PAEDIATRIC OPHTHALMOLOGY AND STRABISMUS - SUBSPECIALTY CURRICULUM - Revision history

Coecsa: /* Duties of the fellowship program director: */

2020-12-02T06:12:38Z

Duties of the fellowship program director:

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Coecsa: /* EXIT CRITERIA */

2020-11-18T08:03:00Z

EXIT CRITERIA

Coecsa: /* i. Program Qualifications */

2020-11-18T07:59:20Z

i. Program Qualifications

Coecsa at 07:57, 18 November 2020

2020-11-18T07:57:04Z

Coecsa at 07:52, 18 November 2020

2020-11-18T07:52:53Z

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Coecsa at 07:45, 18 November 2020

2020-11-18T07:45:35Z

Coecsa: /* SELECTION PROCESS */

2020-11-18T07:29:45Z

SELECTION PROCESS

Coecsa at 06:46, 18 November 2020

2020-11-18T06:46:50Z

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Coecsa at 13:07, 17 November 2020

2020-11-17T13:07:47Z

Coecsa at 12:57, 17 November 2020

2020-11-17T12:57:11Z

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 === EXIT CRITERIA ===
 This shall take three stages:
-o	Stage 1: Final Training Evaluation by the Training Institution, 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
+* Stage 1: Final Training Evaluation by the Training Institution, who will make recommendation to the COECSA subspecialty panel
-o	Stage 3: Validation and Approval by the College Senate
+* Stage 2: Evaluation by the COECSA subspecialty selection panel, who will make recommendation to the College Senate
 === CERTIFICATION AND TITLE OF FELLOW ===
-•	Certification will be done by COECSA in conjunction with the training institution, after the exit process has been thoroughly completed.
+Certification will be done by COECSA in conjunction with the training institution, after the exit process has been thoroughly completed.
 •	Title to be awarded after completion of the training is: Paediatrics & Strabismus Specialist (COECSA)
@@ Line 362: / Line 363: @@
 ==== Institution Organisation ====
-a.	If the Fellowship program in pediatric ophthalmology and strabismus is also in an institution that sponsor residency programs in ophthalmology, there should be coordination of the fellowship and residency programs, so that both benefit. While affiliation of the fellowship and residency programs may not be required, it is recommended. [S]
+a.If the Fellowship program in pediatric ophthalmology and strabismus is also in an institution that sponsor residency programs in ophthalmology, there should be coordination of the fellowship and residency programs, so that both benefit. While affiliation of the fellowship and residency programs may not be required, it is recommended. [S]
-b.	The institution committed to offering a pediatric ophthalmology and strabismus fellowship program should have the capacity––and appropriate infrastructure––for high quality, diverse exposure to complex pediatric ophthalmology and strabismus cases and their management. Educational activities, including didactic lectures and grand rounds, are necessary. Research activities, including presentations at meetings, are part of the pediatric ophthalmology and strabismus fellowship program and fellows are encouraged to participate in such activities. [S]
+b.The institution committed to offering a pediatric ophthalmology and strabismus fellowship program should have the capacity––and appropriate infrastructure––for high quality, diverse exposure to complex pediatric ophthalmology and strabismus cases and their management. Educational activities, including didactic lectures and grand rounds, are necessary. Research activities, including presentations at meetings, are part of the pediatric ophthalmology and strabismus fellowship program and fellows are encouraged to participate in such activities. [S]
-c.	The number of fellowship positions approved will depend on the adequacy of clinical volume, number of faculty, and other resources, as determined by the fellowship director with the support and approval of the departmental chair. [S]
+c.The number of fellowship positions approved will depend on the adequacy of clinical volume, number of faculty, and other resources, as determined by the fellowship director with the support and approval of the departmental chair. [S]
-d.	The fellowship program should receive a letter of support from the chairman and/or program director of the parent department of ophthalmology. The fellowship program, as much as possible, should complement, support, and enhance the residency program. The department chair, fellowship program director, and residency program director should work together and periodically meet to assure that the presence of the subspecialty fellowship does not unduly draw cases, learning opportunities, or funding from the residency program. [S]
+d.The fellowship program should receive a letter of support from the chairman and/or program director of the parent department of ophthalmology. The fellowship program, as much as possible, should complement, support, and enhance the residency program. The department chair, fellowship program director, and residency program director should work together and periodically meet to assure that the presence of the subspecialty fellowship does not unduly draw cases, learning opportunities, or funding from the residency program. [S]
 ==== Facilities and Resources ====
@@ Line 377: / Line 378: @@
 The following are the recommended equipment requirements for the outpatient clinic:
-i)	Direct and Indirect ophthalmoscopes
+i)Direct and Indirect ophthalmoscopes
-ii)	Lenses +20D, +90D and +75D.
+ii)Lenses +20D, +90D and +75D.
-iii)	Torch
+iii)Torch
-iv)	Tonometers; i-care, Sciotz, Tonopen, Perkins or Air puff.
+iv)Tonometers; i-care, Sciotz, Tonopen, Perkins or Air puff.
 v)	Slit lamps- Portable or stand

@@ Line 183: / Line 183: @@
 Curriculum implementation shall be through apprenticeship, tutorials, log books, Workplace based assessments and any other method deemed appropriate
-===== i. Program Qualifications =====
+===== Program Qualifications =====
 a)	The training program must be based at an institution that is accredited by COECSA for paediatric ophthalmology fellowship training. This institution shall be known as the parent institution. [M] 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.
@@ Line 196: / Line 196: @@
 e)	The fellowship program must receive approval/support confirmation from the chairman and/or program director of the parent institution. [S]
-===== ii. Program Compliance =====
+===== Program Compliance =====
 All fellowship programs must comply with the requirements listed below. [M
@@ Line 219: / Line 219: @@
 * Standards Governing the Relationship to the Medical Industry
-===== iii. Programme Characteristics =====
+===== Programme Characteristics =====
 a.	Medical liability coverage must be provided to the fellow by the program or applicant during his/her training (unless provision of such coverage is in conflict with institutional policies or local statutes). [M]
@@ Line 439: / Line 439: @@
 xiii)	B-, and A-Scan for biometry
 ===== Inpatient Facilities  =====
 There must be inpatient facilities with access to sufficient space and beds for good patient care. [M]

@@ Line 18: / Line 18: @@
 ==== Curriculum Model ====
 The Fellowship in subspecialty curriculum is a hybrid model that promotes the following curriculum tenets:
-	• Integration (horizontal & vertical)
-	• Thematic/systematic Courses
+* Integration (horizontal & vertical)
-	• Small group learning methods
+* Thematic/systematic Courses
-	• Student-centred & Student-directed Learning
+* Small group learning methods
-	• Optimum use of IT learning technologies
+* Student-centred & Student-directed Learning
-	• Primary care models (& health promotion approaches)
+* Optimum use of IT learning technologies
 ==== Curriculum Goal, Objectives and Outcomes ====

@@ Line 406: / Line 406: @@
 vii)	Laser
 iii)	Implants
@@ Line 419: / Line 418: @@
 xiii)	B-, and A-Scan for biometry
 ===== Inpatient Facilities  =====
@@ Line 427: / Line 427: @@
 (See appendix D: Detailed institution accreditation guidelines)

@@ Line 30: / Line 30: @@
 ==== Core Competences ====
 Core competencies include:
-•	Patient Care
+* Patient Care
-•	Medical Knowledge
+* Medical Knowledge
-•	Practice-based Learning and Improvement
+* Practice-based Learning and Improvement
-•	Communication Skills
+* Communication Skills
-•	Professionalism
+* Professionalism
-•	Systems-based Practice
+* Systems-based Practice
 === INTRODUCTION ===
@@ Line 59: / Line 59: @@
 Note that the curriculum guidelines have been categorised as:
-* •	(M) Must have/required
+* (M) Must have/required
-* •	(S) Should have
+* (S) Should have
-−
 === STRUCTURE OF THE PROGRAMME ===
@@ Line 224: / Line 224: @@
 === SELECTION PROCESS ===
 All applications shall be reviewed by a selection panel from COECSA and the training institutions.  The panel will consist of:
-	The COECSA Education & Accreditation Committee,
-	2 Paediatric Ophthalmology and Strabismus Specialists, and
+# The COECSA Education & Accreditation Committee,
-	COECSA Education and Training Officer (ex-officio)
+# Paediatric Ophthalmology and Strabismus Specialists, and
 === COURSE DURATION ===
-o	A minimum of 12 months (not necessarily consecutive) of clinical training is required, with vacation time and sick/personal leave at the discretion of the program director, and not exceeding two (2) weeks. Extension of the training period greater than 3 months, or an extended leave of absence, should have prior approval. A 24-month training program with 50% of the fellow’s time in fellowship training can also be considered. [M]
+A minimum of 12 months (not necessarily consecutive) of clinical training is required, with vacation time and sick/personal leave at the discretion of the program director, and not exceeding two (2) weeks. Extension of the training period greater than 3 months, or an extended leave of absence, should have prior approval. A 24-month training program with 50% of the fellow’s time in fellowship training can also be considered. [M]
-o	At least 50% (6 months) of the fellow’s time must be spent at the parent institution or at one of the hospitals or sites that are part of the parent institution. [S]
-o	If part of the 12 months of training is spent away from the parent institution, verification and documentation of such training is the responsibility of the program director. [S]
+* At least 50% (6 months) of the fellow’s time must be spent at the parent institution or at one of the hospitals or sites that are part of the parent institution. [S]
-o	Where training is conducted at two training institutions, the admitting institution 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 part of the 12 months of training is spent away from the parent institution, verification and documentation of such training is the responsibility of the program director. [S]
-o	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
+* Where training is conducted at two training institutions, the admitting institution 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.
-o	During the time of accreditation and commencement of the COECSA Subspecialty Fellowship program, there may be candidates already in training, admitted by the institution. At the accreditation stage:
+* 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 training institution will submit names of candidates in training.
+* During the time of accreditation and commencement of the COECSA Subspecialty Fellowship program, there may be candidates already in training, admitted by the institution.
--	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.
+* At the accreditation stage: The training institution will submit names of candidates in training.
 === FACULTY/TRAINER QUALIFICATIONS AND RESPONSIBILITIES ===
@@ Line 243: / Line 246: @@
 i.	Fellowship Program Director
 There must be a single program director responsible for the fellowship program. [M]
 )	Qualifications of the fellowship program director:
 a.	Required to possess appropriate educational qualifications, including certification in ophthalmology and paediatric/strabismus-fellowship training. [M]
-b.	Required to have at least 3 years of clinical experience in paediatric ophthalmology and strabismus following his/her fellowship training. [M]
+# a.	Required to possess appropriate educational qualifications, including certification in ophthalmology and paediatric/strabismus-fellowship training. [M]
-c.	Required to have undergone COECSA training of trainers’ course.
+# b.	Required to have at least 3 years of clinical experience in paediatric ophthalmology and strabismus following his/her fellowship training. [M]
-Note: In rare circumstances, in regions where there may not be a fellowship-trained program director, a senior ophthalmologist may have 10 or more years experience in substantial (greater than 50%) paediatric/strabismus practice, including contribution to the literature in the way of clinical or basic research. Such a clinician should be considered an appropriate primary supervisor.
+# c.	Required to have undergone COECSA training of trainers’ course. Note: In rare circumstances, in regions where there may not be a fellowship-trained program director, a senior ophthalmologist may have 10 or more years experience in substantial (greater than 50%) paediatric/strabismus practice, including contribution to the literature in the way of clinical or basic research. Such a clinician should be considered an appropriate primary supervisor.
-d.	Should be engaged in ongoing basic and/or clinical science research in the area of pediatrics/strabismus, as demonstrated by regular publications in peer-reviewed journals and/or presentation of research material at national and international meetings. [S]
+# d.	Should be engaged in ongoing basic and/or clinical science research in the area of pediatrics/strabismus, as demonstrated by regular publications in peer-reviewed journals and/or presentation of research material at national and international meetings. [S]
-e.	Required to have a clinical practice with at least 50% of patients who have pediatric/strabismus-related disorders. [M]
+# e.	Required to have a clinical practice with at least 50% of patients who have pediatric/strabismus-related disorders. [M]
-f.	Required to have an academic appointment on the faculty of the affiliated ophthalmology-residency program or affiliated institution. [M]
+# f.	Required to have an academic appointment on the faculty of the affiliated ophthalmology-residency program or affiliated institution. [M]
-g.	Required to be licensed to practice medicine in the state or country where the institution that sponsors the program is located. [M]
+# g.	Required to be licensed to practice medicine in the state or country where the institution that sponsors the program is located. [M]
 )	Responsibilities of the fellowship program director:
 a.	Required to design and supervise the educational experience. [M]
 b.	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. [M]
 c.	Should promote awareness of the fellowship opportunity by providing a job description and requesting applications via a public website. [S]
 d.	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. [M]
 e.	Required to select fellows in accordance with institutional and departmental policies and procedures. [M]
 f.	Required to designate and supervise the faculty through explicit descriptions of supervisory lines of responsibility for the care of patients. [M]
 g.	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. [M]
 h.	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, both medical and non-medical. 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 professional counselling and psychological support services to fellows. Training situations that consistently produce undesirable stress on fellows must be evaluated and modified. [M]
 i.	Required to ensure that accurate statistical and narrative descriptions of the program are developed and maintained. [M]
 j.	Any change in the fellowship director position is to be communicated within 90 days. [M]
 )	Duties of the fellowship program director:
 a.	Maintain an active clinical service in paediatric ophthalmology and/or strabismus at the parent institution. [M]
 b.	Periodically (at least once every 6 months) assess the fellows by means of adequate documentation and make adjustments for areas of deficiency. [M]
@@ Line 411: / Line 427: @@
 (See appendix D: Detailed institution accreditation guidelines)

@@ Line 115: / Line 115: @@
 '''c)	Surgical Requirements for Pediatric Ophthalmologist-Based Fellowship'''
 For a fellowship focused on pediatric ophthalmology, the fellow should perform at least 100 surgical procedures as primary surgeon.
@@ Line 124: / Line 122: @@
 iv.	Examinations under anesthesia do not qualify as major cases.
-ii.	Goal of the Strabismus Programme
+====Goal of the Strabismus Programme====
 The goal of the strabismus program is to train the pediatric ophthalmology fellow to accurately diagnose and treat all forms of adult and pediatric strabismus and ocular motility problems. Fellowship training in strabismus provides the fellow with the necessary knowledge and surgical skills to provide the patient with the highest quality medical and surgical care.
-a)	Strabismus Knowledge and Diagnostic Skills Goals
+'''a)	Strabismus Knowledge and Diagnostic Skills Goals'''
 i.	To describe and perform an accurate ocular motor and sensory examination––both basic and advanced––in pediatric and adult patients, including in patients who might be considered challenging (eg, uncooperative, cognitively impaired, nonverbal, preverbal). [M]
 ii.	To apply the most advanced knowledge of eye movement anatomy, neuroanatomy, and physiology to patient evaluation and surgical-decision making. [S]
 iii.	To describe clinical applications of basic and advanced sensory adaptations in strabismus patients. [S]
 iv.	To be able to recognize and treat any cause of esotropia. [M]
 v.	To be able to recognize and treat any cause of exotropia. [M]
 vi.	To be able to recognize and treat more complex strabismus patterns, such as restriction, paresis, and dissociated strabismus. [S]
 vii.	To be able to recognize and treat most complex etiologies of alphabet patterns and oblique muscle dysfunctions. [S]
 viii.	To be able to appropriately order and interpret testing such as orbital images (eg, CT and MRI) and Hess/Lancaster in the diagnosis, and medical and surgical management of the strabismus patient. [S]
 ix.	To be able to diagnose and correctly manage those strabismus patients in whom refraction management is indicated. [M]
 x.	To competently be able to perform retinoscopy in children. [M]
 xi.	To be able to perform successful Orthoptic assessments.
 b)	Surgical Requirements for Strabismus-Based Fellowships
 a.	For a fellowship focused on strabismus, it is recommended that the fellow perform at least 60 surgical procedures, of which 50 surgical procedures are strabismus procedures performed as the primary surgeon.
-b.	Being the primary surgeon means operating at least one complete muscle, under supervision.
+#a.	For a fellowship focused on strabismus, it is recommended that the fellow perform at least 60 surgical procedures, of which 50 surgical procedures are strabismus procedures performed as the primary surgeon.
-c.	A fellow cannot serve as both a primary surgeon and a first assistant for the same surgical case. Examinations under anesthesia do not qualify as major cases.
+#b.	Being the primary surgeon means operating at least one complete muscle, under supervision.
 c)	Strabismus Specific Surgical Goals
@@ Line 159: / Line 169: @@
 xii.	To assess the competency of the fellow using a measure such as the ICO-OSCARs. [S]
-=== 4.	PROGRAM DELIVERY, CHARACTERISTICS AND TEACHING METHOD ===
+===4.	PROGRAM DELIVERY, CHARACTERISTICS AND TEACHING METHOD===
 The Paediatric Ophthalmology and Strabismus Fellowship must include lectures, conferences, or informal sessions at minimum in the following subject areas. Subject areas can be adapted to reflect local disease patterns and the particular needs of patients in the local area: [M]

@@ Line 38: / Line 38: @@
 === INTRODUCTION ===
-i.	Overview of Childhood Blindness
 Childhood blindness refers to a group of diseases and conditions occurring in childhood or early adolescence, which, if left untreated, result in blindness or severe visual impairment that are likely to be untreatable later in life. Blindness in children can be defined as a visual acuity of <3/60 in the eye with better vision of a child under 16 years of age [1]. This generally means that the child cannot see something three feet (about one meter) away, that another child could see if it was 60 feet (about 20 meters) away [2].  The major causes of blindness in children vary widely from region to region, being largely determined by socioeconomic development, and the availability of primary health care and eye care services.
 It is estimated that there are about 1.4 million blind children in the world and that about one child goes blind every minute. Three-quarters of the world’s blind children live in the poorest regions of Africa and Asia.  Although there are fewer blind children than adults, the number of years lived with blindness is much higher for children. More than half of blindness in children is avoidable (either preventable or treatable); majority of the children who become blind have a lifetime of visual disability ahead of them with all the associated emotional, developmental impact onto the child’s life.
-ii.	Definition of a Paediatric Ophthalmology and Rationale
+==== Definition of a Paediatric Ophthalmology and Rationale ====
 A Paediatric Ophthalmologist is
 a.	 an ophthalmologist who has been trained on paediatric fellowship in a COECSA accredited or recognized centre, OR
@@ Line 57: / Line 58: @@
 Note that the curriculum guidelines have been categorised as:
-.	STRUCTURE OF THE PROGRAMME
+* •	(M) Must have/required
 The overall goal is that the fellows will acquire surgical skills in the common surgical procedures used in pediatric ophthalmology and strabismus
-i.	Goal of the Paediatric Ophthalmology program
+==== Goal of the Paediatric Ophthalmology program ====
 The goal of the pediatric ophthalmology program is to train the fellow to accurately diagnose and treat common and important pediatric eye diseases. Fellowship training in pediatric ophthalmology provides the fellow with the necessary knowledge and surgical skills to provide the patient with the highest quality medical and surgical care.
-a)	Subject Areas
+'''a)	Subject Areas'''
 i.	Vision development in infancy and childhood [M]
 ii.	Ophthalmic examination in children [M]
 iii.	Neonatal ophthalmology, including retinopathy of prematurity [S]
 iv.	Refraction and amblyopia management [M]
 v.	Pediatric eye diseases, including uveitis, glaucoma, cataract, retinal diseases [S]
 vi.	Pediatric ocular tumors [S]
 vii.	Ocular manifestations of systemic diseases in children [S]
 viii.	Surgery, both primary and complex [S]
 b)	Pediatric Ophthalmology Knowledge and Diagnostic Skills Goals
 i.	To perform and interpret eye examinations for children, including visual acuity tests appropriate for the child’s age and condition. [M]
 ii.	To perform refraction in children, including retinoscopy.[M]
 iii.	To identify and manage amblyopia. [M]
 iv.	To participate in diagnosis and management of retinoblastoma. [S]
 v.	To be able to recognize and treat uveitis in children. [S]
 vi.	To be able to recognize and treat glaucoma in children by surgical and nonsurgical treatment. [S]
 vii.	To be able to recognize and treat cataract and lens subluxation in children by surgical and nonsurgical treatment. [S]
 viii.	To be able to recognize and treat retinal diseases in children by nonsurgical, laser, and surgical treatment. [S]
 ix.	To be able to recognize and treat retinopathy of prematurity. [M]
 x.	To be able to recognize and treat optic neuropathies.[S]
 xi.	To able to recognize and treat nystagmus in children. [S]
 xii.	To identify ocular and nonocular manifestations of systemic diseases with ocular involvement. [S]
 c)	Surgical Requirements for Pediatric Ophthalmologist-Based Fellowship
-i.	For a fellowship focused on pediatric ophthalmology, the fellow should perform at least 100 surgical procedures as primary surgeon.
+'''c)	Surgical Requirements for Pediatric Ophthalmologist-Based Fellowship'''
 ii.	At least 80 surgical procedures should be non-strabismus procedures in pediatric ophthalmology, and at least 20 surgical procedures should be strabismus procedures as primary surgeon.
 iii.	A fellow cannot serve as both a primary surgeon and a first assistant for the same surgical case.
@@ Line 132: / Line 159: @@
 xii.	To assess the competency of the fellow using a measure such as the ICO-OSCARs. [S]
-.	PROGRAM DELIVERY, CHARACTERISTICS AND TEACHING METHOD
+=== 4.	PROGRAM DELIVERY, CHARACTERISTICS AND TEACHING METHOD ===
 The Paediatric Ophthalmology and Strabismus Fellowship must include lectures, conferences, or informal sessions at minimum in the following subject areas. Subject areas can be adapted to reflect local disease patterns and the particular needs of patients in the local area: [M]