Competence in patient investigation, patient management, and community eye health , and some aspects of best practice domain is assessed using a CbD form . These forms can be completed by trainers in the following circumstances:

  • During an out-patient clinic. Trainers and trainees may wish to allocate 5-10 minutes to discuss the management of a patient seen during an out-patient clinic. Case selection would be determined by either the trainee or trainer. The trainee should have had some direct clinical role with the patient e.g. history taking, clinical examination, investigations ordered or interpreted, management decisions, management of complications, critical incidents etc.
  • At the end of an out-patient clinic. Trainers and trainees may wish to allocate some time at the end of clinic to review a small number of case notes where the trainee has had a significant role in the management of the patient.
  • Case presentations during postgraduate teaching. Trainees are often asked to present cases at local or regional postgraduate teaching sessions. A nominated trainer should complete a CbD form after the presentation.
  • During a designated teaching session. Trainers and trainees may wish to allocate a period of one-to-one teaching or small group teaching where cases are discussed and a CbD form completed.

A list of Clinical Scenarios (approximately 40) that cover most of the COECSA curriculum is provided in the study guide link. Trainees should aim to cover all these scenarios in their case based discussions if possible so that their portfolio reflects a wide range of clinical management situations.

It is recommended that about half the cases for CbD are chosen by the trainee and half by the trainer.

Trainees need to complete 10 CbDs during each year of training and these should be suitably spread throughout the year. By the end of training a trainee's portfolio should contain at least 40 CbD forms. Case based discussion is an important way to show that a trainee is developing her or his patient management skills and that (s)he is able to relate her/his knowledge and skills to everyday ophthalmic practice. It is therefore appropriate that the level of competence documented on the CbD forms during Y1 and Y2 is at a lower level that during Y3 and Y4.

Clinical Scenarios

Clinical Scenarios

As an ophthalmologist you will be expected to manage a range of clinical scenarios. This may involve referrals from other health professionals, patient self-referrals or screening for ophthalmic disease.

Below is a list of typical problems that may present to an ophthalmologist.

Symptoms

Signs

Decreased Vision

  • Transient
  • Sudden
  • Gradual
  • Painful

Diplopia

Distortion

Dry Eyes

Floaters

Headache

Night Blindness

Pain

  • Ocular
  • Periocular

Red Eye

Trauma

Visual Disturbance

Watery

Ametropia

Corneal Opacities

Conjunctival Pigmentation

Dysgenesis/Colobomata

Lens Opacities

Lid Lumps

Lid Malposition

Macular Exudation

Nystagmus

Ocular Tumours

Optic Disc Atrophy/Swelling

Proptosis

Pupil Abnormalities

Raised Intraocular Pressure

Retinal Haemorrhages

Retinal Pigmentation

Strabismus

Visual Field Defects

Visual Handicap in a Child

Vasculature abnormalities

During your training you will be expected to discuss the management of patients with seniors in the form of a Case-Based Discussion. You should ensure that during your training all these common clinical presentations have been covered in at least one case-based discussion.

In addition, these clinical scenarios may form a focus for learning. Using these commonly encountered scenarios enhances the value of on-the-job learning, increasing learning efficiency and relevancy.

Whilst learning about a patient with one of the above clinical problems you should consider which learning outcomes may be addressed. By thinking of the patient's problem in terms of the 10 learning outcome domains, you can integrate your knowledge (basic science and clinical), skills and attitudes.

The scenarios may be used in a variety of learning situations e.g. clinics, theatre, small / large group teaching, independent study.