GLAUCOMA SUBSPECIALTY CURRICULUM

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; 4th EAC Development Strategy; national eye care plans in the region, and national development plans, towards Universal Health Coverage (UHC). 

COECSA plays a critical role in the sector because of its mandate and available expertise in eye care at different levels. Its work augments what other partners are doing and provides a basis for further intervention in other areas that COECSA is not involved in.  COECSA’s products such as research, curricula, standards, quality assessments, and policy reviews provide the basis to further programmatic intervention. COECSA, therefore, places premium on partnership and collaboration because it is the synergy that is brought by working with others that produces sustainable results. This is the reason why COECSA sees itself as a catalyst for action by many actors.

COECSA’s mandate is to: Support  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 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 Fellowship in subspecialty curriculum is a hybrid model that promotes the following curriculum 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 Fellowship in subspecialty programmers provides essential intellectual and clinical information (i.e. cognitive and technical/surgical skills) that are necessary for 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

COECSA with support from the Commonwealth Eye Health Consortium (CEHC) through the LSHTM embarked on a project to roll out regional Clinical Fellowship Programmes that will provide a well- defined clinical experience in Glaucoma specialty with recognised expertise. The programme is aimed to forestall the challenge of long periods of training abroad and maximize on the available pool of resources, both human resources and infrastructure.

The Glaucoma Subspecialty Clinical Fellowship has been designed in line with the existing COECSA Curriculum as well as theICO Subspecialty Curriculum for Training in Glaucoma. This curriculum was developed to ensure it is up to date and captures all the areas required for comprehensive Glaucoma Clinical experience which includes the expected hours of coverage for key competencies. The fellowship training is generally focused on additional in-depth understanding and management of glaucoma beyond that obtained in residency training.

STRUCTURE OF THE PROGRAMME

Goal

To provide the best possible advanced training / experience for the diagnosis, medical and surgical management of glaucoma that is based in Sub Saharan Africa.

Specific Objectives

a)     To review and develop knowledge, skills and approaches relevant to etiology, pathogenesis, diagnosis, treatment, and prevention of glaucoma.

b)     To understand the classification and pathophysiology of primary open angle and angle closure glaucomas as well as various secondary glaucomas

c)      To understand the classification pathophysiology, diagnosis and management of congenital glaucoma.

d)     To review the management of co‐existing cataract and glaucoma.

e)     To develop good judgment regarding medical, laser, and surgical treatment of various complicated types of glaucoma.

f)       To understand the side effects and complications inherent in the above therapies and options and to be able to prevent and/or best manage side effects and complications.

g)     To become familiar and experienced with the use of diagnostic equipment for the diagnosis and differential diagnosis of various glaucomas.

h)     To instill a deep rooted sense of responsibility for glaucoma patients who often require lifelong follow‐up care with appropriate support services.

i)       To demonstrate the highest ethical standards when developing rapport with and engaging in treatment of glaucoma patients.

j)       To understand the value of basic, clinical, and population research in furthering the understanding of etiology, diagnosis, and the treatment of glaucoma.

k)     To participate in at least one glaucoma‐related research project and present at major regional or international ophthalmic meeting.

l)       To participate in teaching of medical students and residents

m)   To understand principles behind leadership and management roles related to the practice of glaucoma (in an academic and community practice setting). To appreciate considerations in the optimal utilization of finite resources.

n)     To submit for publication at least one paper in a peer‐reviewed ophthalmic journal during the course of the fellowship.

Duration

The clinical fellowship will take place for a minimum of 12 months. Where the course is conducted by two (2) collaborating institutions, the program is to be done in two halves of 6 months at each training institution. Extension of the training period greater than 3 months, or an extended leave of absence, should have prior approval

Admission requirements

Advertisements of the fellowship will be done by COECSA and the training institution. The advertisements MUST contain the selection criterion, a breakdown of the Fees, the living allowance for the participant, if they are selected for the course. The following are the minimum requirements for admission to the Glaucoma Fellowship:

 i.           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.           An ophthalmologist who has worked for a minimum 2 years in a busy working environment

 iii.           Must have a valid medical board registration for their country

 iv.           Must have done at least 10 Trabeculectomy in glaucoma surgery

 v.           Must have done at least 100 Small Incision Cataract Surgery (SICS)

 vi.           The applicant must obtain a letter from the head of his/her home institution that assures that there will be an enabling environment of practice upon completion of the fellowship.

 vii.           A Motivation letter from the applicant

viii.           Must pass an interview

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

• At the accreditation stage, the training institution will submit names of candidates in training.
• 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 training institutions.  The panel will consist of:

• The COECSA Education & Accreditation Committee,
• 2 Glaucoma Specialists, and
• COECSA Education and Training Officer (ex -officio).

NOTE: If the 2 specialists agree, the applicant is admitted into the program; if the 2 specialists do not agree, the applicant is not admitted into the program; if one of the specialists agrees and the other specialist does not agree, the panel will discuss the admission of that applicant.

Delivery Methods

The program will take place in Centres or multiple collaborating Centres that have been accredited by COECSA.  The actual training can take place in one (1) Centre or in multiple collaborating Centres following an agreement between the institutions. 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 program director/trainer is responsible for the structure and content of the educational program. He/she must provide a statement of objectives, methods of implementation, and procedures for assessment of the program by the faculty and the fellows, as per course description and assessments in this curriculum.

Assessment

Training evaluation forms have been developed for training assessment purposes (see appendix B: Training Evaluation Forms). The valuation will be on four levels, as follows;

a)   Program and Faculty Evaluation

The educational effectiveness of the fellowship program will be evaluated annually in a systematic manner. In particular, the quality of the curriculum and the extent to which the fellows have met the educational goals must be assessed. Teaching faculty will be evaluated on a regular basis. Faculty members who serve as clinician, scientist, and professional role models should be evaluated. Evaluation of faculty should include teaching ability, commitment, and clinical knowledge. There must be a formal mechanism by which fellows participate in this evaluation. Written evaluations by fellows, through mechanisms that promote candor and maintain confidentiality as much as possible, should be utilized in the evaluation of both the program and faculty.

b)   Fellow Evaluation

There must be regular evaluation of the fellow’s knowledge, skills, and overall performance, including the development of professional attitudes consistent with being a physician.

The program director, with the participation of members of the faculty, shall:

1. At least semi-annually evaluate the knowledge, skills, professional growth, and curriculum development for each fellow using appropriate criteria and procedures.
2. Communicate each evaluation to the fellow in a timely manner.
3. Advance fellows to positions of higher responsibility on the basis of evidence of their progressive development of knowledge, skills, and professionalism.
4. Maintain a permanent record of evaluation for each fellow and have it accessible to the fellow and other authorized personnel.
5. Keep tracking information of the former fellows’ curriculum and career development and include this information in the record of each former fellow.

c)    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

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

• Stage 2: Evaluation by the COECSA subspecialty selection panel, who will make recommendation to the College Senate.

The panel will consist of:

• The COECSA Education &Accreditation Committee,
• 2 Glaucoma Specialists, and
• COECSA Education and Training Officer (ex-officio).

NOTE: The glaucoma specialists in the panel conducting the evaluation shall not be from the training institution.

• 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 Glaucoma Specialist [COECSA]

Unsuccessful Trainee (Deferment and Training Extension)

In the event that a trainee does not meet the minimum requirements for qualification, at the end of the training period;

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 extension the candidates does not meet the above minimum requirements, training will discontinue.

FACULTY/TRAINER QUALIFICATIONS & RESPONSIBILITIES

Qualifications

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

a)     Must be a COECSA fellow or equivalent

b)     Must be a COECSA registered faculty who has completed at least 2 COECSA/RCOph Train the Trainers Courses

c)      Must be a member of the Glaucoma Community of Practice, if not a member, he/she must be approved by the CoP

d)     Any assisting faculty must be a trained glaucoma specialist approved by the community of practice

Requirements

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

b)    Required to have at least 3 years of clinical experience in glaucoma followinghis/her fellowship training.

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

d)    Required to have a clinical practice with at least 50% of patients who have glaucoma and glaucoma-related disorders.

e)    Required to have an academic appointment on the faculty of the affiliated ophthalmology-residency program or affiliated institution.

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 design and supervise the educational experience.

NOTE: Programs must be provided with the additional professional, technical, and clerical personnel needed to support the administrative and educational activities of the program.

COURSE DESCRIPTION (SYLLABUS/MINIMUM REQUIREMENTS FOR QUALIFICATION)

For a trainee to have qualified, s/he must meet the following minimum standards during the fellowship:

Clinical Components

i.  History Taking - The fellow must have in-depth knowledge to inquire about common and rare clinical conditions that may be associated with worsening disease, covering glaucomatous and non-glaucomatous causes of vision loss.

ii. Clinical Examination Skills - The fellowship must be organized to provide training that will equip the fellows to regularly perform evaluations and consultations, including history and examination, which involve the techniques of ophthalmology specific to glaucoma and related ocular and systemic conditions.

iii. Technical Clinical Examinations- The fellow should become proficient in the indications for and interpretation of results of specialized diagnostic testing appropriate to the subspecialty of glaucoma, including but not limited to the following:

• Tests of visual function, including evaluation of visual disability using standard automated perimetry and Goldmann perimetry.  
• Tests of optic nerve and retinal nerve fiber layer structure, including examination of the optic nerve, disc photography, and familiarity with optical imaging techniques, such as optical coherence tomography (OCT) and Heidelberg retinal tomography (HRT).  
• Assessment of intraocular pressure.  
• Evaluation of the anterior chamber angle with gonioscopy and available anterior segment imaging techniques such as [AS-OCT] and ultrasound biomicroscopy [UBM]).
• Assessment of other risk factors, such as corneal thickness.

 iv.  Therapeutics- The fellow must become familiar with the indications for and limitations of pharmacological, laser, and surgical therapies that may be recommended for patients with glaucoma and related conditions.

 v.  Clinical Experience- The fellow should become proficient in the diagnosis and management of glaucoma. This should be based on differential diagnostic skills development, knowledge of test indications and interpretations, in addition to individualized care based on indications and limitations of pharmacological, laser, and surgical therapies in any patient.

Didactic Components

Fellows are required to make use of the available resources for learning such as the list of books including eBooks, journals and  relevant literature on glaucoma.

Fellows should participate in clinical conferences and didactic lectures in glaucoma and related topics that are separate from patient-care activities within the parent institution, including presenting cases and lectures, and participating in grand rounds and other departmental conferences.

Fellows are expected to participate in 30 hours of such time per year.  Fellows should have basic knowledge of statistics for interpretation of published literature and conducting their own research.

Fellowship preceptors must emphasize the principles of ethical and humane treatment of patients in accordance with the Code of Ethics. Preceptors and faculty should communicate these principles in both didactic and clinical aspects of the fellowship training.

Supervision

Fellows must be appropriately supervised in patient care services by qualified faculty. The program director must ensure, direct, and document appropriate supervision of fellows. Attending physicians who supervise fellows must be available to the fellows and have sufficient experience with the severity and complexity of patient conditions. Fellows who supervise residents that treat glaucoma patients should have an attending physician readily available.

Patient interactions may be later reviewed with the fellow for appropriateness of care, including review of prepared consultation letters.

Duty Hours and Conditions of Work

Duty hours and night and weekend call for fellows must reflect the concept of responsibility for patients and provide for adequate patient care. Fellows must not be required to regularly perform excessively difficult or prolonged duties.

Scholarly Activity

The fellowship must take place in a scholarly atmosphere where resources are available that allow the fellows to participate in scholarly activities, such as research. Fellows should participate in the development of new knowledge and evaluate research findings. The responsibility for establishing and maintaining an environment of inquiry and scholarship rests with the faculty. While not all members of the faculty must be investigators, the staff as a whole must demonstrate broad involvement in scholarly activity. Faculty activity should include:

1. Active participation in clinical discussions, rounds, and conferences in a manner that promotes a spirit of inquiry and scholarship. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice.
2. Participation in journal clubs and research conferences.
3. Active participation in regional, national, or international professional and scientific societies, particularly through presentations at meetings and publications in peer-reviewed journals.
4.  Participation in research, particularly in projects that are funded following peer review and/or result in publications or presentations at regional, national, or international scientific meetings.
5. Offering of guidance and technical support (eg, research design, statistical analysis) for fellows involved in research.
6. Provision of support for fellows participation in scholarly activities.
7. Adherence to the Declaration of Helsinki on the Rights of Research Human Subjects and to the Association for Research in Vision and Ophthalmology’s Guidelines for Use of Research Animals.

Fellow Research Activities

Fellows should be exposed to opportunities to develop research skills by planning and executing at least 1 research project with set milestones. A specific block of time may be set aside for clinical or laboratory research, which may require that the fellowship be extended beyond 12 months.

Surgical and Laser Glaucoma

The fellow will be required to maintain a portfolio of the number of  type and number of laser and surgical procedures that the fellow has done during their fellowship.

A log book of the laser and surgical procedures done will be maintained by the fellow and will be submitted as part of the assessment of the fellow.

The fellow should be exposed to as broad a variety as possible of conditions falling within the scope of glaucoma. Patients seen/procedures performed must cover:

a.      Subspecialty examinations (new and follow-up patient examinations) over 12 months;

b.     Subspecialty new patient examinations over 12 months;

c.      The following subspecialty diagnostic examinations should be performed on a sufficient number of patients to allow the fellow to achieve competence in the indications, interpretation, and limitations of these diagnostic modalities:

• Computerized visual field examination
• Optic nerve and retinal nerve fiber layer imaging
• Optic disc photography, and other adjunctive studies .

d.     Subspecialty surgical procedures performed:

It is recommended that fellows perform a sufficient number of glaucoma operative procedures to achieve competence.  These are the minimum numbers based on local available resources.

Class I (Fellow as Primary Surgeon) and Class II (Fellow as First Assistant)

OPERATIVE PROCEDURES	CLASS 1	CLASS 2
Normal Cataract Phacoemulsification	10	10
Normal cataract Small Incision Cataract Surgery [SICS]	10	10
Complex cataract- Phacoemulsification	10	20
Complex cataract [SICS]	10	10
Trabeculectomy including use of antimetabolites	20	10
Combine SICS + Trabeculectomy	10	5
Phacoemulsification + Trabeculectomy	10	10
Aqueous shunts [Valved and Non-valved]	5	5
Iridotomy	10	5
Laser Suture lysis	10	5
Argon Laser or selective Laser Trabeculoplasty [ALT or SLT]	10	5
Needling of failing/ encysted filtering blebs	10	5
Repair of leaking blebs	10	5
Management of shallow anterior segment	5	2
Management of hypotony and choroidals	5	2
Laser cyclophotocoagulation	20	5
Trabeculotomy or Goniotomy for congenital glaucoma	5	5
Examination under anaesthesia for congenital glaucoma	10	5
Peripheral iridoplasty	2	2
YAG capsulotomy	10	2

APPENDIX

Appendix A: Acknowledgements

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 Prof. Dan Kiage, the Chair of the Glaucoma 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. Faith Masila
• Dr. Neema Daniel
• Dr. Sheila Marco
• Dr. Heiko Phillipin
• Dr. Mundia Dan
• Dr Phyllis Moonga
• Dr. Willard Bwalya Mumbi

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

3^rd March, 2020

Appendix B: Training Evaluation Tools and Portfolio

a)    Glaucoma Fellowship Evaluation Form

Name                                                                               Program                                                                                           Supervisor Glaucoma Subspecialty 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 EXPERT
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)

See Appendix A for more detailed evaluation on Glaucoma learning objectives

Strengths:

Areas to work on:

Overall comments:

Fellowship Supervisor   __________________   ____________________  ________________

                                                      Print                       Signature                                 Date

Fellow

  This evaluation has been reviewed with me.           cc      Yes             No

If no, why not?

_______________________________________________________________________________

_______________________________________________________________________________

Comments:

_______________________________________________________________________________

_______________________________________________________________________________

 _________________________        __________________           __________________

       Print Name (Fellow)                                    Signature                                        Date

a)    Detailed Glaucoma Fellowship Evaluation Form

Objective	Below Average	Average	Above Average	Outstanding	N/A
Objective	Rarely meets Expectations	Below Average	Average	Above Average	Outstanding
To review and develop knowledge, skills and approaches relevant to etiology, pathogenesis, diagnosis, treatment, and prevention of Glaucoma.
To understand the classification and pathophysiology of primary open angle and angle closure glaucomas as well as various secondary glaucomas.
To review the management of co-existing cataract and glaucoma.
To understand the side effects and complications inherent in the above therapies and options and to be able to prevent and/or best manage side effects and complications.
To instill a deep rooted sense of responsibility for retina patients who often require lifelong follow-up care with appropriate support services. To demonstrate the highest ethical standards when developing rapport with and engaging in treatment of retina patients.
To understand the value of basic, clinical, and population research in furthering the understanding of etiology, diagnosis, and the treatment of Glaucoma cases.  To participate in at least one Glaucomarelated research project and present at resident/fellow research days, as well as at a major international ophthalmic meeting.
To participate in teaching of medical students and residents.
To submit for publication at least one paper in a peer-reviewed ophthalmic journal during the course of the fellowship

b)   Glaucoma 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.

c)    Fellow 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.  Did you have the opportunity to participate in a research project?  If so how did this experience turn out?  Any plans for presentations/publications?

8. Was the administrative support during your fellowship adequate?  If not, what could be done to provide additional support?

LOGBOOK

NAME OF SUPERVISORS & MENTORS DURING TRAINING PERIOD:

1^st quarter:

Supervisor
Mentor
From:	To:

2^nd quarter:

Supervisor
Mentor
From:	To:

3^rd quarter:

Supervisor
Mentor
From:	To:

4^th quarter:

Supervisor
Mentor
From:	To:

1. Record of Skills Learnt During 12 Month Training Period

Item	Observed / Assisted	Under Supervision	Independent
Investigations
·       Interpretation of visual field analysis by HVFA
·       Interpretation of visual field analysis by Octopus VFA
·       Ultrasonic Pachymetry
·       Biometry
·       OCT
Clinical
·       Applanation Tonometry
·       Gonioscopy
·       Fundus evaluation by indirect Ophthalmoscope
·       Examination under anaesthesia
Surgical
·       SICS
·       Trabeculectomy
·       Trabeculectomy+SICS
·       Phaco
·       Trabeculectomy+Phaco
·       Bleb revision
·       GDD implantation
LASER (Procedures)
·       Laser PI
·       Laser Capsulotomy
·       SLT
·       ALT
·       Suturelysis
·       Iridoplasty

2. Records of Meetings/ Workshops/ Oral Papers/ Posters:

1.

Meeting/ Workshop
Title
Oral Paper/ Poster
Date:	From:                         To:

2.

Meeting/ Workshop
Title
Oral Paper/ Poster
Date:	From:                         To:

3.

Meeting/ Workshop
Title
Oral Paper/ Poster
Date:	From:                         To:

 3. Departmental/ Central Presentations

1.

Attended	Presented

                                  

Topic

Type of Presentation

Date

Remarks

2.

Attended	Presented

                                  

Topic

Type of Presentation

Date

Remarks

3.

Attended	Presented

                                  

Topic

Type of Presentation

Date

Remarks

4. Publications in Peer-review indexed journals, non-peer-review articles,    book chapters and books (during training period)

1.

                                                 

Title

Journal/Magazine/Book

Associates

Publication date/ Status

2.

                                                 

Title

Journal/Magazine/Book

Associates

Publication date/ Status

5. Research Projects and Clinical Trials (during training period)

1.  

Title
Funding Agency
Principal investigator
Associates
Progress
Outcome
Date:	From:		To:

2.

Title
Funding Agency
Principal investigator
Associates
Progress
Outcome
Date:	From:		To:

3.

Title
Funding Agency
Principal investigator
Associates
Progress
Outcome
Date:	From:		To:

Appendix D: Accreditation of Training Institution

A.     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:

ü  Completed Application Form

ü  Registration Certificate/s

ü  Completed Self-Assessment Form

ü  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.

B.     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.     ASSESSMENT GUIDELINES: INSTITUTION FACILITIES AND RESOURCES

Generally, the following guidelines shall apply for training institutions:

A.     Fellowship programs in glaucoma are often in institutions that sponsor residency programs in ophthalmology. Whenever possible, there should be coordination of the fellowship and residency programs, so that both benefit. While affiliation/accreditation of the fellowship and residency programs may not be required, it is recommended.

B.     The institution committed to offering a glaucoma fellowship program should have the capacity, and appropriate infrastructurefor high quality, diverse exposure to complex glaucoma cases and their management. Educational activities, including didactic lectures and grand rounds, are necessary. Research activities, including presentations at meetings, are part of the glaucoma fellowship program and fellows are encouraged to participate in such activities.

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.

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.

D.    INSTITUTION 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
a)     Process	The Centre applied to COECSA for accreditation as a Glaucoma Training Centre in writing?
b)    Institution Organisation	Give brief description of the institution governance structure. The institution will offer Training as a Single Training Centre/in Collaboration? 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 glaucoma cases and their management? Educational activities, including didactic lectures and grand rounds, are available? The institution shall support fellows to participate in research activities, including presentations at meetings, which are part of the Glaucoma fellowship program What is the current institution annual clinical volume? (Specify Monthly Volumes) Work place policies are available (itemize).
c)     Staff	Fellowship Program Director What are the qualifications for the program Director? How many years of clinical experience does the director have in Glaucoma following his/her fellowship training? Has undergone COECSA training of trainers’ course? Is engaged in ongoing basic and/or clinical science research in the area of Glaucoma? (Show evidence of regular publications in peer-reviewed journals and/or presentation of research material at national and international meetings). Has a clinical practice? (What percentage of patients seen annually have Glaucoma related disorders? Has an academic appointment on the faculty of the affiliated ophthalmology-residency program or affiliated institution? Is licensed to practice medicine in the state or country where the institution that sponsors the program is located? Other Program Personnel There are available additional professional, technical, and clerical personnel needed to support the administrative and educational activities of the program? (List additional personnel)
EQUIPMENT FOR GLAUCOMA SPECIALIST
d)    Equipment - Diagnostic	1. How many of the following equipment are available? a.       Slit lamp b.      Goldman Applanation Tonometer c.       Direct Ophthalmoscope d.      Lenses                                                 i.     90D lens                                               ii.     b. 60D/1x digital lens e.       Gonioscopy lens                                                 i.     Goldman 1 or 4 mirror lens                                               ii.     Sussman or Zeiss 4 mirror lens f.       Perimeters                                                 i.     Standard Automated Perimeter                                               ii.     FDT                                             iii.     Goldman Kinetic Perimeter g.       Pachymeter h.      Digital Fundus Camera i.       Teaching Scope /Screen 2. OCT 3. Perkins tonometer 4. Ultrasound Biomicroscopy [UBM] 5. B Scan
e)     Medical Treatment	o   Is there ready access to the diagnostic equipment listed above? o   Is there ready access to a full range of glaucoma medications including combination therapy? §  Blockers [egTimolol] §  Adrenergic Agonists [egBrimonidine] §  Prostaglandins [egLatanoprost] §  Oral Carbonic Anahydrase inhibitors §  Topical Carbonic Anhydrase inhibitors §  Parasympatomimetics [egPilocarpine] ü  Hyperosmotics
f)      Equipment – Surgical and laser treatment	a.       Operating Microscope with teaching scope/screen b.      Glaucoma surgery instrument sets c.       Consumables                                                 i.     Sutures                                               ii.     Ant-metabolites                                             iii.     Needles and syringes d.      Lasers                                                 i.     Argon                                               ii.     Yag                                             iii.     SLT Abrahams PI lens Glaucoma Drainage Devices Swan- Jacob lens Instruments for paediatric glaucoma surgery eg Ritch panoramic gonioprism, Worst knife for goniotomy Phaco machine
g)     Library and Internet Services	Is there ready access to a major medical library and facilities for electronic retrieval of information from medical databases?
COMMENTS/ RECOMMENDATIONS BY ACCREDITOR: