VITREO-RETINAL - SUBSPECIALTY CURRICULUM

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

PREAMBLE

COECSA Background

The College of Ophthalmology of Eastern Central and Southern Africa (COECSA) is a specialized virtual College founded in 2012 after a successful voluntary merger between the Eastern Africa College of Ophthalmologists (EACO) and Ophthalmological Society of Eastern Africa (OSEA).


The College seeks to work in tandem with regional and global initiatives and to support international commitments including Sustainable Development Goals (SDGs), WHO Vision2020: The Right to Sight; WHO AFRO Road Map for scaling up HRH[KG1] ; 4th EAC Development Strategy; national eye care and development programmes in contributing to Universal Health Coverage (UHC). 


COECSA’s expertise in research, curricula, standards, quality assessments, and policy reviews provide the basis to further programmatic interventions. COECSA, therefore, places a premium on partnerships and collaborations and further acts as a catalyst for action by many actors in the eye care space.

COECSA’s mandate is to:

  • ·        Support the development of human resource for health through quality training in ophthalmology;
  • ·        Set standards for professional ophthalmic practice;
  • ·        Facilitate continuing professional development;
  • ·        Contribute to health policy development;
  • ·        Advocate for relevant policy changes in the region;
  • ·        Promote research which advances ophthalmology practice in the region and ;
  • ·        Create a forum for the ophthalmic practitioners to promote the profession and exchange skills and knowledge.


Its Mission is: To improve the number and quality of eye care workers in Eastern, Central and Southern Africa through training, leadership and promoting standards of practice, research and advocacy.


The Vision is: Eye health for all in Eastern, Central and Southern Africa.

The Goal of COECSA is: Skilled and motivated eye health work force for quality eye care in Eastern Central & Southern Africa region.

 Curriculum Model

The subspecialty fellowship curriculum is a hybrid model that promotes the following tenets:

           • Integration (horizontal & vertical)

           • Thematic/systematic Courses

           • Small group learning methods

           • Student-centred & Student-directed Learning

           • Optimum use of IT learning technologies

           • Primary care models (& health promotion approaches)

 Curriculum Goal, Objectives and Outcomes

The subspecialty fellowship programmes provides essential intellectual and clinical information (i.e. cognitive and technical/surgical skills) that are necessary for subspecialty ophthalmic personnel. The curriculum is a content outline for a fund of knowledge. It is not designed to be all-inclusive but rather a guideline for the subspecialty training.

 Core Competences

Core competencies include:

·        Patient Care

·        Medical Knowledge

·        Practice-based Learning and Improvement

·        Communication Skills

·        Professionalism

·        Systems-based Practice

INTRODUCTION/RATIONALE

Vitreoretinal diseases are conditions that affect structures in the eye called the retina and the vitreous. The retina is the light-sensitive layer in the back of the eye that receives focused images and transmits that information to the brain via the optic nerve. The vitreous is a clear gel that fills the space between the lens (at the front of the eye) and the retina.


Because the retina and macula are integral to vision, any disease in this part of the eye can temporarily or permanently diminish vision. Therefore, any symptoms related to vitreoretinal disease need to be evaluated by a retinal specialist as quickly as possible.

To ensure the availability of retinal specialists in the ECSA region, COECSA with support from the Commonwealth Eye Health Consortium (CEHC) embarked on a project to roll out a regional Clinical Fellowship Programmes that will provide a well- defined clinical experience in Vitreo-Retina specialty with recognised competencies in both medical and surgical retina. The programme is aimed to forestall the challenge of long periods of training abroad and maximize on the available pool of resources, both human and hospitals that are available in the region.

STRUCTURE OF THE PROGRAMME

Goal

The goal of the VR Fellowship is to provide training/experience for the diagnosis, medical and surgical management of retinal and vitreous conditions using a regional, hospital based fellowship program.

Objectives

History taking skills.

The fellow must have in-depth knowledge to take a comprehensive history about common and rare Vitreo-Retina clinical conditions that may be associated with worsening disease and/or vision loss

Clinical Investigation Skills

To acquire skills necessary to examine vitreo-retina pathology and related ocular and systemic conditions. In particular, the fellow will be required to be proficient with the use of the indirect ophthalmoscope along with skills of indentation to examine the peripheral retina.

Performing Technical VR diagnostic Tests and their Clinical interpretations.

To acquire knowledge and become proficient in identifying the indications for various diagnostic tests and interpretation of the results of such specialized diagnostic tests appropriate to the subspecialty of VR, including but not limited to the following:

o  Should be able to do B Scan Ultrasonography (USG), evaluating and diagnosis of various posterior segment conditions. Give a concise and complete report on the USG findings. Should be proficient in various different USG examination techniques.

o  Should understand the OCT testing modality and how to interpret the results and follow up on conditions such as DME, AMD, CSR, IPCV, CNVM etc . The fellow should be able to differentiate all the layers of the retina and determine the disease processes. The fellow should be able to use the OCT comfortably for anterior segment and disc evaluation along with RNFL/GCC interpretation.

o  Evaluation of retina using wide field fundus photography

o  Assessment of various vascular diseases using FFA/ICGA/OCT Angiography.

Therapeutics Modalities and their limitations

To acquire knowledge related to management of various VR conditions as related to medical, radiological and surgical interventions.

The fellow must become familiar with the indications for and limitations of all important pharmacological, LASER, and surgical therapies that may be recommended for patients with VR and related conditions.

They must also be familiar with other systemic conditions whose management has direct or indirect impact on management of VR conditions. In case of drug interactions, they must be familiar with specific antidote or line of management for adverse effects from such interactions or from independent unwanted side effects.

VR Clinical Experience

The fellow should become proficient in the diagnosis and clinical/surgical management of VR and related structures such as the uvea. Fellow should be proficient in dissemination of VR knowledge to the other medical cadres who are part of the eye care team.

  • To instill a deep-rooted sense of responsibility for VR patients who often require long term follow‐up and psychosocial care and support.
  • To demonstrate the highest ethical standards in treatment VR patients.
  • To understand the value of basic, clinical, and population-based research in furthering the understanding of etiology, diagnosis, and the treatment of VR conditions.
  • To participate in at least one VR‐related research project and present at resident/fellow research days, as well as at a major international ophthalmic meeting/ conference.
  • To participate in teaching of medical students and residents whenever possible.
  • To understand principles behind leadership and management roles related to the practice of VR (in an academic and community practice setting).
  • To appreciate considerations in the optimal utilization of limited resources.
  • To submit for publication at least one paper in a peer‐reviewed ophthalmic journal during the course of the fellowship.
  • To fulfill surgical competencies as outlined in the logbook requirements.

Delivery/Teaching Method

The program will take place in one center or multiple collaborating centers so long as there is an agreement between the centers. All centers must be accredited by COECSA. Where training is conducted in two training institutions:

  • the admitting institutions assumes full responsibility for the candidates training. This will include, but not limited to verification and documentation of such training undertaken at the partner institution.
  • If during the course of the training, any of the two institutions involved in the training decides to be accredited as a standalone training centre, a consideration will be made at the end of the training cycle.


The course shall have no lectures. However, the trainer shall be required to:

·        Have 1 weekly presentation that may include:

1 diagnostics presentation

  • 1 case presentation and OR
  • 1 journal club presentation
  • The trainee shall also be required to attend and present in at least 2 Ophthalmic conferences during the training period

ADMISSION REQUIREMENTS

The call for applications shall be made by the admitting institution and COECSA. In order for a consideration to be made for admission to the VR fellowship, a trainee shall be required to present the following documents when applying for the VR fellowship course

The applicant must be a COECSA fellow or meet the following guidelines:

  • The fellowship is primarily only open to fellows (1st Priority). Fellows will be admitted at a Subsidized rate.
  • Second option is members of COECSA in good standing – These will be admitted at a Higher Fee agreed on in liaison with the Executive Committee.
  • Third option – Licensed, Qualified Ophthalmologists outside the region at a Much Higher Fee as agreed on in liaison with the executive committee

      ii.           Motivation letter and duly filled application form[KG2] .

    iii.           Must have a log of 100 or more successful phacoemulsification cataract surgeries and an equivalent log of successful small incision cataract surgeries with accompanying audit of pre and post op outcomes and complication rates.

    iv.           Must have good depth perception (Stereopsis)

      v.           Must be proficient in indirect Ophthalmoscopy.

    vi.           Must have a medical license with the relevant board in the country of training.

  vii.           Must have evidence of upkeep either through a bank statement or scholarship.

viii.           Must have health and indemnity insurance to cover the entire training duration.

    ix.           Must have a letter of commitment from the centre where he will be working to provide a VR unit, or proof of an existing VR unit that will absorb him/her upon VR fellowship training completion.

      x.           Must be proficient in English. An English proficiency certification may be required where the applicants medium of learning was not English.

    xi.           NOTE: Institutions with some candidates already in training at the time of accreditation, will be handled on a case by case basis as follows:

a.       At the accreditation stage, the training institution will submit names of candidates in training.

b.      The candidates will then be assessed against COECSA’s admission and exit criteria to ascertain if they meet the minimum requirements for a COECSA fellowship/specialist qualification.

SELECTION PROCESS

All applications shall be reviewed by a selection panel from COECSA and the defined members from the training institutions. The panel will consist of:

§  Representation from chair of the COECSA Education & Accreditation Committee,

§  2 VR Specialists from the training institution(s) and

§  COECSA Education and Training Officer (ex-officio) 

There is a veto by the two VR specialists if they both decline to approve the application.

COURSE DURATION

This training will take place for continuous minimum period of 18 months; and a maximum of 21 months in case the trainee does not meet the minimum requirements for qualification.  

TRAINING ASSESSMENT AND EVALUATION

Training evaluation forms have been developed for training assessment purposes (see appendix B: Training Evaluation Forms). Using the Evaluation forms, there will be;

a)     Monthly assessment of the trainee by the trainer which will be sent to COECSA Education Officer monthly.

b)     A final evaluation that indicates whether the candidate has qualified or not. The program director must provide a written, final evaluation for each fellow who completes the program. The evaluation must include a review of the fellow’s performance during the period of training and should verify that the fellow has demonstrated sufficient professional ability to practice competently and independently. This final evaluation should be part of the fellow’s permanent record maintained by the institution.

EXIT CRITERIA

o  Stage 1: Final Training Evaluation by the Training Institution/programme director, who will make recommendation to the COECSA subspecialty panel

o  Stage 2: Evaluation by the COECSA subspecialty selection panel, who will make recommendation to the College Senate. The panel will consist of:

1.      The COECSA Education &Accreditation Committee,

2.      Vitreo Retina Specialist, and

3.      COECSA Education and Training Officer (ex-officio).

4.      NOTE: The Vitreo Retina Specialist in the panel conducting the evaluation shall not be from the training institution.

o  Stage 3: Validation and Approval by the College Senate

FELLOWSHIP AWARD

The award and title for the participant upon completion of the program, which will be given by COECSA in conjunction with the training institution is Vitreo Retina (VR) Specialist [COECSA]

UNSUCCESSFUL TRAINEE

In the event that a trainee does not meet the minimum requirements during the training period of 18 months;

a)     There will be an extension of the training by 3 months in order to meet the requirements.

b)     In the event that after the 3 months of extension the candidates does not meet the minimum requirements, training will be discontinued and this decision will be final.

FACULTY/TRAINER QUALIFICATIONS AND RESPONSIBILITIES

Qualifications

The following are the qualifications for a faculty member or trainer/director:

a)     Must be a COECSA fellow in good standing or its equivalent[KG3] .

b)     Must have undergone COECSA Train the Trainers (TTT)

c)      Must have undergone VR Fellowship training and Must be a full time practicing VR surgeon with at least 100 unsupervised posterior segment surgeries per year.

d)     Must have a minimum of 3 years working experience as a VR surgeon.

e)     Must have a letter of reference from a COECSA recognised Vitreo- Retinal surgical trainer.

Requirements

a)     Required to possess appropriate educational qualifications, including certification in ophthalmology and VR-fellowship training.

b)     Required to have at least 3 years of clinical experience in VR following his/her fellowship training.

c)      In rare circumstances, in regions where there may not be a fellowship trained program director, a senior ophthalmologist may have 8 or more years of experience in substantial (greater than 50%) VR practice, including contribution to the literature in the way of clinical or basic research. Such a clinician may be considered an appropriate primary supervisor.

d)     Should be engaged in ongoing basic and/or clinical science research in the areas of VR, as demonstrated by regular publications in peer-reviewed journals and/or presentation of research material at national and international meetings.

e)     Required to have a clinical practice with at least 50% of patients who have VR and related disorders.

f)       Required to be licensed to practice medicine in the state or country where the institution that sponsors the program is located.

Responsibilities of the fellowship trainer/director

a)     Required to prepare a written statement outlining the educational goals of the program with respect to knowledge, skills and other attributes, and educational goals for each major rotation or other program assignments.

b)     Should promote awareness of the fellowship opportunity by providing a training vacancy description and requesting applications via a public/COECSA website.

c)      Required to develop and maintain documentation of institutional or inter-institutional agreements, the fellowship selection process, patient-care statistics, evaluations of faculty and the program, and assessment of the fellows’ performance.

d)     Required to select fellows in accordance with COECSA and institutional l policies and procedures.

e)     Required to designate and supervise the faculty through explicit descriptions of supervisory lines of responsibility.

f)       Required to ensure the implementation of fair procedures and due process regarding academic discipline and fellow complaints or grievances, as established by the sponsoring institution.

g)     Required to keep open lines of communication with their fellows and be sensitive to issues of professional and personal stress, which may interfere with the fellows’ interaction with patients and colleagues in medical and nonmedical departments. Further, the fellowship program director should be aware of issues that would interfere with the professional development of their fellows and be willing to facilitate timely provision of confidential counselling and psychological support services to fellows by professionals. Trainer should ensure that the training schedules are not producing undesirable stress on fellows. From time to time the training programme must be evaluated and modified when the need arises.

h)     Required to ensure that accurate statistical and narrative descriptions of the training program developed is maintained up to date.


Note that any change in the fellowship director position is to be communicated to the COECSA education committee within 30 days.

COURSE DESCRIPTION (SYLLABUS/MINIMUM REQUIREMENTS FOR QUALIFICATION)

For a trainee to have qualified she/he must have done the following during the fellowship:

a)     At least 3 full Scleral Buckles.

b)     Vitrectomy – Must have done the following surgeries:

  • 5 retinal detachments
  • 2 Macular hole
  • 1 ERMP
  • 1 Posterior segment foreign body
  • 1 dropped IOL 
  • 1 dropped Nucleus
  • 2 posterior segment trauma 
  • 100 PRP Laser of which 50 must be with the LIO.
  • 25 Macular Laser – Grid or sub-threshold.
  • 50 Intra-vitreal Injections-
  • 20 Posterior Subtenon injections
  •  2 Scleral fixated IOLS

INSTITUTION FACILITIES AND RESOURCES (ACCREDITATION GUIDELINES)

Generally, the following guidelines shall apply for training institutions:

a)     If training is done in a single centre, the centre must have at least 2 VR surgeons to enable the trainee gain as much exposure as possible.

b)     If this is not the case, then the trainee should rotate in 2 or 3 Centres during the training period all of which must be COECSA accredited.

(See appendix C: Detailed accreditation guidelines)

TRAINING COSTS

See appendix D: VR Fellowship Training costs

APPENDIX

Appendix A: Acknowledgement

The College of Ophthalmology of Eastern, Central & Southern Africa (COECSA) leadership wishes to acknowledge the Education & Accreditation Committee for providing leadership in the overall development of the subspecialty training curriculum.

The curriculum has been developed through a participatory and consultative environment with significant contributions and support from various individuals and institutions. I therefore wish to extend my sincere appreciation to all those that contributed to the process of developing this curriculum.

I wish to pay special tribute to Dr. Amos Kibata Githeko, the Chair of the Vitreo-Retina Curriculum Subcommittee for the significant input and commitment to this process. I also acknowledge the tremendous contributions of the members of the subcommittee, in particular I wish to thank the following:

  • Dr. Petros Kayange
  • Dr. Muchai Gachago
  • Dr. Onyango Oscar
  • Dr. Kareko Catherine
  • Dr. Shafiq Jafferji
  • Dr. Ben Roberts
  • Dr. William Makupa
  • Dr. Emeritus Chibuga
  • Dr. P T Nyaga


The College extends special gratitude to the Commonwealth Eye Health Consortium (CEHC) for providing funding through the London School of Hygiene and Tropical Medicine (LSHTM), International Centre for Eye Health (ICEH) that made this process possible. We are particularly grateful to Ms. Sally Gillespie and Dr John Buchan of LSHTM for their unrelenting support.


Last but not least, we would like to acknowledge the secretarial and logistical support of the COECSA secretariat.


Yours Sincerely,


Dr. John Nkurikiye

President - COECSA

3rd March, 2020


Appendix B: Training Evaluation Tools

VR Fellowship Evaluation Form


Name                                                                                                                                     


Program Supervisor


Ophthalmology – VR Fellowship


Report Covers Training Period: From                                 To: ____ ______________



EXPECTATIONS

Does not apply Could not evaluate Rarely meets Inconsistently meets Generally meets Sometimes exceeds Consistently exceeds
0 1 2 3 4
A.  MEDICAL EXPERTISE
a) Basic science knowledge
b) Clinical knowledge
c) History/physical exam – complete, accurate, organized
d) Clinical decision making
e) Recognition and management of emergencies
f) Technical and procedural skills
B.  COMMUNICATOR
a) Communicates effectively with patients, families
b) Communicates effectively with other health professionals
c)  Documentation timely, accurate
C.  COLLABORATOR
a) Recognizes roles of, and interacts effectively with other health professionals
b) Consults and delegates effectively
D.  MANAGER
a) Uses information technology effectively
b) Allocates finite healthcare resources wisely
c)  Manages time effectively
d) Applies quality improvement principles effectively
E.  HEALTH ADVOCATE
a) Identifies socio-economic determinants of health of patients and communities
b) Understands when and how to advocate appropriately on behalf of patients and communities
F.  SCHOLAR
a) Personal continuing education strategy  
b)    Critical appraisal
c)  Helps others learn
d) Contributes to development of new knowledge
G.  PROFESSIONAL
a) Demonstrates integrity, honesty, compassion and respect for diversity
b) Applies ethical principles appropriately
c)  Seeks and accepts advice, demonstrates awareness of personal limitations
d) Meets deadlines, is punctual/meets commitments made


COMMENTS (Including Strengths, Weaknesses and Need for Special Attention, attach additional sheet if necessary)


Strengths:


Areas to work on:


Overall comments:

Fellowship Supervisor   __________________   ____________________  ________________

                                                      Print                       Signature                           Date

Fellow

  This evaluation has been reviewed with me.           c              c

          Yes             No If no, why not? 

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

Comments:

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________


    _________________________      __________________         __________________

       Print Name (Fellow)                             Signature                                 Date


VR Fellowship Faculty Evaluation Form

Name of Faculty Member:           

Evaluation Period (provide start & end dates): 

Name of Fellow:

Informal Teaching

N/A Lowest

1

2

3

4

Highest

5

Shows me interesting patients
Discusses interesting patients and problems
Is available to supervise fellow for clinical work
Shows interest in clinical opinion of fellow
Delegates responsibility well to fellow in clinic
Provides appropriate supervision in clinic
Delegates responsibility to fellow in surgery
Provides appropriate supervision and advice during surgery

Formal Teaching

N/A Lowest

1

2

3

4

Highest

5

Is punctual and dependable  in  Conferences
Seminars are organized and logical
Invites fellow discussion and questions
Shows enthusiasm in teaching fellows
Demonstrates a keen interest in improving teaching sessions
Overall quality of seminars/teaching sessions

Interaction with Fellow

N/A Lowest

1

2

3

4

Highest

5

Offers timely feedback in an appropriate setting
Provides positive reinforcement when appropriate
Stimulates independent study/inquiry
Teaches a logical approach to problem solving
Stimulates research questions
Provides appropriate support for research project(s)
Freely admits when he/she does not know something
Offers and receives advice gracefully
Overall availability
Overall dependability
Is an effective role model for fellow

Overall Assessment

N/A Lowest

1

2

3

4

Highest

5

Overall assessment



Please specify at least three things that this teacher did well: 





Please specify what this faculty member could do differently to improve their effectiveness as a teacher: 





Any other constructive comments:





Thank you very much for taking the time to complete this form.

VR Log - Surgical Techniques

SCLERAL BUCKLE – ONLY SUCCESFUL CASES DONE ALONE OR WITH ASSISTANCE

DATE PATIENT IP NO DIAGNOSIS SUPERVISORS NAME SIGN





PORT POSTERIOR VITRECTOMY: ONLY SUCCESFUL CASES DONE ALONE OR WITH ASSISTANCE

DATE PATIENT IP NO DIAGNOSIS SUPERVISORS NAME SIGN




MACULA HOLE – ILM PEEL AND GAS: ONLY SUCCESFUL CASES DONE ALONE OR WITH ASSISTANCE

DATE PATIENT NAME& IP NO DIAGNOSIS SUPERVISORS NAME SIGN



VITRECTOMY – EPIRETINAL MEMBRANE: ONLY SUCCESFUL CASES DONE ALONE OR WITH ASSISTANCE

DATE PATIENT IP NO DIAGNOSIS SUPERVISORS NAME SIGN


VITRECTOMY – POSTERIOR SEGMENT FOREIGN BODY/IOL/DROPPED NUCLEUS : ONLY SUCCESFUL CASES DONE ALONE OR WITH ASSISTANCE

DATE PATIENT IP NO DIAGNOSIS SUPERVISORS NAME SIGN




VITRECTOMY – POSTERIOR SEGMENT TRAUMA: ONLY SUCCESFUL CASES DONE ALONE OR WITH ASSISTANCE

DATE PATIENT IP NO DIAGNOSIS SUPERVISORS NAME SIGN




VITRECTOMY – SCLERAL FIXATED IOL’S

DATE PATIENT IP NO DIAGNOSIS SUPERVISORS NAME SIGN




PAN RETINA PHOTOCOAGULATION

DATE PATIENT IP NO DIAGNOSIS LIO OR SLA SUPERVISORS NAME SIGN
1
2
3

CENTRAL / GRID PHOTOCOAGULATION

DATE PATIENT IP NO DIAGNOSIS NORMAL / MICROPULSE SUPERVISORS NAME SIGN
1
2
3

INTRA-VITREAL INJECTIONS

DATE PATIENT IP NO DIAGNOSIS DRUG SUPERVISORS NAME SIGN
1
2
3


POSTERIOR SUB-TENON INJECTIONS

DATE PATIENT IP NO DIAGNOSIS DRUG SUPERVISORS NAME SIGN
1
2
3


Fellow Exit Evaluation of Fellowship Program.

We appreciate it very much if you could please complete the following questions in order that we may be able to continuously improve the fellowship program experience in our Department.

  1. What two or three things did you feel went especially well from a logistics/process perspective?
  2. What two or three things could be improved to provide better support for future fellows?
  3. Did you receive notification of grand rounds, Journal Clubs and other academic activities?  If so did you feel that these added value to your experience?
  4. Was informal feedback provided to you by your preceptor(s) on an ongoing basis and could anything be done to improve this?
  5. Were you provided with a formal evaluation via your primary preceptor and/or subspecialty fellowship director? Did you have the opportunity to discuss the evaluation in person with this individual?
  6. How would you rate your educational experience overall? What could be done to enhance the educational experience for future fellows?
  7. Did you feel that there was a balanced distribution of learning opportunities in the clinic/OR between fellow and resident(s)?  If not, what could be done differently to improve your learning opportunities?
  8. Was the administrative support during your fellowship adequate?  If not, what could be done to provide additional support?

Appendix C: Institution Accreditation Guidelines and Form

ACCREDITATION PROCESS

The following process apply to the COECSA accreditation process:


1)     STEP 1: Application for Accreditation

·        Institution express interest for accreditation in writing to the Secretariat

·        Application/Accreditation pack will be made available which will include the Self-Assessment Form, Detailed relevant curriculum and this application form.

·        The completed file/forms must be returned to COECSA Secretariat. If COECSA does not receive the completed application pack within a month, it is assumed that there is no longer interest in continuing the process.

·        NOTE: The application will only be considered valid if the following documents have been attached:

Completed Application Form

Registration Certificate/s

Completed Self-Assessment Form

Partnership Agreement/s (where two or more institutions are collaborating)


2)     STEP 2: Desk Review

·        The application is reviewed by the College Education & Accreditation Committee

·        The applicant will then be informed of the committees findings.

·        If the preliminary findings do not meet accreditation standards, the applicant can take remedial action within months, and continue with the same application. However, if remedial action is not completed within this period, a fresh application will have to be started.

·        If preliminary findings meet the threshold for accreditation, an agreement will be reached with the applicant on the dates for site visits by the accreditation team.


3)     STEP 3: Site Evaluation Visit

·        COECSA appoints an appropriate accreditation team.

·        The Accreditation Team conducts on-site assessment

·        Evaluation report is drafted by the Chairperson of the Team

·        Report is submitted to the Education & Accreditation Committee


4)     STEP 4: Accreditation and Certification

·        Accreditation Report is submitted to the Senate by the Education & Accreditation Committee chairperson.

·        The final outcome including recommendations are communicated to the applicant

·        Unfavorable applicants can reapply for a second site visit. This reapplication must be accompanied with details of how compliance recommendations have been addressed.

·        Should the evaluation results be favorable, the institution will be granted a provisional COECSA accreditation valid for 18 months. If during its validity, no trainee is enrolled, then the accreditation process will have to be restarted.

·        The full COECSA accreditation certificate valid for 3 years, will only be granted following assessment 1 year after commencement of training.

APPLICATION FORM

APPLICATION FORM

Accreditation as COECSA Subspecialty Training Institution

Subspecialty for which this application is made: ………………………………………………….

SECTION A: Applicant Information

Legal Name
Trade Name
Type of Institution
Location
Registration Status/Number
Annual Budget
Short Description (Vision, Mission, Goals, Principles)



Postal Address
Postal Code
Physical Address
Code
Phone Number/s
Fax Number
Province/District/County


Contact Person Name
Phone Number
Cell Phone Number
Email Address
Signature/Date


SECTION B: Applicant Host Institution

Legal Name
Trade Name
Type of Institution
Location
Registration Status/Number
Short Description (Vision, Mission, Goals, Principles)



Postal Address
Postal Code
Physical Address
Code
Phone Number/s
Fax Number
Province/District/County


Contact Person Name
Phone Number
Cell Phone Number
Email Address
Signature/Date


SECTION C: Collaborating Institution/s (Where the training will be offered in two collaborating institutions, the applicant must provide details of collaborators. This must be supported by an agreement clearly outlining the roles and responsibilities of each partner institution)

Legal Name
Trade Name
Type of Institution
Location
Registration Status/Number
Short Description (Vision, Mission, Goals, Principles)


Postal Address
Postal Code
Physical Address
Code
Phone Number/s
Fax Number
Province/District/County
Contact Person Name
Phone Number
Cell Phone Number
Email Address
Signature/Date


SECTION D: Declaration by Host Institution (where the applicant is a department or section under a main institution. The purpose is to ensure that the applicant has the full support/approval of the host institution to run the training programme.)


We …………………………….. (name of host institution) hereby declare that we have approved and fully support the decision by ………………………… (name of applicant) to seek COECSA accreditation for the ………………………………… (title of supspecialty) subspecialty fellowship programme. We will provide full support during the accreditation process, and in implementing the programme thereafter.


…………………………………………..                   ……………………….             ………………………….

Name of Authorized Person                                    Signature                                Date


Thank you for your interest in partnering with COECSA.


END.


c)    DATA

Monthly data should be availed for past 6 months showing

  1. Outpatient volume
  2. Retina OPD Volume
  3. Laser volumes
  4. Intravitreal injection volumes
  5. VR Surgical volume
  6. Cataract surgical volume


This will help in assessing its adequacy as a training Centre.


d)   STAFF

o  The Centre should have at least 1 VR surgeon with 3 years’ experience.

o  The Surgeon should be a COECSA Fellow or equivalent and should preferably have attended the COECSA Training of Trainers (TOT) course.

o  The VR Surgeon will be the Director of Training.

o  If there are more than one VR surgeons, one will be selected to be the Director of Training in charge of coordinating the process and doing regular fellow evaluations as documented in the training course.

o  The VR Surgeon must also be doing at least 100 VR surgeries per year. Evidence to be obtained from theatre register.

o  If the Fellow is to rotate through one center for the entire duration of the course, the center should have at least 2 VR surgeons.

o  If a center has only one VR Surgeon, then it can participate as one of the rotations that the Fellow will go through in the course of his training for 3 – 6 months. All participating centers must be COECSA accredited.

o  Adequate support staff at the center to allow efficient use of the Fellow’s time: Optometrists, opticians, technicians, etc.


e)   FACILITIES - CLINIC

The Fellow should have a dedicated lane during his/her clinic days and the lane should have at a bare minimum:

  1. Slit lamp
  2. Indirect ophthalmoscope
  3. 90D or equivalent
  4. 20D or equivalent
  5. Seats for patient and doctor and an accompanying person
  6. Diagnostics: Topical anesthetics, dilating drops, fluorescein strips, cotton buds, spirit swabs and ROS Set.


f)     FACILITIES - LASERS

i.                   Basic

1.     Slit lamp-based laser

2.     Laser indirect ophthalmoscope

3.     Area centralis lens or equivalent

4.     Quadraspheric lens or equivalent

5.     2.2 lens or equivalent


ii.                Advanced

1.     Cyclophotocoagulation (CPC) laser

2.     YAG Laser

g)    FACILITIES -DIAGNOSTICS

i.                   Basic-mandatory

1.     Optical coherence tomography (OCT)

2.     B Scan ultrasound


ii.                Advanced-optional

1.     Fundus fluorescein angiography (FFA)

2.     Indocyanine Green Angiography (ICGA)

3.     Fundus photo

4.     Electrophysiology – VEP, ERG, mfERG, EOG

5.     OCT-Angiography


h)     FACILITIES - LIBRARY

  1. Internet access
  2. Online access to journal portals


i)     FACILITIES – SURGICAL/ THEATRE

i.                   Basic-mandatory

o  Intravitreal injection sets

  • Operating microscope suitable for vitrectomy
  • BIOM or equivalent wide-angle viewing surgical system or VR Surgery
  • Laser machine for endolaser (at least any of 532nm, 577nm or 810nm)

(Note- some vitrectomy machines are built with illumination and laser systems so this should be considered when assessing the facility)

  • Complete scleral buckling set with array of buckles/bands/sponges
  • Complete vitrectomy set + microsurgical instruments for either 20G, 23G, 25G or 27G instrumentation including cutters and all relevant tubings, light pipes, Charles’ needle, ILM forceps, serrated forceps, scissors.
  • Posterior Vitrectomy machine.
  • Intraocular tamponade agents: Gas (at least one of SF6, C2F6, C3F8), Silicone oil (at least one of 1000Cs or 5000Cs oil), Heavy liquids e.g. Decalin, PFCL.
  • Surgical dyes – Trypan blue, Brilliant blue, Infracyanine green (or Indocyanine green ICG)
  • Intravitreal drugs:

a.      Steroids: Triamcinolone, dexamethasone

b.     Anti-VEGF: At least one of Bevacizumab, ranibizumab, or aflibercept

c.      Antibiotics: At least Vancomycin, Ceftazidime and Amphotericin B

  • Anesthetic agents: At least lignocaine and bupivacaine
  • Autoclave


ii.                ADVANCED-OPTIONAL

1.     Facility for general anesthesia-mandatory

2.     Gassing facility- Plasma or ETO


j)     SELF - ASSESSMENT FORM


NAME OF INTITUTION: ……………………………………………………   

CITY: ……………………………………………………………….  COUNTRY: ………………………………..

REPORT COMPLETED BY: (Name and Signature): …………………………………………… 

TITLE: ……………………………………………………..                             DATE: ………………..

ASSESSMENT AREA/ QUALITY INDICATOR GUIDELINES/ PREFERRED PRACTICE STATUS:

A = AVAILABLE/Yes

N = NOT AVAILABLE/No

COMMENTS
Process
  • The Centre applied to COECSA for accreditation as a Vitreoretinal (VR) Surgery Training Centre in writing, via letter or email?
Institution Organization
  • Briefly describe the institution governance structure?
  • The institution sponsors residency programs in ophthalmology?
  • There is coordination of the fellowship and residency programs, so that both benefit?
  • The fellowship and residency programs are affiliated to other institutions?
  • The institution has the capacity – and appropriate infrastructure – for high quality, diverse exposure to complex cases and their management?
  • Educational activities, including didactic lectures and grand rounds, are available.
  • There is confirmation of support from the chairman and/or program director of the parent institution.
  • The institution has available work place policies (itemize).
Data Monthly data to justify the volumes at the Centre is available for the past 6 months showing:
  • Outpatient volume
  • Retina OPD Volume
  • Laser volumes
  • Intravitreal injection volumes
  • VR Surgical volume
  • Cataract surgical volume
Staff Does the center have/meet the following (indicate number)?
  • The Centre has a VR surgeon with how many years experience?.
  • The Surgeon is COECSA Fellow or equivalent and preferably has attended the COECSA Training of Trainers (TOT) course.
  • The VR Surgeon will be the Director of Training.
  • The VR Surgeon is doing how many surgeries per year. (As per theatre register).
  • Will the fellow rotate through one Centre for the entire duration of the course?
  • Adequate support staff are available at the Centre to allow efficient use of the Fellow’s time: Optometrists, opticians, technicians (List available staff)
Facilities - Clinic The Centre has (indicate number):
  • Slit lamp
  • Indirect ophthalmoscope
  • 90D or equivalent
  • 20D or equivalent
  • Seats for patient and doctor and an accompanying person
  • Diagnostics: Topical anesthetics, dilating drops, fluorescein strips, cotton buds, spirit swabs and ROS Set.
Facilities – Lasers iii.               Basic
  • Slit lamp-based laser
  • Laser indirect ophthalmoscope
  • Area centralis lens or equivalent
  • Quadraspheric lens or equivalent
  • 2.2 lens or equivalent
  • Advanced-optional
  • Cyclophotocoagulation (CPC) laser
  • YAG Laser
Facilities -Diagnostics iii.               Basic
  • Optical coherence tomography (OCT)
  • B Scan ultrasound


iv.               Advanced

o   Fundus fluorescein angiography (FFA)

o   Indocyanine Green Angiography (ICGA)

o   Fundus photo

o   Electrophysiology – VEP, ERG, mfERG, EOG

o   OCT-Angiography

Facilities - Library
  • Hard copy books of basic ophthalmology and retina texts
  • Hard copy or soft copy ophthalmology atlases.
  • Internet access
  • Online access to journal portals
Facilities – Surgical/ Theatre iii.               Basic
  • Intravitreal injection sets
  • Operating microscope suitable for vitrectomy
  • BIOM or equivalent wide-angle viewing surgical system or VR Surgery
  • Laser machine for endolaser (at least any of 532nm, 577nm or 810nm)

o   Complete scleral buckling set with array of buckles, bands, sponges

  • Complete vitrectomy set + microsurgical instruments for either 20G, 23G, 25G or 27G instrumentation including cutters and all relevant tubings, light pipes, Charles’ needle, ILM forceps, serrated forceps, scissors.
  • Intraocular tamponade agents: Gas (at least one of SF6, C2F6, C3F8), Silicone oil (at least one of 1000Cs or 5000Cs oil), Heavy liquids e.g. Decalin, PFCL.
  • Surgical dyes – Trypan blue, Brilliant blue, Infracyanine green (or Indocyanine green ICG)
  • Intravitreal drugs:

a.       Steroids: Triamcinolone, dexamethasone

b.     AntiVEGF: At least one of Bevacizumab, ranibizumab, or aflibercept

c.       Antibiotics: Vancomycin, Ceftazidime and Amphotericin B

  • Anaesthetic agents: lignocaine and bupivacaine
  • Autoclave


iv.               Advanced

o   Facility for general anaesthesia-mandatory

o   Gassing facility- Plasma or ETO

o   Endoscopic surgical facilities

o   Heads-up Ingenuity 3D surgical system

COMMENTS/ RECOMMENDATIONS BY ACCREDITOR:

name


Appendix D: VR Training Costs

Training Costs.jpg