think:

  • ·How would you examine a patient who complained of a watery eye?
  • ·When should I and how do I know when to order and how to interpret relevant investigations?
  • ·How and when do I do probing and syringing

Activities

  • ·Learn the various clinical and radiological tests that can be done to assess lacrimal function
  • ·Observe these procedures in the clinic and theatre.
  • ·Perform some under supervision and later on your own,

Resources:

  • ·Management of Epiphora. Focus. Royal College of Ophthalmologists. Spring 2000. Available on request
  • ·www.emedicine.com/oph/topic465.htm
  • ·Nguyen LK, Linberg JV: Evaluation of the lacrimal system. In: Surgery of the eyelid, orbit, and lacrimal system. American Academy of Ophthalmology 1995; 3: 254-69
  • ·Anatomy and physiology of eye. A.K. Khurana, I. Khurana. CBS Publishers and Distributors. 2nd Edition. 2008. Pg. 393-396.
  • ·Principles and Practice of Lacrimal Surgery edited by Mohammad Javed Ali Page 147

Self-Assessment:

·www.djo.harvard.edu/site.php?url=/physicians/kr/731&page=KR_ QU

Corneal scrape

Learning outcome Overview

PRACTICAL SKILLS (PS)
Learning Outcome Corneal scrape
Code PS7
Description Trainees must be able to perform a corneal scrape for diagnostic and therapeutic purposes. They must understand the indications and risks of the procedure. They must know how to handle any samples taken from the cornea to increase the diagnostic yield and must liaise with laboratory staff so that the specimen is properly identified, presented and transported. They must make appropriate and reliable arrangements for the result to be acted upon in a timely fashion.

They must also be able to appropriately stain and examine under the microscope the sample taken in order to identify the causative organisms.

Assessment DOPS, portfolio/logbook and end of year review/ COECSA Exams
Target Year of Achievement Year 2 yr
Related Learning Outcomes PS1- PS14
Other Links Study Guide  3.5.7.2 below

Corneal scraping Study Guide

Think:

  • ·When is a corneal scrape indicated?
  • ·How should it be taken?
  • ·How should the specimen(s) be treated (plating-out etc), labeled and transported?
  • ·What does the laboratory need to know and how is this best communicated?

Activity:

  • ·Contact your local microbiology department to find out what the plating procedures are in your hospital and what other specific requirements need to be addressed including for sample preparation, documentation and transportation.
  • ·Follow up your patient
  • ·Ensure that you receive the result promptly, or at least ensure that someone knows you have delegated this to them
  • ·Ensure you know the significance of the result (eg changing or maintaining medication), and discuss this with colleagues/trainers if necessary

Resources:

  • ·Coster DJ. Procedures. Cornea. BMJ; 2002.
  • ·Allen BD, Dart JK. Strategies for the management of microbial keratitis. BJO 1995; 79: p777-786
  • ·Frederick S. Brightbill Corneal Surgery: Theory, Technique and Tissue4th Edition - 2009 - Page 474

Ocular surface foreign body

Learning outcome Overview

PRACTICAL SKILLS (PS)
Learning Outcome

Ocular surface foreign body

Code PS8
Description Trainees must be able to remove an ocular surface foreign body safely. They must be able to manage any tissue contamination, such as a rust ring. They must recognise and take appropriate action if there is a risk of intraocular penetration. They must be able to take appropriate measures to reduce the risk of infection.
Assessment

DOPS, portfolio/logbook and end of year review/ COECSA Exams

Target Year of Achievement Year 1
Related Learning Outcomes PS1- PS14
Other Links Study Guide  3.5.8.2 below

REMOVAL OF ocular surface foreign body Study Guide

Think:

  • How does the nature and location of a foreign body affect your management plan?
  • What medications would you use after removing the foreign body?

Activity:

  • This is a very common procedure in casualty clinics. Take advantage of opportunities very early in your training to performing this under supervision, as it is a skill you are likely to need soon
  • Familiarize yourself with the different types of topical anaesthetic you may need.
  • Familiarize yourself with the different instruments you may need to remove a foreign body.
  • Practice foreign body removal in a wet lab.
  • Perform as many foreign bodies as possible.

Reference:

  • ·AAO BCSC External Disease and Cornea Chapter 19 page 404-406
  • ·Frederick S. Brightbill Corneal Surgery: Theory, Technique and Tissue 4th Edition - 2009 - Page 136
  • ·Harwood-Nuss' Clinical Practice of Emergency Medicine edited by Allan B. Wolfson, Gregory W. Hendey, Louis J. Ling, Carlo L. Rosen 2009 Section 5 Chapter 57

Removal of sutures from eye and adnexae

Learning outcome Overview

PRACTICAL SKILLS (PS)
Learning Outcome Removal of sutures from eye and adnexae
Code PS9
Description Trainees must be able to remove sutures from the eye and adnexal tissue. They must know how sutures degrade and when it is appropriate to remove them. They must be able to manage any retained material and wound problems resulting from suture removal.
Assessment DOPS, portfolio/logbook and end of year review/ COECSA Exams
Target Year of Achievement Year  2 yr program
Related Learning Outcomes PS1- PS14
Other Links Study Guide  3.5.9.2

Ocular and adnexa suture removal Study Guide

Think:

  • ·Can you identify the different types of suture material?
  • ·When is the best time to remove different sutures?
  • ·When may it be appropriate to prescribe topical treatment following suture removal?

Activities

  • ·Preparation of appropriate instruments and anaesthetic agents for suture removal
  • ·Preparation of appropriate anaesthetic agents
  • ·Observe senior colleagues perform the procedure with and without a slit lamp as appropriate.
  • ·Practice suture removal in the eye clinic and theatre under supervision and later on your own.

Resources

Watch Removal Of Five Releasable Sutures In Trabeculectomy At https://www.youtube.com/watch?v=0lssWhoKdKY and Suture removal at slit lamp in uncooperative patient

Bandage contact lens

Learning outcome Overview

PRACTICAL SKILLS (PS)
Learning Outcome Bandage contact lens
Code PS10
Description All trainees must be able to fit a therapeutic bandage contact lens. They must know the risks involved and how they can be limited
Assessment DOPS, portfolio/logbook and end of year review/ COECSA Exams
Target Year of Achievement Year 2– 3  
Related Learning Outcomes PS1- PS14, PM11, PM12
Other Links Study Guide  3.5.10.2 below

Bandage contact lens FITTING Study Guide

Think:

  • ·Which patient would need a bandage contact lens?
  • ·How would you determine which size of bandage contact lens to use?
  • ·How long would a patient take using a bandage contact lens?
  • ·Do you know where to access a bandage contact lens?

Activities.

  • ·Familiarize with indications for bandage contact lens.
  • ·Observe senior colleagues perform the procedures for inserting and removing a bandage contact lens.
  • ·Familiarize with what instructions to give patients after inserting bandage contact lens.

Resources:

·www.assoc-optometrists.org/uploaded_files/pdf/fm-tcl-info1.pdf

·https://www.youtube.com/watch?v=jyZcd2ILtd0

Corneal glue

Learning outcome Overview

PRACTICAL SKILLS (PS)
Learning Outcome Corneal glue
Code PS11
Description Trainees must be able to apply appropriate glue to the cornea when indicated, for example for the management of corneal perforation. They must be able to recognise the complications thereof.
Assessment DOPS, portfolio/logbook and end of year review/ COECSA Exams
Target Year of Achievement Year 3/4
Related Learning Outcomes PS1- PS14
Other Links Study Guide  3.5.11.2 below

Corneal glue Study Guide

Think:

  • ·When might glueing be necessary?
  • ·When might I have to do it myself in an emergency?
  • ·How can I ensure my competence, as it is needed only rarely?

Activity:

  • Observe senior colleagues perform this procedure
  • Practice corneal glue application in wet lab
  • Perform glue application

Resources:

  • ·Coster DJ. Procedures. Cornea. BMJ. (2002) (Some good tips here)
  • ·Brightbill, FS, McDonnell PJ, McGhee CNJ. Corneal surgery: theory, technique and tissue. Mosby (2009)
  • ·Watch Ocular News Video Bandage Contact Lenses: Review of Indications and Innovations for Treatment of Ocular Surface Disease at http://video.healio.com/video/Bandage-Contact-Lenses-Review-o

Perform forced duction tests

Learning outcome Overview

PRACTICAL SKILLS (PS)
Learning Outcome Perform forced duction tests
Code PS12
Description Trainees must be able to perform a basic forced duction test as part of a clinical assessment. They must be able to achieve appropriate anaesthesia for the patient. They must understand the limitations of the test and be able to interpret the findings.
Assessment DOPS, portfolio/logbook and end of year review/ COECSA Exams
Target Year of Achievement Year 1, 2 / Year 3/4
Related Learning Outcomes PS1- PS14
Other Links Study Guide  3.5.12.2 below

Perform forced duction tests Study Guide

Think:

  • ·This patient has a squint - could there be any mechanical restriction?

Activity:

  • ·Take appropriate opportunities in theatre during squint lists to observe and perform forced duction tests and also on awake patients if possible

Resources:

  • ·Manual of Strabismus Surgery. 1st ed. MacEwen CJ, Gregson RMC. Butterworth Heinemann. (2001)
  • ·The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease. 4th ed. Appendix 5. Forced Duction Test. Kunimoto DY, Rapuano CJ, Friedberg MA, Maker M, Kanitkar KD. Lippincott Williams and Wilkins. (2004)
  • ·Wills Eye Video Atlas of Ocular Surgery DVD-ROM 2006by Derek Y. Kunimoto MD (Editor), William Tasman MD (Editor),

Biometry

Learning outcome Overview

PRACTICAL SKILLS (PS)
Learning Outcome

Biometry

Code PS13
Description Trainees must be able to perform and interpret appropriate biometry investigation particularly in relation to cataract surgery.  Using both automated and manual keratometry and different types of A-scan.  They should be able to understand and use different and appropriate formulas and be able to select relevant A-constants for different types of IOL.
Assessment

DOPS, portfolio/logbook and end of year review/ COECSA Exams

Target Year of Achievement Year 3/4
Related Learning Outcomes PI9
Other Links Study Guide  3.5.13.2 below

Biometry Study Guide

Think

  •                What intraocular lens do I implant after cataract surgery?
  •                What factors need to be considered in determining the intraocular lens power to give a patient?

Activities

  • ·        Familiarize yourself with the various formulae used in calculating IOL power.
  • ·        Familiarize yourself with the A scan ultrasound and Keratometer (whether manual or automated) in your eye department.
  • ·        Match Biometry reading to appropriate A constants for the different lenses.
  • ·        Do several tests and assess your consistency.
  • ·        Assess surgical outcome for targeted refractive error and actual outcome and asses for consistency between the two.
  • ·        Familiarize yourself with the automated biometry machines e.g IOL Master, Biograph, etc.

Resources.

  • AAO BCSC Lens and Cataract Chapter 7 and 8
  • Community Eye Health. How to avoid mistakes in biometry Nick Asbury and Balasubramanya Ramamurthy 2006; 19(60): 70–71.

Perform the correct hand hygiene technique

Learning outcome Overview

PRACTICAL SKILLS (PS)
Learning Outcome

Perform the correct hand hygiene technique

Code PS14
Description Trainees must be able to reduce the risk of cross infection by adopting the correct technique of hand cleaning and maintaining hand hygiene.

They must understand and apply local and national hand hygiene policies.

Assessment


MSF, Portfolio, end of year exams, COECSA Exams

Target Year of Achievement End of foundation year(1 and 2)
Related Learning Outcomes PS1- PS14
Other Links Study Guide  3.5.14.2 below

Perform the correct hand hygiene technique Study Guide

Think:

  • ·Do you disinfect your hands before and after every patient, after contact with bodily fluids and patient surroundings and before carrying out an aseptic procedure?
  • ·Do you know the correct procedure for gowning and gloving prior to surgical procedures?

Activities

  • Observe theatre and clinic staff to learn correct technique for hand washing and scrubbing.
  • Familiarize with the different hand-cleaning solutions.

Familiarize with the correct gowning and de-gowning technique prior to performing surgical procedures

Resources:

Retrieved from "https://curriculum.coecsa.org/index.php?title=PRACTICAL_SKILLS_(PS)&oldid=70"