SURGICAL SKILLS (SS)

Simulation and wetlab

Learning Outcome Overview

SURGICAL SKILLS (SS)
Learning Outcome	Simulation And Wet lab
Code	SS1
Description	Trainees must use simulation and wet lab facilities prior to undertaking surgical practice.
Assessment	OSATS1 , Portfolio, end of year exams, COECSA Exams
Target Year of Achievement	Year 2 (annual review)
Related Learning Outcomes	SS1 – SS17
Other Links	Study Guide  3.6.1.2 below

Simulation and Wetlab Study Guide

a)      Early In Training

Think:   Before I touch a human eye:

·Do I know my anatomy?

·What instruments will I be using, how do I use them and what are they called?

·Can I practice this in a simulated environment (see resources)?

·Can I be assessed in a simulated environment/wet-lab setting?

·Many skills, such as suturing, cataract surgery and trabeculectomy can be assessed in a simulated environment

Activity:

·Ask a theatre sister/deputy to show you the instruments, and to let you be scrub nurse

·Watch experienced surgeons or   senior trainees and ask questions

·Practice, practice, practice

Resources:

·Wet lab, or operating microscope out of hours (use plastic practice eyes) with and without supervision

·Surgical simulator

·Videos, web sites, books

· Ophthalmic Surgical Training: A Curriculum To Enhance Surgical Simulation. Grodin Mh, Johnson Tm, Acree Jl, Glaser Bm.

·Retina. 2008 Nov-Dec;28(10):1509-14. doi: 10.1097/IAE.0b013e31818464ff.  PMID: 18695630 [PubMed - indexed for MEDLINE]

b)      Later In Training:

Think:

·(As you progress) What are my weak points, how can I improve?

·What useful techniques have I seen used that are not assessed under other SS learning outcome requirements?

        Guidance note:

·You should be assessed in different skills as you progress through training

·As cataract surgery is regularly assessed separately it should not be used for this learning outcome

·Several Surgical Skills (e.g. biopsy, surface protection, cantholysis, tarsorrhaphy) are compulsorily assessed twice between 2^nd /3^rd year or 3^rd/4^th year; consider having further assessment of them under this heading to show progression of skills

·For this learning outcome you do NOT have to perform a complete procedure - so look out for surgical procedures of which you have the opportunity to perform only a (significant) part, where you utilise different skills from those you have had assessed previously

Activity:

·Watch experienced surgeons to identify different skills and techniques

·Discuss with your trainer additional surgical skills they can assess such as different suturing techniques for different ocular and adnexal tissues to show understanding of different sutures and knots

·Ask to perform steps in a longer procedure that would be a transferable skills, where you might be unlikely to perform the entire procedure

Operating microscope

Learning Outcome Overview

SURGICAL SKILLS (SS)
Learning Outcome	Operating Microscope
Code	SS2
Description	Trainees must be able to use the operating microscope with good understanding of the underlying optics.  They should be able to understand pupillary distance, focal length, changing zoom, focus, X-Y adjustment and hand foot coordination. They should have basic knowledge of microscope maintenance.
Assessment	OSATS1, Portfolio, end of year exams, COECSA Exams
Target Year of Achievement	Year  1 yr program
Related Learning Outcomes	SS1 – SS17
Other Links	Study Guide  3.6.2.2 below

Use the operating microscope Study Guide

Think:

·How does the microscope work (optics and mechanics)?

·Which buttons do what?

·How should I get comfortable at the microscope?

·What checks do I need to make before I start operating?

·What do I do if the bulb goes out or something else seems to go wrong during an operation??

Activity:

·Ask an experienced surgeon to show you the controls and to help you get comfortable

·Watch experienced surgeons and ask questions

·Practise under supervision, and on your own, both in and out of hours

·Learn how to perform simple maintenance tasks on the particular microscope(s) you use - especially bulb replacement (and know where the spares are kept!)

Resources:

·Manufacturer's manual (?web based?)

·Videos, books, websites

·TEXTBOOK OF OPHTHALMOLOGY VOL. 1 Edited by Sunita Agarwal, Athiya Agarwal, Lucio Buratto, David J. Apple, Jorge L. Ali Published by Jaypee Brothers Publishers. Copyright.

·Safety Of The Clean Air Storage Hood For Ophthalmic Instruments In The Operating Room , Herman DC. Am J Ophthalmol. 1995 Mar;119(3):350-4. PMID: 7872397 [PubMed - indexed for MEDLINE]

·Ophthalmic Microsurgical Training: Are We Approaching A Crisis Point? Ormonde SE. Clin Experiment Ophthalmol. 2005 Oct;33(5):453-4. PMID: 16181267, [PubMed - indexed for MEDLINE]

Aseptic technique

Learning Outcome Overview

SURGICAL SKILLS (SS)
Learning Outcome	Aseptic technique
Code	SS3
Description	All trainees must able to perform surgery using an appropriate aseptic technique.
Assessment	OSATS3, Portfolio, end of year exams, COECSA Exams
Target Year of Achievement	Year 1 yr program
Related Learning Outcomes	SS1 – SS17
Other Links	Study Guide  3.6.3.2 below

Aseptic surgical technique Study Guide

Think:

·By what routes could the operative field become contaminated?

·What can I touch safely when scrubbed?

·What is "non-touch technique?

·What do I do in the event of a needle stick injury to myself or one of the team?

Activity:

·Ask theatre sister/deputy to check your scrubbing, gowning & gloving technique

·Ask to be a scrub nurse for a list - or even for a week

·Watch experienced surgeons and nurses and ask questions

·Practice and ask for constructive criticism

·Always be alert for you or a colleague inadvertently or deliberately breaking sterility and don't be afraid to speak up about it

Resources

• BASIC PRINCIPLES OF OPHTHALMIC SURGERY , Thomas A. Oetting – 2011: This updated edition introduces the resident to key concepts and elements in the realm of ophthalmic surgery.
• Grodin Mh, Johnson Tm, Acree Jl, Glaser Bm.OPHTHALMIC SURGICAL PROCEDURES, PS. Hersh, BM Zagelbaum, SL Cremers. Thieme, 2^ndEdition. 2011. Pg. 175-179 & 346 – 348.

Cataract surgery

Learning Outcome Overview

SURGICAL SKILLS (SS)
Learning Outcome	Cataract surgery
Code	SS4
Description	All trainees must be able to perform contemporary cataract surgery. In the early stages of training this may involve a modular approach with performance of stages in the operation. By the end of training they must be able to complete a full operating list independently. The technique of surgery will be determined by clinical indications and current surgical practice. They must be able to adapt their technique according to pre-operative findings. They must be able to manage intra-operative and post-operative complications
Assessment	OSATS1, Portfolio, end of year exams, COECSA Exams
Target Year of Achievement	Year 3/4 (annual review)
Related Learning Outcomes	SS1 – SS17
Other Links	Study Guide  3.6.4.2 below

Cataract surgery Study Guide

a) Early in training

Think:

·Exactly what am I trying to achieve by each manoeuvre?

·What am I trying to avoid?

·How can I learn this with minimal risk to the patient, and minimal stress to the patient, the trainer and me?

Activity:

·Ask for supervised simulated experience then practice over and over again in the wet-lab and/or in theatre out-of-hours with plastic practice eyes (simulation can be done with a virtual reality simulator if available)

·Discuss with your trainer how (s)he will organize your training (modular, "reverse-chaining" etc.) and how you will be given protected operating time

·Agree what signal the trainer will give to tell you (s)he must take over

·Record every operation on video/digital recording, to review regularly yourself and frequently with your trainer

·Note that although the specific number of cataract operations actually required of trainees, the COECSA advises a minimum number of 50-100 complete procedures during the 2^nd/3^rd or 3^rd/4th years of training to help ensure adequate progress.

·Throughout your training, you MUST perform a continuous ongoing audit of any of your cataract surgery cases in which significant complications occur. This must be recorded using the COCESA electronic logbook (preferably on-line), and an updated synopsis must appear in your e-portfolio for each ARCP. The synopsis must include details of the final outcome of these cases, including the final visual acuity and (where available) refraction, and details of any further complications which arise.

Resources:

·Books, videos, meetings, wet lab/out-of/hours theatre, surgical simulator

·TEXTBOOK: ILLUSTRATIVE GUIDE TO CATARACT SURGERY: A STEP-BY-STEP Agarwal - 2011 - ‎No preview

·TEXTBOOK: MANUAL SMALL INCISION CATARACT SURGERY. Garg, ‎Luther L. Fry, ‎Francisco J. Gutierrez-carmona - 2008 - ‎Preview - ‎More editions

·TEXTBOOK: THE WILLS EYE MANUAL: OFFICE AND EMERGENCY ROOM DIAGNOSIS AND TREATMENT OF EYE DISEASE. Kunimoto DY, Rapuano CJ, Friedberg MA, Maker M, Kanitkar KD.  4th ed. Appendix 7. Technique for Sub-Tenon’s and subconjunctival injections. Lippincott Williams and Wilkins; 2004

b) Later in training

Think:

·How can I refine my skills (ECCE, MSICS, Phaco) to be safe and effective in all cataract cases, even complex ones?

·How can I learn this with minimal risk to the patient, and minimal stress to the patient, the trainer and me?

·How can I be sure that my surgery is good enough?

Activity:

·Ask your trainer to show you how to approach difficult cases and then to take you through them

·Continue to use video/digital recording and the wet-lab/ simulator

·Continue to seek feedback from your trainers, both formal and informal

·Note that although the specific number of cataract operations required of trainees may vary, the COECSA advises a minimum number of 150-200 complete procedures during the 3 or 4 years of training to help ensure satisfactory progress to fully independent practice. These procedures should include the full variety of complex cases; in this context complex cases must include high myopes, cases with previous anterior or posterior segment surgery, cases with previous iritis, unusually hard or soft cataracts, white cataracts, cases with pseudoexfoliation syndrome, subluxated lenses and post-trauma cases.

·Throughout your training, you MUST perform a continuous ongoing audit of any of your cataract surgery cases in which significant complications occur. This must be recorded using the COECSA electronic logbook (preferably online), and an updated synopsis must appear in your e-portfolio for each ARCP. The synopsis must include details of the final outcome of these cases, including the final visual acuity and (where available) refraction, and details of any further complications which arise.

Surgery for raised IOP

Learning Outcome Overview

SURGICAL SKILLS (SS)
Learning Outcome	Surgery raised IOP
Code	SS5
Description	Trainees must be able to manage patients with raised intraocular pressure (IOP) and glaucoma. They must understand and recognise the causes of raised IOP and the surgical options available. They must be able to manage raised IOP and glaucoma by performing appropriate procedures. The technique of surgery will depend upon clinical indications and current surgical practice. They must recognise when the management requires expert referral. They must be able to perform appropriate surgery for the emergency management of elevated IOP, such as in acute angle closure.
Assessment	OSATS1, Portfolio, end of year exams, COECSA Exams
Target Year of Achievement	Year 3/4 yr program
Related Learning Outcomes	SS1 – SS17
Other Links	Study Guide  3.6.5.2 below

Surgical measures to lower IOP Study Guide

Think:

·When is surgery appropriate?

·What am I trying to achieve?

·What am I trying to avoid?

·How can I learn this with minimal risk to the patient, and minimal stress to the patient, the trainer and me?

Activity:

·Ask for supervised simulated experience then practice over and over again (wet-lab/animal eye, should also include out-of-hours in-theatre work; simulation can be with virtual reality systems when available)

·Discuss with your trainer which procedures are appropriate for you to learn, and how your training will be achieved. This could include the needling of blebs.

·Record every operation, to review regularly yourself and frequently with your trainer

·Ideally actual surgical procedures should be assessed, but if this is not feasible then additional laser procedures, especially cyclodiode laser.

Resources:

·Books, videos, meetings, wet lab/out-of-hours theatre, surgical simulator

·TEXTBOOK: MANAGEMENT OF CATARACTS AND GLAUCOMA - PAGE VIII Anne Louise Coleman, ‎John C. Morrison - 2004 - ‎Preview - ‎More editions

·TEXTBOOK: Complications of Glaucoma Surgery. Robert M. Feldman, MD, ‎Nicholas P. Bell - 2013 - ‎Preview - ‎More editions

·TEXTBOOK: Clinical Ophthalmology: A Systematic Approach. Jack J. Kanski, ‎Brad Bowling - 2011 - ‎Preview - ‎More editions

Trauma surgery

Learning Outcome Overview

SURGICAL SKILLS (SS)
Learning Outcome	Trauma surgery
Code	SS6
Description	Trainees must be able to perform surgical repair of ocular and adnexal tissues, including the cornea, sclera, eyelids and conjunctiva using the appropriate sutures. The technique of repair will be determined by clinical indications and current surgical practice. They must be able to adapt their technique according to pre-operative findings. They must be able to manage intra-operative and post-operative complications. They must recognise when subspecialist assistance is required, ensuring prompt onward referral when necessary.
Assessment	OSATS1, Portfolio, end of year exams, COECSA Exams
Target Year of Achievement	Year 1, 2 yr program/ Year 3/4 yr program
Related Learning Outcomes	SS1 – SS17
Other Links	Study Guide  3.6.6.2 below

Perform surgical repair of ocular and adnexal tissues after trauma Study Guide

Think:

·How can I maximize my exposure to ocular trauma management?

·What can I do to practice in a simulated situation?

·In what elective procedures can I develop transferable skills for trauma repair?

·What are the general principles of surgical repair?

Activity:

·Take full advantage of training opportunities to learn suturing in elective, simulated and trauma situations; ask trainers/senior trainees to supervise you in these contexts

·Watch trainers and ask questions

·Ensure you are readily available for on-call duties

Resources:

·Books, videos, meetings, wet lab/out-of-hours theatre, surgical simulator

·TEXTBOOK: Eyelid, Conjunctival, And Orbital Tumors: An Atlas And ... - Page 134: Jerry A. Shields, ‎Carol L. Shields - 2008 - ‎Preview - ‎More Editions

·TEXTBOOK: Surgical Anatomy Of The Ocular Adnexa: A Clinical Approach, David Jordan, ‎Louise Mawn, ‎Richard L. Anderson - 2012 - ‎Preview - ‎More editions

Common lid surgery

Learning Outcome Overview

SURGICAL SKILLS (SS)
Learning Outcome	Common Lid Surgery
Code	SS7
Description	Trainees must be able to manage patients with lid problems. They must understand and recognise the causes of lid mal-position and lash mis-direction and the surgical options available. They must be able to perform tarsal plate rotation surgery for trachoma trichiasis. They must be able to manage lid lesions by performing appropriate incision, curettage, biopsy or excision. They must recognise when the management requires expert referral.
Assessment	OSATS1, Portfolio, end of year exams, COECSA Exams
Target Year of Achievement	Year 3/4
Related Learning Outcomes	SS1 – SS17
Other Links	Study Guide  3.6.7.2 below

Surgical management of lid problems Study Guide

Think:

·What anatomy do I need to know?

·What can go wrong with eyelids which are amenable to surgical correction?

·What complications are possible, and why?

·Who can I watch performing lid surgery?

·Are my basic tissue-handling/suturing skills good? - What can I do to improve them?

·How should I plan my progression through simple to more-complex lid surgery?

·How should I explain the options and procedures to the patient?

·Are there any situations where cryotherapy could be useful? If, in conjunction with my trainer, I consider cryotherapy to be useful how would I arrange cryotherapy if working in a unit that does not offer this procedure?

Activity:

·Read up lid anatomy and pathology

·Ask to attend clinics dealing with structural lid problems

·Watch more senior surgeons and ask them to explain what they are doing, and why

·Practice suturing in the wet-lab, or using spare sutures with apples, grapes, etc.

·Ask to be taken through lid procedures (simple at first) and practice them under supervision

·Assess your patients carefully pre and post-op and audit the results

·Your surgical logbook should include a range of procedures and your training should concentrate on helping you develop transferable skills. It is expected that the procedures would include correction of simple entropion and ectropion, pentagon excision for lid margin lesions, upper lid blepharoplasty, chalazion surgery and ideally, tarsorrhaphy.

Resources:

·Books, videos, meetings, practice situations

·TEXTBOOK: Eyelid, Conjunctival, And Orbital Tumors: An Atlas And ... - Page 134: Jerry A. Shields, ‎Carol L. Shields - 2008 - ‎Preview - ‎More Editions

·TEXTBOOK: Clinical Ophthalmology: A Systematic Approach https://books.google.co.zm/books?isbn=070204511X Jack J. Kanski, ‎Brad Bowling - 2011 - ‎Preview - ‎More editions

OCULAR Surface protection

Learning Outcome Overview

SURGICAL SKILLS (SS)
Learning Outcome	Ocular Surface protection
Code	SS8
Description	Trainees must be able to undertake appropriate surgical and pharmacological measures, including botulinum toxin, for the protection of the cornea and ocular surface. The technique will be determined by the clinical findings and current practice. They must recognise when the patient should be referred for expert management.
Assessment	OSATS1, Portfolio, end of year exams, COECSA Exams
Target Year of Achievement	Year 3/4
Related Learning Outcomes	SS1 – SS17
Other Links	Study Guide  3.6.8.2 below

Ocular surface PROTECTION Study Guide

Think:

·When is lid protection necessary?

·Does it need to be temporary or permanent?

·When is a surgical approach (e.g amniotic membrane, Frost suture with bolster, tarsorrhaphy) likely to be better than a conservative approach (eg ointments/lubricants, protective cover, bandage contact lens, botulinum toxin)?

·How can I learn the different techniques?

·Who can best teach me?

Activity:

·Ask to attend clinics/ward visits dealing with corneal exposure

·Look up the techniques available, surgical and otherwise

·Watch experienced surgeons performing these procedures

·Ask to be taken through the procedures where feasible

·Assessment can be in simulation (wet lab) if necessary

Resources:

• TEXTBOOK: Ocular Surface Disease: Medical And Surgical Management - Pa. Mark J. Mannis, ‎Edward J. Holland - 2006 - ‎Preview - ‎More editions
• TEXTBOOK: Ocular Surface Disease: Cornea, Conjunctiva and Tear Film: ... Edward J. Holland, ‎Mark J. Mannis, ‎W. Barry Lee - 2013 - ‎Preview - ‎More editions

SURGICAL SKILLS (SS)

• Textbooks/videos on lid surgery

Lateral canthotomy/lysis

Learning Outcome Overview

SURGICAL SKILLS (SS)
Learning Outcome	Lateral canthotomy/lysis
Code	SS9
Description	All trainees must be able to perform lateral canthotomy and cantholysis as an emergency procedure. The technique of surgery will be determined by the clinical findings and current surgical practice. They must understand when it is indicated and recognise when the patient should be referred for expert management.
Assessment	OSATS1, Portfolio, end of year exams, COECSA Exams
Target Year of Achievement	Year 3/4
Related Learning Outcomes	SS1 – SS17
Other Links	Study Guide  3.6.9.2 below

Perform lateral canthotomy and cantholysis Study Guide

Think:

·When is cathotomy/cantholysis required?

·What may be the alternatives?

·How can I get involved with patients needing these procedures?

·Can I manage this patient myself, or do I need help?

Activity:

·Actively try to get involved with patients needing these procedures

·Watch experienced surgeons/ask to be taken through the procedures

·Get involved in the follow-up of these patients

Resources:

·Textbooks/videos

·Textbook:  Reconstructive Surgery Of The Eyelids And Ocular Adnexa - Page 210. Alston Callahan - 1966 - ‎Snippet View

·Textbook: Eyelid, Conjunctival, And Orbital Tumors And Intraocular Jerry A. Shields, ‎Carol L. Shields - 2008 - ‎No Preview - ‎More Editions

Ocular biopsy

Learning Outcome Overview

SURGICAL SKILLS (SS)
Learning Outcome	Ocular biopsy
Code	SS10
Description	All trainees must be able to perform a biopsy of ocular and adnexal tissues. They must understand the indications, limitations and risks of the biopsy. They must ensure that they prepare the biopsy sample correctly for subsequent laboratory analysis and must liaise with laboratory staff so that appropriate media, identification of edges and transport are used to maximise the diagnostic yield of the biopsy. They must make appropriate and reliable arrangements for the result to be acted upon in a timely fashion.
Assessment	OSATS1, Portfolio, end of year exams, COECSA Exams
Target Year of Achievement	Year 3/4
Related Learning Outcomes	SS1 – SS17
Other Links	Study Guide  3.6.10.2 below

Eyelids and the ocular surface BIOPSY Study Guide

Think:

·What tissues may I need to biopsy?

·Is incisional or total biopsy indicated?

·What are the risks, and can I explain them well enough to the patient?

·Can I apply skills I have learned elsewhere, or do I need to learn new skills?

·Can I do it myself alone, or with supervision, or do I need to refer the patient to an expert?

·How can I be sure I can cope (eg in emergency with endophthalmitis needing vitreous biopsy?)

·When will the result be available, and who will ensure that it is acted upon expeditiously?

·What are the protocols for ensuring correct labeling?

Activity:

·Attend clinics dealing with lid and external eye tumours, conjunctival mass/growth like pterygium

·Practice skills in "wet-lab" or other simulated situation

·Ask to attend lid surgery lists, observe biopsy and ask to be taken through appropriate procedures

·Observe and do appropriate surgical procedures for conjunctival mass/growth like pterygium

·Take advantage of on-call opportunities to perform vitreous biopsy under supervision

·Ask to attend VR lists and to be allowed to set up for pars plana vitrectomy and perform the core vitrectomy yourself under supervision

·Liaise closely with your local laboratories regarding specific requirements for sample preparation, documentation and transportation, particularly in regard to specimens being transported by non-NHS personnel such as taxi drivers

·Ensure that you will 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, and discuss this with colleagues/trainers if necessary.

Resources:

·Books, videos, meetings, wet-labs (formal or informal)

·Textbook: Eyelid, Conjunctival, And Orbital Tumors And Intraocular, Jerry A. Shields, ‎Carol L. Shields - 2008 - ‎No Preview - ‎More Editions

·Textbook; Ocular Surface Disease: Medical And Surgical Management Edward J. Holland, ‎Mark J. Mannis - 2001 - ‎Preview - ‎More Editions

Strabismus surgery

Learning Outcome Overview

SURGICAL SKILLS (SS)
Learning Outcome	Strabismus surgery
Code	SS11
Description	Trainees must be able to perform or assist at basic extraocular muscle surgery.  They must be able to identify the muscle, safely detach it and suture it to the sclera.
Assessment	OSATS1, Portfolio, end of year exams, COECSA Exams
Target Year of Achievement	Year 3/4
Related Learning Outcomes	SS1 – SS17
Other Links	Study Guide  3.6.11.2 below

Perform surgery on the extraocular muscle s Study Guide

Think:

·How do I decide whether this patient needs muscle surgery at all, and if so which muscle and which operation?

·What are the pros and cons of surgery and how should I explain these to the patient/parent?

·How can I learn muscle surgery with the least possible risk to the patient and minimal stress to my trainer and myself?

Activity:

·Take an active role in orthoptic/pediatric/strabismus clinics seeing child and adult patients

·Read up on muscle surgery

·Discuss cases with, and then watch, experienced surgeons and then ask to be taken through simple, then more complex procedures

·Follow up your patients

Resources:

·Orthoptic clinics, textbooks, videos

·Textbook:  Strabismus Surgery And Its Complications - Page 3,David K. Coats, ‎Scott E. Olitsky - 2007 - ‎Preview - ‎More Editions

·Textbook:Clinical Strabismus Management:Principles And Surgical , Https://Books.Google.Co.Zm/Books?Isbn=0721676731, Arthur L. Rosenbaum, ‎Alvina Pauline Santiago - 1999 - ‎Full View - ‎More Editions

Eye removal

Learning Outcome Overview

SURGICAL SKILLS (SS)
Learning Outcome	Eye removal
Code	SS12
Description	Trainees must be able to perform evisceration, enucleation and exenteration.  They must be able to communicate and empathise with the patient.  They should understand the indications for the removal of the tissue and the rationale for the choice of surgery.  They must be able to manage the complications and refer appropriately for rehabilitation.  They must be aware of future adjunctive therapies required and appropriate follow up
Assessment	OSATS1, Portfolio, end of year exams, COECSA Exams
Target Year of Achievement	2 yr program
Related Learning Outcomes	COM 5,BP3
Other Links	Study Guide  3.6.12.2 below

Remove the eye when indicated Study Guide

Think:

·When should removal of an eye be considered?

·What are the alternatives?

·How should I approach the subject with the patient, and how much time should I give them to consider the alternatives? (And is it really as urgent as I think it might be?)

·What alternative techniques are there, and do I need to balance pros and cons (eg good cosmesis with implants against risks of extrusion and possible future delay in detection of secondary tumour)

·How can I learn the techniques with minimal risk to the patient and minimal stress to the trainer and myself?

·Can I provide adequate counseling, or does my patient need expert help?

·What special considerations apply to the removal of a donor eye from a cadaver?

Activity:

·Get involved in trauma cases

·Attend clinics dealing with ocular tumours

·Read up about the options and discuss with experts

·Observe expert surgeons and ask to be taken through procedures. You must observe and then perform at least five enucleations and five evisceration; if the opportunity to perform these does not arise in your clinical practice you should be assessed (using OSATS) in the retrieval situation (for enucleation) and the wet-lab (for evisceration)

·Follow up your patients when feasible

·Find out what support services are available and how to access them

Resources:

·Books, videos, manufacturer's information (on orbital implants, etc)

·TEXTBOOK:  Basic Surgical Skills and Techniques - Page 37 Sudhir Kumar Jain, ‎David L. Stoker, ‎Raman Tanwar - 2013

Laser to lens capsule

Learning Outcome Overview

SURGICAL SKILLS (SS)
Learning Outcome	Laser to lens capsule
Code	SS13
Description	Trainees must be able to apply appropriate laser for the management of problems with the lens capsule after cataract surgery. They must understand the indications, risks and limitations of laser treatment. They must know how to manage the complications of laser treatment. The type of laser applied will be determined by clinical findings and current clinical practice.
Assessment	OSATS1, Portfolio, end of year exams, COECSA Exams
Target Year of Achievement	Year 2
Related Learning Outcomes	SS1 – SS17
Other Links	Study Guide  3.6.13.2 below

Laser for the management of the lens capsule STUDY GUIDE

Think:

·What are the indications for laser to the lens capsule?

·How does the laser work and what safety precautions are required?

·Does my Institution/facility require a formal laser induction process?

·What is the balance of risks and benefits, and how should I explain these to the patient?

·Are there any underlying conditions which would alter the risk/benefit ratio?

·What complications could ensue, what follow-up is necessary, what warnings should the patient be given, and will I be able to handle complications myself or will I need help?

·How can I learn the techniques with minimal risk to the patient and minimal stress to my trainer and myself?

Activity:

·Read up on the subject

·Check up on Institution/facility procedures

·Read the laser manufacturer's manual

·Listen to experts talking to patients about the procedure

·Watch experts performing laser, then ask to be taken through it with easy and then with more tricky cases

·Follow up your patients and consider an audit

·Talk to patients before and after laser

Resources:

·Books, videos, meetings, manufacturers' manuals

·Textbook:  Ophthalmic Diagnosis And Treatment - Page 65 Myron Yanoff - 2013 - ‎Preview

·Textbook:  Ophthalmology - Page 1518  Myron Yanoff, ‎Jay S. Duker, ‎James J. Augsburger - 2009 - ‎Preview - ‎More Editions

Laser for management of raised IOP

Learning Outcome Overview

SURGICAL SKILLS (SS)
Learning Outcome	Laser for management of raised IOP
Code	SS14
Description	Trainees must be able to apply appropriate laser for the management of raised intraocular pressure. They must understand the indications, risks and limitations of laser treatment. They must know how to manage the complications of laser treatment. The type of laser applied will be determined by clinical findings and current clinical practice.
Assessment	OSATS1 Portfolio, end of year exams, COECSA Exams
Target Year of Achievement	Year 2 (2 assessments) and 6 assessments during Year 3/4
Related Learning Outcomes	SS1 – SS17
Other Links	Study Guide  3.6.14.2 below

Laser for the management of raised intraocular pressurE STUDY GUIDE

Think:

·What sorts of laser procedures are possible for IOP, and what are their indications?

·How does the laser work and what safety precautions are required?

·Does my Institution/facility require a formal laser initiation procedure?

·What is the balance of risks and benefits, and how should I explain these to the patient?

·Are there any underlying conditions which would alter the risk/benefit ratio?

·What complications could ensue, what follow-up is necessary, what warnings should the patient be given, and will I be able to handle complications myself or will I need help?

·What pre and post-operative treatment is indicated for my patient?

·How can I learn the techniques with minimal risk to the patient and minimal stress to my trainer and myself?

Activity:

·Read up on the subject

·Check up on Institution/facility procedures

·Read the laser manufacturer's manual

·Listen to experts talking to patients about the procedure

·Watch experts performing laser, then ask to be taken through it with easy and then with more tricky cases

·Follow up your patients and consider an audit

·Endeavour to perform a variety of laser procedures

·Talk to patients before and after laser

Resources:

·Books, videos, meetings, manufacturers' manuals

·TEXTBOOK:  Ophthalmology - Page 1185, Myron Yanoff, ‎Jay S. Duker, ‎James J. Augsburger - 2009 - ‎Preview - ‎More Editions

·TEXTBOOK:  ANGLE CLOSURE AND ANGLE CLOSURE GLAUCOMA: REPORTS AND  Robert N. Weinreb, ‎David S. Friedman - 2006 - ‎Preview - ‎More Editions

Laser for management of retinal problems

Learning Outcome Overview

SURGICAL SKILLS (SS)
Learning Outcome	Laser for management of retinal problems
Code	SS15
Description	Trainees must be able to apply appropriate laser for the management of retinal disorders. They must understand the indications, risks and limitations of laser treatment. They must know how to manage the complications of laser treatment. The type of laser applied will be determined by clinical findings and current clinical practice.
Assessment	OSATS1, Portfolio, end of year exams, COECSA Exams
Target Year of Achievement	Year 2 (2 assessments) and 6 assessments during Year 3/4
Related Learning Outcomes	SS1 – SS17
Other Links	Study Guide  3.6.15.2 below

Laser for the management of retinal problems Study Guide

Think:

·What are the indications for laser treatment to the retina, and what tests may be helpful in deciding about treatment?

·What sorts of lasers are available, and on what basis should one choose between them? How do the lasers work and what safety precautions are required?

·Does my Institution/facility require a formal laser initiation procedure?

·What techniques of laser application are available (delivery systems and treatment strategies)?

·What are the pros and cons of treatment, and how can I best communicate these to the patient?

·What complications could ensue, what follow-up is necessary, what warnings should the patient be given, and will I be able to handle complications myself or will I need help?

·How can I learn the techniques with minimal risk to the patient and minimal stress to my trainer and myself?

Activity:

·Read up on the subject

·Check up on Institution/facility procedures

·Read the laser manufacturer's manual

·Learn about the various imaging techniques which help with clinical decision-making

·Listen to experts talking to patients about the procedure

·Watch experts performing laser, then ask to be taken through it with easy and then with more tricky cases

·Follow up your patients and consider an audit

·Talk to patients before and after laser

Resources:

·Books, videos, meetings, manufacturers' manuals

·Moorfields Manual Of Ophthalmology,Timothy L. Jackson - 2008 - ‎Preview - ‎More Editions

·Clinical Pathways In Vitreoretinal Disease - Page 270, Scott M. Steidl, ‎Mary Elizabeth Hartnett - 2011 - ‎Preview - ‎More Editions

AC/Vitreous sampling

Learning Outcome Overview

SURGICAL SKILLS (SS)
Learning Outcome	AC/Vitreous sampling
Code	SS16
Description	Trainees must be able to perform anterior chamber and vitreous sampling through pars plana approach. They must understand the risks of the procedure. They must know how to handle any samples taken from the eye to increase the diagnostic yield and must liaise with laboratory staff so that the specimens are properly identified, presented and transported. They must make appropriate and reliable arrangements for the result to be acted upon in a timely fashion.
Assessment	OSATS1, Portfolio, end of year exams, COECSA Exams
Target Year of Achievement	Year 3/4
Related Learning Outcomes	SS1 – SS17
Other Links	Study Guide  3.6.16.2 below

Vitreous And Anterior Chamber Tap Study Guide

Think:

·What are the indications for anterior chamber tap and vitreous tap?

·How and where should these procedures be done?

·What are the risks and complications of doing these procedures and what precautions should be taken?

Activity:

·Read up the subject

·Observe seniors perform these procedures

·Seek to do as many procedures as possible under supervision

Resources

·Cataract Surgery - Page 575, Roger F. Steinert - 2010 -

·Ophthalmology - Page 533, Myron Yanoff, ‎Jay S. Duker, ‎James J. Augsburger - 2009

Anterior vitrectomy

Learning Outcome Overview

SURGICAL SKILLS (SS)
Learning Outcome	Anterior vitrectomy
Code	SS17
Description	Trainees must be able to perform anterior vitrectomy employing both sponge and mechanical approach. They must understand the indications, risks and possible complications of the procedure. They must also be able to choose the most appropriate approach for anterior vitrectomy.
Assessment	OSATS1, Portfolio, end of year exams, COECSA Exams
Target Year of Achievement	Year 2/3 (annual review)
Related Learning Outcomes	SS1 – SS17
Other Links	Study Guide  3.6.17.2 below

Perform Anterior VITRECTOMY Study Guide

Think:

·What are the indications for anterior vitrectomy?

·How and where should this procedure be done?

·What are the risks and complications of doing this procedure and what precautions should be taken?

Activity:

·Read up the subject

·Observe seniors perform these procedures

·Seek to do as many procedures as possible under supervision

Resources

·Cataract Surgery - Page 575, Roger F. Steinert - 2010

·Ophthalmology - Page 533, Myron Yanoff, ‎Jay S. Duker, ‎James J. Augsburger - 2009  ‎