COECSA RESIDENCY CURRICULUM

PREAMBLE

INTRODUCTION

The College of Ophthalmology of Eastern, Central and Southern Africa (COECSA) is a specialized virtual college. The college was registered in 2012 after a successful merger between the Eastern Africa College of Ophthalmologists (EACO) and the Ophthalmological Society of Eastern Africa (OSEA). The aim of this college is to address the chronic shortage of ophthalmologists in Eastern, Central and Southern Africa (ECSA) as well as improve the quality of eye care services in the region. The institution is anchored within the Vision 2020 framework developed under the aegis of the World Health Organization (WHO) and the International Agency for Prevention of Blindness (IAPB). Its establishment was informed by similar initiatives including the Medical Colleges in South Africa and the United Kingdom. However, COECSA aims to address the unique needs ECSA region based on evidence and priorities identified in the region. COECSA’s geographic focus is the ECSA region comprising Kenya, Uganda, Tanzania, Rwanda, Burundi, Malawi, Ethiopia, Zambia, South Sudan, Zimbabwe, Somalia and Mozambique. COECSA works closely with other players in  eye health and allied sectors in making interventions in the region.

Vision

Eye health for all in Eastern, Central and Southern Africa.

Mission

To improve the quality of eye care through training, research and advocacy; provide leadership in eye care; and create a forum for exchange of ophthalmic skills, knowledge and resources in Eastern, Central and Southern Africa.

Scope of COECSA’s work

COECSA’s work is derived from its mission. The College acts as the voice of the profession in the region, tasked to set the curriculum and examinations for trainee ophthalmologists, provide training in ophthalmology, set and maintain standards in the practice of ophthalmology and promote research and advance science in the specialty. COECSA is not a regulatory body and does not have a role in disciplinary actions relating to ophthalmologists. COECSA does not offer advice to patients on their individual condition or treatment options.

COECSA’s Mandate

COECSA operates within the wider environment of health in the region. However, eye health remains an obscure footnote in the health agenda. More often than not, focus on eye health is not given sufficient attention and support. COECSA and its partners wish to make better known the issues of eye health in the region. The mandate of COECSA is to:

• Contribute to the  human resources  for  health through  quality  training in ophthalmology
• Set standards for  professional  ophthalmic  practice
• Facilitate continuing professional development
• Contribute to health policy development 
• Promote research which advances ophthalmology in the region
• Create a forum for exchange of skills and knowledge

COECSA CURRICULUM

The COECSA curriculum offers regional consensus on what competences are required and what should be taught to residents. This curriculum is meant to be a guide for ophthalmology departments in designing training programs in their respective institutions. The curriculum will also act as a guide to trainees by providing a reference against which they can assess their progress. All institutions accredited to offer residency training programs shall be required to comply fully with the provisions of the College Council accreditation norms and standards.

ACKNOWLEDGEMENT

The COECSA Residency Curriculum – 2020 Version has been developed following a review of the 2017 version of the curriculum based on recommendations from an independent consultancy which was commissioned by the College. The consultancy was a review of curriculum documents, an assessment on how they can be utilised and development of additional resources that will enhance and be supplementary to the existing curriculum. The curriculum review will now be conducted every after 5 years.

The key highlights of the 2020 Version aside from the general correction of formatting errors include:

• A break of the different learning domains into detailed sub domains/competences
• Defined learning milestones for each of the sub-domain
• Assessment forms for each competence
• Description of the Exams to be administered under the curriculum and an additional learning outcome on Gonioscopy

COECSA leadership wishes to acknowledge the immediate past President Dr. Ibrahim Matende under whose leadership the COECSA curriculum work was initiated. We further acknowledge the Education and Accreditation Committee for providing leadership in the development and review of the residency curriculum.  The College acknowledges in particular the able leadership of Dr. Anna Sanyiwa (Muhimbili University of Health &Allied Sciences), Chair of the Curriculum Subcommittee (2016-2019) under which this work was made a success.

We further acknowledge the following for the immense contributions towards development of the first version of this curricula.

• Dr. Anne Ampaire Musika (from Makerere University, Uganda)
• Dr. Seneadza Asiwome
• Dr. Millicent Kariuki, Prof. Dunera Ilako and Dr. Kahaki Kimani (all of University of Nairobi, Kenya)
• Dr. John Nkurikiye and Prof. Wanjiku Mathenge (both of Rwanda International Institute of Ophthalmology)
• Dr. Levi Kandeke (Burundi)
• Dr. Gerald Msukwa and Dr. Petros Kayange (University of Malawi),
• Dr. Yeshigeta Gelaw (Jimma University, Ethiopia),
• Dr. Grace Chipalo - Mutati (University Teaching Hospital, Zambia),
• Dr. Geoffrey Wabulembo and Dr. Grace Ssali (Makerere University, Uganda),
• Dr. William Makupa (Kilimanjaro Christian Medical Centre),  
• Prof. Amos Twinamasiko and Dr John Onyango (both of Mbarara University of Science and Technology, Uganda)
• Dr.  Elias Hailu (Addis Ababa University, Ethiopia)
  

We also extend our gratitude to the team that reviewed and compiled the 2020 Version of the curriculum, for their commitment and hard work. These are:

1.      Prof. Ciku Mathenge, (Rwanda International Institute of Ophthalmology, Rwanda)

2.      Dr. John Cropsey (Kibuye Hope Hospital, Burundi)

3.      Mr. Robert Ntitima (COECSA – Education and Training)

4.      Dr. Zipporah Phiri (University Teaching Hospital, Zambia)

Special thanks also go to the Royal College of Ophthalmologists (RCOphth, UK) curriculum team comprising Dr. David Cottrell, Dr. Mike Nelson, Dr. Fiona Spencer, Prof. Carrie MacEwen, Ms. Kathy Evans, Mrs. Emily Beet, Ms. Beth Barnes, Ms. Denise Mabey and Ms. Susannah Grant for the technical input and support throughout the development process.

We further appreciate Softcall Communications for developing the online curriculum management system and for offering technical and training support.

The College extends special gratitude to Tropical Health Education Trust (THET) for providing funding through the London School of Hygiene and Tropical Medicine (LSHTM) and the International Centre for Eye Health (ICEH) that made this process possible. We are particularly grateful to Mr. Nick Astbury and Ms. Marcia Zondervan of the LSHTM for their unrelenting support.

Last but not least, we would like to acknowledge the secretarial and logistical support of the COECSA Secretariat throughout this process.

Dr. John Nkurikiye

COECSA President

Rationale

As a virtual college, COECSA works closely with accredited residency training institutions in the region to deliver ophthalmology training. This curriculum is meant to be a guide for ophthalmology departments in designing training programs in their respective institutions. Departments will be expected to structure their programs according to the system in their universities.  At present, some universities still operate on term system while others have adapted the semester system.  Also program duration varies from one institution to the other. In most residency training institutions in the region, the ophthalmology residency program (Master of Medicine in Ophthalmology) runs for three years, while in some institutions it runs for four years.  Departments will therefore be required to organize the recommended content to fit within their own time structure. The curriculum will also act as a guide to trainees by providing a reference against which they can assess their progress.

All institutions accredited to offer residency training programs shall be required to comply fully with the provisions of the College accreditation norms and standards.

PROGRAM DELIVERY

Recommended length of COECSA Residency Program

To deliver all the learning outcomes in the COECSA curriculum, it is recommended that a residency training program should be structured to be completed in a minimum period of 4 years.

ASSESSMENT TOOLS

The resident will be assessed using the assessment and feedback tools recommended in the curriculum and by the COECSA examination. The assessment and feedback tools allow each workplace based assessment to be recorded and the minimum recommended numbers are included for the relevant learning outcomes.

COECSA residency curriculum adoption by existing training programs

The institutions that are just about to commence training are recommended to use the COECSA Competency Based Curriculum as the foundation of their training course. It is suggested that:

• A presentation be made to have the COECSA Competency Based Curriculum accepted at the National Accrediting Authorities.
• Existing institutions integrate the curriculum at the earliest opportunity during the curriculum review process.
• A staff meeting / workshop be conducted to introduce the COECSA Competency Based Curriculum.
• An introductory lecture at ophthalmology meetings locally or nationally could be used to introduce the COECSA Competency Based Curriculum to a wider audience.
• All the parties involved should be encouraged to familiarize themselves with the learning outcomes and assessment / feedback tools. A workshop for making the assessment and feedback tools effective is important (see Training the Trainers).
• Issuance of a Digital Version of the COECSA Competency Based Curriculum be made to each resident so they have access to it where web access is limited.

Achievement of learning outcomes

This curriculum has 139 learning outcomes (see 2.0: learning outcomes summary table). For the different learning outcomes to be achieved, reference should be made to the 10 domains of the COECSA curriculum to establish the specified target years of achievement.

The domains describe the outcomes which the ophthalmology trainee should strive to achieve and ophthalmologists should refer to these domains throughout the process of maintaining competence. The 10 domains include Basic & Clinical Sciences, Clinical Assessment, Patient Investigation, Patient Management and Practical Skills. Others are Surgical Skills, Community Eye Health, Communication, Best Practice and Management and Leadership.

It should be noted that the various domains have some crosscutting learning outcomes; thus, there is need to pay attention to the related learning outcomes while addressing a particular learning outcome.

Learning Methods/Delivery

A combination of several methods of delivery will be used to achieve face to face apprenticeship. The methods include Lectures, Clinical Work, Clinical Teachings, Tutorials, Seminars, Conferences and Demonstrations.

It will further be implemented through teaching in Surgical Skills Laboratory and Wet Lab, Log Books, Dissertations, Self-Directed Learning, Clinical Clerkship including normal working hours and calls as well as conducting Ward Rounds. Other methods include Supervising and Teaching the Junior Medical Staff who include undergraduate Medical Students and Paramedical Trainees, carrying out Call Duties as per the Hospital Schedule as well as external Clinical Rotations with the goal to have 2 external Clinical Rotations of 8 weeks each during the 2nd and 3rd Year of the Course.

THE SUMMARY TABLE

DOMAINS	1) Basic & Clinical Sciences	2) Clinical Assessment	3) Patient Investigation	4) Patient Management	5) Practical Skills	6) Surgical   Skills	7) Community Eye Health	8) Communication	9) Best Practice	10) Management and Leadership
LEARNING  OUTCOMES	Anatomy And Embryology	Clinical History	Orthoptic Assessment	Management Plan	Refraction	Simulation And Wet Lab	Screening	Establishing Rapport	Learning	Health Service Organization
	Physiology	Assess Vision	Corneal Assessment	Triage/Prioritization	Periocular And Intraocular Drug Administration	Operating Microscope	Injury Prevention	Active Listening	Records	Clinical Governance
	Biochemistry & Cell Biology	External Eye Examination	Ultrasonography	Therapeutics/Local And Systemic Therapies	Diathermy/Cautery	Aseptic Technique	Disease Risk Reduction	Delivering Information	Guidelines	Cooperation With Other Services
	Pathology	Pupil Examination	Angiography	Patient Selection For Surgery	Cryotherapy	Cataract Surgery	Immunization And Supplementation	Directing Patients To Information	Portfolio	Role As A Leader
	Optics	Ocular Motility	Retinal And Optic Nerve Imaging	Recognize And Manage Complications	Assess Tear Film	Surgery For Raised IOP	Determining the magnitude and burden of blindness	Obtaining Consent	IT	Role As A Community/Clinical Researcher
	Clinical Ophthalmology	IOP Measurement	Radiology/ Other Imaging	Emergencies/ First Aid/Resuscitation	Assess Lacrimal Drainage	Repair Trauma	Develop Health Promotion Action Plan	Breaking Bad News	Manage Referrals	Role As A Teacher
	Clinical Pharmacology	Slit Lamp	Electrophysiology	Rehabilitation And Low Vision	Corneal Scrape	Common Lid Surgery		Barriers To Communication	Waiting List Management	Role As A Manager
	General Medicine For Ophthalmology	Fundus Examination	Laboratory Investigations	Refer Appropriately	Ocular Surface Foreign Body	Surgery For Surface Protection		Body Language	Use Of Databases	Apply Clinical Reasoning Using An Evidence Based Approach
	1) Basic & Clinical Sciences	2) Clinical Assessment	3) Patient Investigation	4) Patient Management	5) Practical Skills	6) Surgical   Skills	7) Community Eye Health	8) Communication	9) Best Practice	10) Management and Leadership
	Research Methodology, Epidemiology And Evidence Based Medicine	General Medical Examination	Biometry	Systemic Implications	Removal Of Sutures	Lateral Canthotomy/Lysis		Respond To Complaints	Critical Incident Management	Departmental Audit
	Instruments	Paediatric/ Developmental Examination	Visual Fields	Spectacle Lenses	Bandage Contact Lens	Biopsy Eyelid And Ocular Tissue		Communicate With Other Professionals	Compassionate	Personal Audit
	Statistics	Neuro Examination	Contact lens and diagnostic equipment care	Contact Lenses	Corneal Glue	Strabismus Surgery		Keeping Clinical Records	Patient Autonomy	Health Economics/Managing Resources
	Clinical Genetics	Differential Diagnosis			Forced Duction Test	Removal Of Eye		Write And Dictate Clearly	Consideration	Prepare Monitoring And Evaluation Tools Of Projects
		Gonioscopy
					Biometry	Laser - Lens Capsule		Preparing An Operating List	Patient Empathy
					Hand Hygiene	Laser - Raised IOP		Organizing Leave	Patient Confidentiality
						Laser - Retina			Insight Into Limitations
						AC/Vitreous Tap			Seeking Help
						Anterior Vitrectomy			Appraisal And 360 Degree Feedback
									Equality And Ethics
									Probity
									Practice According To National Legal Requirements
									Data Protection
									Human Tissue
									Child Protection/ Safeguarding
									Time Management
									Reflective Practice
									Self-Learning
									Uncertainty
									CPD
									Career Development
									Personal Health

COECSA DOMAINS FOR CLINICAL PRACTICE SUMMARY

COECSA has defined 10 domains for clinical ophthalmology practice. These domains describe a framework of competencies applicable to all ophthalmologists across the continuum of professional development from formal medical education and training through to maintenance of professional competence. They describe the outcomes which the ophthalmology trainee should strive to achieve and ophthalmologists should refer to these domains throughout the process of maintaining competence.

The 10 domains include:

1. Basic & Clinical Sciences          
2. Clinical Assessment    
3. Patient Investigation  
4. Patient Management  
5. Practical Skills              
6. Surgical Skills
7. Community Eye Health
8. Communication            
9. Best Practice
10. Management and Leadership

The table below summarizes the competences for the learning outcomes in their respective domains.

PLEASE NOTE that in the various domains there are some crosscutting learning outcomes, hence the need to pay attention to the related learning outcomes while addressing a particular learning outcome.  

ASSESSMENTS

Assessments Overview

Broadly speaking the learning outcomes for each domain of clinical practice are assessed as follows:

	Domain of Practice	Assessment
BCS	Basic and clinical sciences	Part 1 COECSA, Part 2 COECSA exams
CA	Clinical assessment	WpBA*rating scales, Part 2 COECSA exams
PI	Patient investigation	WpBA*rating scales, Part 2 COECSA exams
PM	Patient management	WpBA*rating scales ,Part 2 COECSA exams
PS	Practical skills	WpBA*rating scales ,Part 2 COECSA exams
SS	Surgical skills	WpBA*rating scales, Part 2 COECSA exams
CEH	Community eye health	WpBA*rating scales ,Part 2 COECSA exams
Com	Communication	WpBA*rating scales ,Part 2 COECSA exams
BP	Best practice	WpBA*rating scales
ML	Management and leadership	WpBA*rating scales

EXAMINATIONS

A.     Summative assessment in Ophthalmology residency

To qualify as an ophthalmologist under COECSA, a candidate must pass:

• ¨  Basic sciences exam ( Part1)
• ¨  Refraction and Optics (intermediate)
• ¨  Ophthalmic medicine and Ophthalmic surgery exam( Part 2)
• ¨  Clinical final exam
• ¨  (Dissertation/Publication)

B.      Exams: Part 1 (Visual/Basic Sciences & Refraction and Optics)

• ¨  COECSA Part 1: ideally done during the first year of training. In the interim period, COECSA has opted to use ICO part one for convenience. The standards of ICO exams are universally accepted and a good number of residents are already sitting it in the region.
• ¨  ICO Part 1 will be adopted as COECSA part 1 till April 2021.
• ¨  The University MMed part 1 will be accepted as equivalent till end of 2019
• ¨  In 2020, COECSA senate shall assess the value of ICO exams for COECSA, and decide whether to continue or set own?
• ¨   From March 2022, COECSA will have its own part 1 exam if a decision to go that route is taken.
• ¨  Further, COECSA Optics and refraction exam will also be the ICO exam from April 2019 until April 2022.
• ¨   COECSA will have its own exam intermediate exam (Optics) from March 2023
• ¨  MMed Optics and Refraction (if any), will be accepted as equivalent till End of December 2020

C.       Exams: Part 2 (Opth medicine and surgery)

• ¨  COECSA Ophthalmic Medicine and surgery part 2 exam will be the ICO exam from April 2021 till March 2024.
• ¨  MMed part 2 exam will be accepted as equivalent till end of 2021.
• ¨  From April 2025, COECSA will have its own part 2 exam subject to College Senate decision

D.      Clinical Final Exam

• ¨  The current COECSA Fellowship Exam will remain as the final exit Clinical Exam

Target Year of Achievement (TYA)

These are summarized as follows:

TYA	Explanation	Example
Year 1	This LO must normally be achieved during the first year of training and by the end of year 1 at the latest.	CA1 (Clinical history)
Year 2	This LO must normally be achieved during the first or second year of training and by the end of year 2 at the latest. Failure to achieve a significant number of these LO before the end of year 2 without mitigating circumstances may lead to a trainee being removed from the training programme.	BCS (Basic & Clinical Sciences)
Year 3	This LO must normally be achieved during the first three years of training and by the end of year 3 at the latest. Failure to achieve a significant number of these LO before year 3 may require year 3 to be repeated.	SS4 (Cataract) PS1 (Refraction)
Year 1,2,3/4 annual review	This LO must be achieved before the end of year 2 and will be assessed annually thereafter.	BP10-30 COM1-14
Year 3/4	This LO must be achieved in order to complete the core curriculum. It is unlikely to be achieved in the first two years of training but may be achieved anytime during years 3/4	SS5 (surgery to lower IOP)

WorkPLACE BaseD Assessments

The following WpBA assessment tools are available for Training:

Tool	Code	Number of tools	Main Learning Outcome Domains Assessed
Clinical Rating Scale (modified CEX)	CRS	8	Clinical Assessment; Practical Refraction
Case based Discussion	CbD	1	Patient Investigation; Communication; Patient Management; Best Practice; Community Eye Health; Management and Leadership; Basic and Clinical Sciences
Direct Observation of Procedural Skills	DOPS	1	Practical Skills; Communication; Patient Investigation
Objective Assessment of Surgical and Technical Skills Ophthalmology Surgical Competency Assessment Rubric	OSATS OSCAR	4	Surgical Skills; Communication
Multi-source feedback (modified PAT)	MSF	1	Communication; Best Practice

The WpBA tools are available through the website to download for completion, validation by the trainer and can be stored in a paper-based portfolio/e-portfolio (when available). Guidance is available at your institution about who should be the assessor as not all assessments need to be performed by a consultant ophthalmologist. The target year of achievement (TYA) guidance indicates when each WpBA should be achieved.

If a trainee does not complete an assessment successfully, the assessment tool will act as a useful source of feedback and allow preparation for a subsequent assessment. It therefore allows for both formative (developmental) and summative (competence) assessment. Trainees should be encouraged to undergo formative assessment regularly as part of their training and not see 'failure' at an assessment as a problem. Trainees should keep all assessment forms in their portfolio to show that they are obtaining appropriate feedback and making progress. A portfolio that only contains 'passed' assessments should be discouraged - there should be a "culture of deferred success". A variety of assessors should be used, and especially where two satisfactory assessments are required in any year these should be completed by different assessors where possible.

MILESTONES

Milestones are knowledge, skills, attitudes, and other attributes organized in a developmental framework from less to more advanced.  They are descriptors and targets for resident performance as the resident moves from entry into residency through graduation.  These milestones were adapted from the ACGME Milestones used for residency training in the USA facilitated by the International Council of Ophthalmology and Orbis International. Each of the COECSA sub-domains of performance have been mapped to the milestones. The original ACGME milestone language has been modified when necessary to reflect practice in the COECSA region and correspond to the COECSA Curriculum. 

Every six months, the level of milestones that best describes each resident’s current performance level should be selected based on appropriate assessment methods. The suggested methods are listed after each milestone.  Thus, a variety of assessment tools must be completed every 6 months. These include oral and/or written tests, multisource feedback (360 degree assessment), observed clinical evaluations (CRS, OCEX) and assessments of procedural and surgical skill (DOPS, OSATS, OSCAR). This reporting form should be reviewed with each resident individually to give feedback regarding their progress. Completion of the milestone document will show if there are specific weaknesses in individual residents and allow early detection and hopefully successful remediation.

Milestones are arranged into expectations based on progression through training and not necessary according to the year of residency.  Level 3 corresponds to the halfway point of training which will depend on the number of years of training the program has. Selection of a level implies that the resident substantially demonstrates the milestones in that level as well as those in earlier level.  (See Reporting Form diagram below.)   

Level 1: The resident demonstrates milestones expected of someone at the beginning ophthalmology residency.  

Level 2: The resident is advancing and demonstrating year 1 milestones.  

Level 3: The resident continues to advance and is demonstrating additional milestones; the resident consistently demonstrates the majority of milestones targeted for mid residency. 

Level 4: The resident has advanced so that he or she now substantially demonstrates the milestones targeted for residency.  This level is designed as the graduation target. Successfully graduating residents should be achieving this level in all areas.

Level 5: The resident has advanced beyond performance targets set for residency and is demonstrating “aspirational” goals which might describe the performance of someone who has been in practice for several years.  It is expected that only a few exceptional residents will reach this level.  

PORTFOLIO

The trainee's portfolio serves 2 important purposes for WBA:

• It contains all of the documents produced through the WBA tools described above
• It contains evidence that the trainee collects to show that they have met the remaining LO in the curriculum

The trainee should regularly maintain the portfolio and use it for the following:

• To store and organize WBA documents as they occur
• To record clinical experience (log book)
• To reflect upon clinical experience and plan learning (reflective diary)
• To record meetings with educational supervisor (appraisal documents)
• To prepare for the annual assessment (revalidation)
• To record formal and informal learning episodes (CPD document)
• To store audit/research/teaching activities
• To record any critical incidents, complaints, guidelines (clinical governance)
• Any other information that supports the trainee's Good Medical Practice e.g. letters from patients, feedback

Specific Learning Outcomes that are assessed at the annual assessment by reviewing the portfolio are:

Learning Outcome (LO)		Target Year (TYA)*	Example of possible evidence
PS1	Refraction	2	DOPS
PS13	Biometry	2	DOPS
PS14	Hand Hygiene	1	MSF
BP17	Appraisal and 360 degree feedback	2	Record of discussion, MSF,
BP19	Probity	1	Statement
BP20	Practice according to National Legal requirements	2	Record of discussion,  MSF
BP21	Data Protection	1	Record of discussion
BP22	Human Tissue	2	Record of discussion
BP23	Child Protection and safeguarding	2	Record of discussion
BP30	Personal Health	1	Statement
PS8	Ocular surface foreign body	1	DOPS forms
PS7	corneal scrape	1	DOPS forms
SS2	Operating Microscope	1	OSATS forms

QUALITY ASSURANCE

In order to ensure that trainees have undergone the same training, quality assurance (QA) tools will be demanded at the end of the training programme as part of the assessment.

APPENDIX

ThE COECSA MILESTONES

Milestone Reporting

This section presents milestones designed for programs to use in semi-annual review of resident performance. Milestones are knowledge, skills, attitudes, and other attributes organized in a developmental framework from less to more advanced.  They are descriptors and targets for resident performance as the resident moves from entry into residency through graduation.  These milestones were adapted from the ACGME Milestones used for residency training in the USA facilitated by the International Council of Ophthalmology and Orbis International. Each of the COECSA sub-domains of performance have been mapped to the milestones. The original ACGME milestone language has been modified when necessary to reflect practice in the COECSA region and correspond to the COECSA Curriculum.  

Every six months, the level of milestones that best describes each resident’s current performance level should be selected based on appropriate assessment methods. The suggested methods are listed after each milestone.  Thus, a variety of assessment tools must be completed every 6 months. These include oral and/or written tests, multisource feedback (360 degree assessment), observed clinical evaluations (CRS, OCEX) and assessments of procedural and surgical skill (DOPS, OSATS, OSCAR). This reporting form should be reviewed with each resident individually to give feedback regarding their progress. Completion of the milestone document will show if there are specific weaknesses in individual residents and allow early detection and hopefully successful remediation.

Milestones are arranged into expectations based on progression through training and not necessary according to the year of residency.  Level 3 corresponds to the halfway point of training which will depend on the number of years of training the program has. Selection of a level implies that the resident substantially demonstrates the milestones in that level as well as those in earlier level.  (See Reporting Form diagram below.)

   

Level 1: The resident demonstrates milestones expected of someone at the beginning ophthalmology residency.  

Level 2: The resident is advancing and demonstrating year 1 milestones.  

Level 3: The resident continues to advance and is demonstrating additional milestones; the resident consistently demonstrates the majority of milestones targeted for mid residency. 

Level 4: The resident has advanced so that he or she now substantially demonstrates the milestones targeted for residency.  This level is designed as the graduation target. Successfully graduating residents should be achieving this level in all areas.

Level 5: The resident has advanced beyond performance targets set for residency and is demonstrating “aspirational” goals which might describe the performance of someone who has been in practice for several years.  It is expected that only a few exceptional residents will reach this level.  

COECSA Milestones Template Description

The diagram below presents an example set of milestones for one sub-competency in the same format as the milestone report worksheet.  For each reporting period, a resident’s performance on the milestones for each sub-competency will be indicated by:

·        selecting the level of milestones that best describes the resident’s performance in relation to the milestones

Or

·        selecting the “Has not Achieved pre-residency level” option

Each COECSA curriculum Sub-domain is mapped to the appropriate milestone here

PC-1 Patient Interview COECSA CA1, CA10

Has not achieved Level 1

Level 1

Level 2

Level 3

Level 4

Level 5

NA for PC-1 Filling this box at the first assessment means the trainee has made no progress since enrolment COECSA Milestones Template Description

1.  Obtains and documents basic history for ophthalmic complaint

1. Acquires accurate and relevant problem-focused history for common ocular complaints 2. Obtains and integrates outside medical records

1. Obtains relevant historical subtleties including paediatric milestones in children that inform and prioritize both differential diagnoses and diagnostic plans, including sensitive, complicated, and detailed information that may not often be volunteered by the patient

1.  Demonstrates role model interview techniques to obtain subtle and reliable information from the patient for junior members of the healthcare team, particularly for sensitive aspects of ocular conditions

1. Incorporates new information from literature to tailor interview questions

Selecting a response box on the line in between levels indicates that milestones in lower levels have been substantially demonstrated as well as some milestones in the higher levels. Comments:

Selecting a response box in the middle of a level implies that milestones in that year and in lower levels have been substantially demonstrated.

Assessment method indicated here

COMPLETE LIST OF COECSA MILESTONES

PATIENT CARE AND PROCEDURAL SKILLS

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents must demonstrate competency in:

PC-1 Patient Interview COECSA CA1, CA10

Has not Achieved Level 1

Level 1

Level 2

Level 3

Level 4

Level 5

1.  Obtains and documents basic history for ophthalmic complaint

1. Acquires accurate and relevant problem-focused history for common ocular complaints 2. Obtains and integrates outside medical records

1. Obtains relevant historical subtleties including paediatric milestones in children that inform and prioritize both differential diagnoses and diagnostic plans, including sensitive, complicated, and detailed information that may not often be volunteered by the patient

1.  Demonstrates role model interview techniques to obtain subtle and reliable information from the patient for junior members of the healthcare team, particularly for sensitive aspects of ocular conditions

1. Incorporates new information from literature to tailor interview questions

Comments:

         Assessment Tools: Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD)

PC-2 Patient Examination COECSA CA2-11

Has not Achieved Level 1

Level 1

Level 2

Level 3

Level 4

Level 5

1.  Describes components of complete ophthalmic examination 2. Performs the basic parts of a screening or bedside eye examination without special equipment

1. Performs and documents a complete ophthalmic examination targeted to a patient’s ocular complaints and medical condition 2. Distinguishes between normal and abnormal findings

1.  Performs problem-focused exam and document pertinent positive and negative findings 2. Consistently identifies common abnormalities; may identify subtle findings

1.  Identifies subtle or uncommon findings of common entities and typical or common findings of rarer entities

1. Incorporates into clinical practice new literature about exam techniques

Comments:

Assessment Tools:  Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD)

PC-2A Vision Testing & Low Vision COECSA CA2, PM7, PM10, PM11, PS1
Level 1	Level 2	Level 3	Level 4	Level 5
1. Check visual acuity (VA) in each eye with a near card and perform confrontation visual field testing	1. Accurately measure and document VA, routine refractive errors, and color and field deficits, including Amsler grid 2. Recognize when low vision services are needed	1. Perform more difficult refractions; use retinoscopy to refine technique and diagnose 2. Ability to prescribe glasses and contact lenses appropriately 2. Describe types of low vision devices.	1. Perform complicated refractions, including post-operative; apply specialized visual tests (e.g., vertical prism test for non-organic visual loss)	1. Develop advanced techniques for measuring vision in unusual circumstances
Comments:

Assessment Tools:  Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD)

PC-2B External COECSA CA3
Level 1	Level 2	Level 3	Level 4	Level 4		Level 5
1. Describe components of external exam	1. Detect obvious abnormalities (e.g., ptosis, exophthalmos); assess 5th and 7th cranial nerve function	1. Identify less obvious abnormalities (e.g., mild ptosis, lid retraction, globe dystopia)	1. Detect or verify most subtle abnormalities; confirm presence or absence of pertinent disease-specific findings (e.g., floppy lid, subtle retropulsion resistance)		1. Develop advanced techniques for assessing external exam findings in unusual circumstances
Comments:

Assessment Tools:  Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD)

PC-2C Ocular Motility/Orthoptic Evaluation COECSA CA5, PI1, PS12
Level 1	Level 2	Level 3	Level 4	Level 5
1. Describe components of ocular motility exam; test versions and ductions	1. Accurately test and record ductions, versions, saccadic and pursuit movements; detect obvious ocular misalignment; identify nystagmus	1. Accurately measure alignment with prisms; detect less obvious misalignment; distinguish phoria and tropia, perform forced ductions	1. Detect or verify subtle motility abnormalities; classify common nystagmus patterns	1. Recognize and classify complex eye movement abnormalities at subspecialty level
Comments:

Assessment Tools:  Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD)

PC-2D Pupils COECSA CA4
Level 1	Level 2	Level 3	Level 4	Level 5
1. Describe components of pupil testing, including test for relative afferent pupillary defect (RAPD)	1. Accurately grade pupil size and reactivity; detect obvious asymmetry and RAPD	1. Detect less obvious abnormalities (e.g., mild RAPD, efferent defect, sympathetic denervation); perform and interpret pharmacologic testing	1. Detect or verify subtle abnormalities (e.g., light-near dissociation); search for associated neurologic findings; (e.g., lid or motility abnormalities)	1. Recognize and classify pupillary abnormalities at subspecialty level
Comments:

Assessment Tools:  Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD)

PC-2E Slit Lamp Biomicroscopy COECSA CA7
Level 1	Level 2	Level 3	Level 4	Level 5
1. Describe components of slit lamp exam; identify corneal abrasion	1. Identify anterior segment structures; recognize common corneal and conjunctival abnormalities, iritis	1. Recognize less obvious abnormalities (e.g., corneal edema, endothelial loss, dysplasia)	1. Detect or verify subtle abnormalities (e.g., corneal thinning); search for associated findings (e.g., orbital signs)	1. Recognize and classify anterior segment abnormalities at subspecialty level
Comments:

Assessment Tools:  Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD)

PC-2F Gonioscopy
Level 1	Level 2	Level 3	Level 4	Level 5
1. Describe purpose of gonioscopy	1.  Describe principles and indications, and properly perform basic techniques of gonioscopy 2.  Recognize normal angle structure; identify angle closure	1. Grade more questionable angles using compression and lens tilting; identify more subtle features (e.g., neovascularization, recession, synechiae)	1. Perform in technically difficult examinations; detect or verify subtle abnormalities (e.g., pigmentation, plateau iris)	1. Recognize and classify gonioscopic abnormalities at subspecialty level
Comments:

Assessment Tools:  Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD)

PC-2G Tonometry COECSA CA6
Level 1	Level 2	Level 3	Level 4	Level 5
1. Describe applanation technique of measuring intraocular pressure	1. Accurately measure intraocular pressure in routine patients using applanation		1. Combine or modify techniques in patients with abnormal corneas or limited cooperation (e.g., Tono-Pen, average Goldmann readings 90 degrees apart)	1. Develop advanced techniques for measuring intraocular pressure in unusual circumstances
Comments:

Assessment Tools:  Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD)

PC-2H Ophthalmoscopy (Direct and Indirect) COECSA CA8
Level 1	Level 2	Level 3	Level 4	Level 5
1.  Identify optic nerve using direct ophthalmoscopy 2.  Estimate optic nerve cup-disc ratio	1.  Perform slit lamp indirect ophthalmoscopy 2.  Recognize normal optic nerve and retinal appearance; detect obvious abnormalities (e.g., optic atrophy, papilledema, retinal detachment)	1.  Perform slit lamp ophthalmoscopy with the Hruby, +78, +90 lenses, 3- mirror contact lens, and trans-equator (pan- funduscopic) contact lens 2.  Detect less obvious abnormalities (e.g., early glaucomatous excavation, macular degeneration, large retinal tear) 3.  Perform indirect ophthalmoscopy and peripheral retinal examination	1. Detect or verify subtle abnormalities and unusual presentations (e.g., mild maculopathy, shallow detachment, subtle tear); perform scleral depression	1. Recognize and classify complex optic disc and retino-vitreous abnormalities at subspecialty level
Comments:

Assessment Tools:  Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD)

PC-3 Diagnostic Procedures & Instruments COECSA BCS10, PI7

Has not Achieved Level 1

Level 1

Level 2

Level 3

Level 4

Level 5

1. Describes role of office   diagnostic procedures in diagnosis of ophthalmic disease

1. Selects and/or performs appropriate routine diagnostic tests and imaging procedures based on patient’s ocular complaints and medical condition

1. Interprets routine findings.  Recognize indications for advanced diagnostic tests and imaging procedures

1.  Interprets unusual findings, identify artifacts. Employ routine and advanced diagnostic tests and imaging procedures according to evidence based medicine

1.  Selects diagnostic procedures in a cost-effective manner

Comments:

Assessment Tools:  Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD)

PC-3A Perimetry COECSA PI10

Level 1

Level 2

Level 3

Level 4

Level 5

1. Describe role of perimetric tests to quantify and categorize visual loss in damage of the visual pathway

1. Describe fundamentals of perimetry, including kinetic and static techniques; interpret perimetry in routine optic nerve and central nervous system (CNS) disorders

1. Interpret perimetry in more complex optic nerve disorders, including glaucoma, and CNS disorders, including homonymous and bitemporal defects

1. Interpret complex perimetric results, including change over time, using statistical algorithms; identify artifacts

1. Recognize and classify complex perimetric abnormalities at subspecialty level

Comments:

Assessment Tools:  Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD)

PC-3B Corneal Pachymetry and Topography COECSA PI2

Level 1

Level 2

Level 3

Level 4

Level 5

1. Describe purpose of corneal pachymetry and topography

1. Describe indications for pachymetry and tomography; interpret basic abnormalities (e.g., irregular astigmatism, corneal thinning)

1. Perform and interpret corneal topographic and pachymetric measurements, and apply these to refraction, contact lens fitting, glaucoma management

1. Perform and interpret advanced corneal topographic and pachymetric measurements, and apply these to refractive surgery

1. Recognize and classify complex pachymetry and topography abnormalities at subspecialty level

Comments:

Assessment Tools:  Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD)

PC-3C Ultrasonography & Biometry COECSA PI3, PI9, PS13

Level 1

Level 2

Level 3

Level 4

Level 5

1. Describe role of ultrasonography for diagnosis when ocular media not clear

1. Describe principles of, indications for, and techniques of ocular A- and B-scan ultrasonography

1. Perform A- and B-scan and interpret basic findings (e.g., retinal and choroidal detachment, axial length)

1. Utilize A-scan data to calculate intraocular lens (IOL) power; interpret complex A- and B-scan ultrasonography (e.g., choroidal melanoma)

1. Recognize and classify complex ultrasonographic abnormalities at subspecialty level

Comments:

Assessment Tools:  Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD)

PC-3D Optic Coherence Tomography (OCT)/Confocal Laser Tomography (CLT) COECSA PI5

Level 1

Level 2

Level 3

Level 4

Level 5

1. Describe purpose of OCT and CLT

1. Describe principles of, indications for, and techniques of OCT and CLT in analyzing retina and optic disc

1. Interpret basic OCT and CLT findings (e.g., nerve fiber layer thinning, macular edema, optic disc excavation)

1. Interpret complex findings (e.g., epiretinal membranes); identify artifacts

1. Recognize and classify complex OCT and CLT abnormalities at subspecialty level

Comments:

Assessment Tools:  Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD)

PC-3E Fluorescein Angiography COECSA PI4

Level 1

Level 2

Level 3

Level 4

Level 5

1. Describe role of fluorescein angiography in diagnosis of retinal and optic nerve disease

1. Describe principles of, indications for, and techniques of fluorescein angiography in analyzing the retina and optic disc (e.g., phases of the angiogram) 2. Interpret basic fluorescein angiography in common retinal disorders (e.g., diabetic retinopathy, cystoid macular edema)

1. Interpret fluorescein angiography in less common retinal diseases

1. Interpret fluorescein angiography in complex retinal vascular and other diseases (e.g., occult and recurrent choroidal neovascular membranes)

1. Recognize and classify complex fluorescein angiographic abnormalities at subspecialty level

Comments:

Assessment Tools:  Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD)

PC-3F Neuroimaging (CT and MRI) COECSA PI6

Level 1

Level 2

Level 3

Level 4

Level 5

1. Describe basic principles of CT and magnetic resonance (MR) imaging

1. Describe indications for neuroimaging in ophthalmology; identify major MR sequences (e.g., T1, T2, FLAIR, fat suppression)

1. Recognize normal anatomy of orbits and parasellar regions

1. Identify major abnormalities (e.g., orbital and parasellar tumor, stroke, multiple sclerosis [MS] lesions)

1. Recognize and classify complex CT & MRI abnormalities at subspecialty level

Comments:

Assessment Tools:  Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD), oral/written exams, DOPS

PC-3G Ocular Lubrication Testing COECSA PS5

Level 1

Level 2

Level 3

Level 4

Level 5

1. Describe role of office testing to identify dry eyes

1. Describe indications for and perform tests to identify dry eye syndrome and exposure keratopathy (e.g., assessment of tear film breakup time, corneal stain with fluorescein and rose bengal dyes, Schirmer test)

1. Perform diagnostic temporary punctal occlusion

1. Develop advanced techniques for quantifying ocular lubrication in unusual circumstances

Comments:

Assessment Tools:  Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD), oral/written exams, DOPS

PC-4 Disease Diagnosis COECSA BCS6, CA12, PM9, PM10

Has not Achieved pre-residency

Level 1

Level 2

Level 3

Level 4

Level 5

1. Describes basic clinical features of common ophthalmologic disorders, e.g. red eye, glaucoma, cataract, diabetic retinopathy

1.  Recalls and presents clinical facts of the history and basic eye exam without higher level of synthesis and generates at least one item of the differential diagnosis for common ophthalmologic disorders

1.  Abstracts and reorganizes elicited clinical findings 2. Prioritizes potential causes of patient complaint; compares and contrasts diagnoses under consideration, considers manifestations of systemic diseases 3. Generates more focused differential diagnosis and organized final assessment

1. Organizes clinical facts in a hierarchical level of importance.   Identify discriminating features between similar patients Incorporates most current literature findings in formulation of differential diagnosis 2. Generates focused differential and evaluation strategy to finalize diagnosis 3. Verifies diagnostic assessments of junior members of healthcare team

1 Continues to incorporate most current literature findings in formulation of differential diagnosis

Comments:

Assessment Tools:  Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD), oral/written examination

PC-5 Nonsurgical Therapy COECSA BCS7, PM1, PM2, PM3, PM6, PS10

Has not Achieved pre-residency

Level 1

Level 2

Level 3

Level 4

Level 5

1.  Describes basic concepts of ophthalmic pharmacotherapy, e.g. most common topical diagnostic and therapeutic agents 2. Ability to manage medical emergencies (e.g. allergic reaction, cardio-respiratory failure, LOC),

1.  Describes categories of medications (e.g. lubricant, antibiotic, anti-inflammatory, anesthetic); describes basic pharmacology of drug therapy and broad indications/contraindications for medical therapy of common ophthalmic conditions; describes routes of drug administration (e.g. topical, oral, periocular, and intravenous) and dosing regimens

1.  Initiates therapy with medication for common ophthalmic diseases; monitor for adverse drug reactions and interactions 2.  Describes indications for oral and intravenous therapy; recognize possible racial, gender, and genomic differences in outcomes of medical therapy 3.  Demonstrates ability to use electronic prescribing (where available); demonstrate competence in periocular injections 4. Ability to use bandage contact lenses appropriately.

1.  Manages and individualizes medical therapy for more complex ophthalmic conditions 2.  Recognizes indications for alternative therapies, including surgical intervention; integrate environmental/behavioral factors 3.  Manages complications 4.  Considers non-medical factors such as cost, convenience, ability to receive medication 5.  Demonstrates competence in intravitreal injections

1. Adopts new therapies based on CME and literature review. Identifies gaps in care and process for improvement

Comments:

           Assessment Tools:  Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD), oral/written examination/DOPS

PC-6 Minor Surgery COECSA PM1, PM2, PM4, PM5

Has not Achieved pre-residency

Level 1

Level 2

Level 3

Level 4

Level 5

1.  Describes essential components of care related to non-OR surgery, e.g., informed consent, indications and contraindications for surgery, pertinent anatomy, anaesthetic and operative technique, potential intra- and postoperative complications

For each procedure: 1.  Lists indications and describe relevant anatomy and pathophysiology of disorder 2.  Identifies findings that are indicators for the procedure and potential postop complications 3.  Describes anaesthetic & surgical technique, mechanism of effect, and specific instruments required 4.  Performs directed pre-op assessment; administers anesthesia and performs procedure with direct supervision; provides appropriate post-op care

1. Administers anaesthesia and perform procedure with indirect supervision   2.  Recognizes intra- and postoperative complications

1.  Administers anaesthesia and performs procedure with oversight supervision 2. Manages intra- and postoperative complications 3. Ability to interpret and act on results

1.  Attains individual outcome & process measures within 2 standard deviations of benchmark means

Comments:

Assessment Tools: DOPS, OSAT

PC-6A Laser Procedures COECSA SS13, SS14, SS15

Level 1

Level 2

Level 3

Level 4

Level 5

1. Describe uses of laser in ophthalmology

1.  Identify mode of tissue interaction, therapeutic effect, side effects, complications, safety issues 2.  Describe appropriate laser settings 3.  Use equipment effectively with correct contact lens, including peripheral retina, lens capsule

1. Perform glaucoma (e.g., iridotomy, trabeculoplasty) and retina (e.g., panretinal photocoagulation, laser retinopexy for isolated retinal breaks) procedures, Yag capsulotomy

1. Perform more complicated retinal procedures (e.g., diabetic focal/grid macula, repeat panretinal photocoagulation laser retinopexy of large or multiple breaks)

1. Perform laser procedures at subspecialty level

Comments:

Assessment Tools: DOPS, OSAT

PC-6B Nasolacrimal Probing and Irrigation COECSA PS6

Level 1

Level 2

Level 3

Level 4

Level 5

1. Describe purpose of nasolacrimal probing and irrigation

1. Perform basic lacrimal assessment (e.g., dye testing, punctal dilation, canalicular probing)

1. Perform basic lacrimal procedures (e.g., lacrimal drainage testing, irrigation, dye disappearance test) and lacrimal intubation

1. Perform advanced lacrimal assessment (e.g., intra- and post-operative testing, canalicular probing in trauma)

1. Perform nasolacrimal probing and irrigation in unusual circumstances at subspecialty level

Comments:

Assessment Tools: DOPS, OSAT

PC-6C Chalazion Excision, Excision/Biopsy Lid/Conjunctiva Lesion Tarsal plate rotation Corneal scrape COECSA SS10

Level 1

Level 2

Level 3

Level 4

Level 5

1. Demonstrates PC-6 Level 1 milestones for the procedures above with direct supervision

1. Demonstrates PC-6 Level 2 milestones for the procedures above with direct supervision

1. Demonstrates PC-6 Level 3 milestones for the procedures above with indirect supervision

1. Demonstrates PC-6 Level 4 milestones for the procedures above with oversight supervision

1. Demonstrates PC-6 Level 5 milestones for the procedures above with oversight supervision

Comments:

Assessment Tools: DOPS, OSAT

PC-7 OT Surgery COECSA PM4, PM5, PS3, PS4, SS1, SS2, SS3, COM5, COM6, COM13

Has not Achieved pre-residency

Level 1

Level 2

Level 3

Level 4

Level 5

1. Describes essential components of care related to OR surgery, e.g., informed consent, indications and contraindications for surgery, pertinent anatomy, anesthetic and operative technique, potential intra- and postoperative complications

For each procedure: 1. Lists indications for, procedure selection, describe relevant anatomy, instrumentation for procedures, including calibration and operation of the microscope, and necessary postoperative care 2. Identifies common intra-operative and post-operative complications and perform postoperative care managing common complications 3. Prepares and drapes for extraocular & intraocular procedures (good aseptic technique) 4. Describes methods for regional and general anesthesia 5. Performs portions of selected procedures 6. Wet lab participation

1.  Obtains informed consent and perform selected procedures 2. Identifies and manages less common intraoperative and postoperative complications 3. completion of surgical wet lab curriculum, simulation if available, and assisting rotation 4. Prepares theater list considering patient needs (oversees all pre-operative planning)

1. Obtains informed consent and perform selected procedures 2. Identifies and manages uncommon intraoperative and postoperative complications

1. Attains individual outcome & process measures within 2 standard deviations of benchmark means 2. Uses results of MOC to develop individual PI plan

Comments:

Assessment Tools: DOPS, OSATS, OSCARs, video review with rubric,

PC-7A Cataract Surgery COECSA SS4

Level 1

Level 2

Level 3

Level 4

Level 5

1. Describe indications and technique of cataract surgery

1. Perform selected portions of cataract surgery, including wound construction and microsurgical suturing

1. Perform informed consent for cataract surgery 2. Describe MSICS/ phacoemulsification instruments and  settings and how they facilitate the procedure 3. Describe categories of IOLs, advantages, and disadvantages 4. Perform cataract surgery 5. Perform post-operative care of cataract surgery patients, identify post-operative complications

1. Perform cataract surgery proficiently, including complex technical aspects 2. Describe indications and insertion techniques for premium IOLs to correct astigmatism and provide near correction Manage post-operative complications

1. Perform cataract surgery at subspecialty level

Comments:

Assessment Tools: DOPS, OSATS, OSCARs, video review with rubric,

PC-7B Strabismus Surgery COECSA SS11

Level 1

Level 2

Level 3

Level 4

Level 5

1. Describe indications for and technique of strabismus surgery

1. Perform selected portions of strabismus surgery, including extraocular muscle suturing 2. Perform post-operative care of strabismus surgery patients

1. Obtains informed consent for strabismus surgery 2. Perform horizontal strabismus surgery recession and resection 3. Manage intra- and post- operative complications of strabismus surgery

1. Perform vertical and oblique muscle strabismus surgery 2. Describe surgical considerations for re- operations in strabismus surgery

1. Perform strabismus surgery at subspecialty level

Comments:

Assessment Tools: DOPS, OSATS, OSCARs, video review with rubric,

PC-7C Cornea COECSA PS7, PS8, PS9, PS11

Level 1

Level 2

Level 3

Level 4

Level 5

1. Describe indications for and technique of cornea surgery

1. Describe concepts of corneal astigmatism/ refractive error, stromal scarring, and endothelial function, and their surgical management 2. Perform corneal foreign body removal at slit lamp

1. Obtains informed consent for common corneal surgeries 2. Perform suture removal and corneal scrape at slit lamp 3. Describe techniques of corneal patch grafting, gluing, chelation of band keratopathy, conjunctival flaps, and amniotic membrane grafting 4. Perform suturing of corneal wounds (traumatic or surgical) 5. Perform pterygium surgery

1. Perform limbal relaxing incisions or arcuate keratotomy as part of cataract surgery 2. Perform post-operative care for common keratorefractive surgeries 3. Recognize and initiate management of common post-operative complications (e.g., graft rejection)

1. Perform cornea surgery at subspecialty level

Comments:

Assessment Tools: DOPS, OSATS, OSCARs, video review with rubric

PC-7D Glaucoma COECSA SS5
Level 1	Level 2	Level 3	Level 4	Level 5
1. Describe indications for and technique of glaucoma surgery	1.  Describe indications for glaucoma surgery 2.  Describe basic steps and goals of glaucoma surgery 3.  Identify common post- operative findings	1.  Obtains informed consent for common glaucoma surgeries (e.g., trabeculectomy, tube shunt, ciliary body ablation) 2.  Assist on and perform selected portions of selected procedures 3.  Perform post-operative evaluation, and identify post-operative complications	1.  Perform common glaucoma surgeries (e.g., trabeculectomy, tube shunt, ciliary body ablation) 2.  Perform post-operative care for uncomplicated glaucoma surgery patients 3.  Manage post-operative complications for common glaucoma surgeries	1. Perform glaucoma surgery at subspecialty level

Comments:

Assessment Tools: DOPS, OSATS, OSCARs, video review with rubric

PC-7E Oculoplastic/Orbit COECSA SS6, SS7, SS8, SS9, SS12

Level 1

Level 2

Level 3

Level 4

Level 5

1. Describe indications for and technique of oculoplastic/orbit surgery

1.  Demonstrate basic lid and skin suturing techniques 2.  Close simple wounds not involving the eyelid margin 3.  Provide appropriate post- operative care for selected procedures

1.  Use functional symptoms and exam findings to generate a treatment plan for oculoplastic care 2.  Assess facial and eyelid trauma (including imaging studies) to develop a treatment plan 3.  Obtains informed consent for oculoplastic procedures 4.  Close complex wounds, including those involving the eyelid margin and evisceration

1.  Demonstrate and incorporate knowledge of facial anatomy into treatment plan 2.  Weigh alternative treatment options and describe risks and benefits of each 3.  Perform basic oculoplastics procedures (e.g., tarsal strip, blepharoplasty, ptosis repair, closure of complex wounds, canthotomy, cantholysis, enucleation) 4.  Perform simple flaps and grafts

1. Perform oculoplastic/orbit surgery at subspecialty level including exenteration

Comments:

Assessment Tools: DOPS, OSATS, OSCARs, video review with rubric,

PC-7F Retino-vitreous COECSA SS16

Level 1

Level 2

Level 3

Level 4

Level 5

1. Describe indications for and technique of retinovitreous surgery

1. Describe indications for and associated risks of intra- vitreal injections

1.  Perform intra-vitreal injections & taps 2.  Describe indications for, and techniques and complications of pars plana vitrectomy and sclera buckling surgery; assist on retinal surgery 3.  Describe indications for, and techniques and complications of radiation therapy for ocular tumors (e.g., radioactive plaque localization, external beam radiation, radiation retinopathy)

1.  Obtains informed consent for vitreoretinal surgery 2.  Perform parts of a scleral buckling surgery and/or pars plana vitrectomy for retinal detachments

1. Perform retinovitreous surgery at subspecialty level

Comments:

Assessment Tools: DOPS, OSATS, OSCARs, video review with rubric,

PC-7G Globe Trauma COECSA SS6

Level 1

Level 2

Level 3

Level 4

Level 5

1. Describe indications for and technique of globe trauma surgery

1.  Describe common setting for globe trauma and injury prevention 2.  Describe use of protective eye shield in potential globe rupture 3.  Perform examination under anesthesia for suspected globe rupture 4.  Prepare patient with suspected rupture for surgery 4.  Describe surgical steps to identify globe rupture 5.  Describe techniques and sutures for repair of ruptured globe

1.  Obtains informed consent for ruptured globe repair 2.  Perform closure of corneal or scleral wounds 3.  Manage ruptured globes post-operatively, including complications

1. Perform repair of complicated corneal and scleral wounds

1. Perform globe trauma surgery at subspecialty level

Comments:

Assessment Tools: DOPS, OSATS, OSCARs, video review with rubric,

PC-8 Consultation COECSA BP6, BP7, BP16, BP27, ML3

Level 1

Level 2

Level 3

Level 4

Level 5

Level 1

1.  Describes the role of ophthalmology consultation in systemic disease

1.  Provides specific, responsive ophthalmologic consultation to other medical specialties 2.  Recognizes urgent versus non-urgent ophthalmic consultation and seeks help when needed. 3. Examines inpatient at bedside, including visual acuity and field, portable slit lamp exam (+  fluorescein stain), IOP measurement, ophthalmoscopy 4.  Communicates findings (written and oral) to consulting service

1.  Recognizes ophthalmic emergencies and immediate, necessary interventions 2.  Provides appropriate differential diagnosis and initiate nonsurgical treatment plan 3.  Orders ancillary testing; request ophthalmic subspecialty involvement when indicated 4.  Maintains continuing communication with other  involved medical specialists

1.  Identifies consultations requiring surgical intervention, including procedural options and timing 2.  Interprets ancillary tests, formulate and initiate treatment plan independently 3. Coordinates treatment plan with multiple specialties

1.  Provides ophthalmic subspecialty consultation when indicated

Comments:

Assessment Tools: Clinical Rating Scale – consultation skills, OCEX, Case Based Discussion (CbD), oral/written exams

PC-9 Community Eye Health: Screening, Eye Injuries, Immunizations, Health Promotion COECSA CEH1, CEH2, CEH5, CEH6

Has not Achieved pre-residency

Level 1

Level 2

Level 3

Level 4

Level 5

1 understand general principles of screening and immunization

1. understand basic principles of the public health aspect of eye care.  2. describe local eye-care screening and management programs 3. understand global initiatives that effect eye care (e.g. Vision 2020).

1. participate in community screening and refer when appropriate 2 educate community about relevant diseases including eye injuries, immunizations and vitamin deficiencies

1. Apply basic principles of the public health aspect of eye care.  2. Understand how to assess burden of eye disease and define context specific strategies for control

1. organize/conduct new screening programs and surveys 2. advocate for occupational eye safety plans 3 develop eye-care health promotion action plan

Comments:

Assessment tools: written or oral tests, faculty evaluation

MEDICAL KNOWLEDGE

Residents must demonstrate knowledge of established and evolving basic science, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents must demonstrate level-appropriate knowledge in the following core domains: anatomy, physiology, biochemistry, molecular and cell biology, genetics, General Medicine; Fundamentals & Principles of Ophthalmology; Optics & Refraction; Ophthalmic Pathology & Intraocular Tumors; Neuro-Ophthalmology; Paediatric Ophthalmology & Strabismus; Orbit, Eyelids, & Lacrimal System; Cornea, External Disease, & Anterior Segment Trauma; Lens & Cataract; Refractive Management & Intervention; Intraocular Inflammation & Uveitis; Glaucoma; Retina/Vitreous

MK-1 Demonstrate level-appropriate knowledge COECSA BCS 1-5

Has not Achieved pre-residency

Level 1

Level 2

Level 3

Level 4

Level 5

1.  Has successfully completed internship after basic medical degree graduation

1. successfully passes exams of medical knowledge as required to progress through program

1. successfully passes exams of medical knowledge as required to progress through program

1. successfully passes exams of medical knowledge as required to progress through program

1. Achieves COECSA Fellowship certification.

Comments:

Assessment Tools:  Viva, written exams (semester/annual), ICO Exams, COECSA Fellowship exam

MK-2 Demonstrate level-appropriate knowledge applied to patient management COECSA BCS8, BCS12

Has not Achieved pre-residency

Level 1

Level 2

Level 3

Level 4

Level 5

1. Demonstrates level-appropriate knowledge for patient management on ophthalmology rotation

1.   Demonstrates level-appropriate knowledge for patient management for level

1.   Demonstrates level-appropriate knowledge for patient management for level

1.  Demonstrates level-appropriate knowledge for patient management on for level

1. Participates in CPD according to country requirements

Comments:

Assessment Tools:  Observed patient encounter (OCEX CCRS), Viva preferred over written, Case-Based Discussion evaluation 

MK-3 Equipment Maintenance COECSA CEH4

Has not Achieved pre-residency

Level 1

Level 2

Level 3

Level 4

Level 5

Appreciate cost and delicate nature of ophthalmic equipment

1 Able to describe parts and function of diagnostic equipment/lenses and their basic maintenance 2.Use appropriately for their level

Level appropriate use and maintenance of diagnostic equipment/lenses

1 Able to describe and teach proper diagnostic equipment use and maintenance

Works within the system to obtain most cost-efficient equipment

Comments:

Assessment tools: faculty evaluation, written/oral test

PROFESSIONALISM

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  Residents are expected to demonstrate:

PROF-1: Compassion, integrity, and respect for others; sensitivity and responsiveness to diverse patient populations COECSA BP18

Has not Achieved pre-residency

Level 1

Level 2

Level 3

Level 4

Level 5

1.  Recognizes and never participates in: verbal or physical abuse to patients, peers, staff, or supervisors; sexual harassment 2.  Recognizes and never participates in: discrimination based on gender, age, culture, race, religion, disability, sexual orientation, socioeconomic status

1.  Consistently demonstrates behaviour that conveys caring, honesty, and genuine interest in patients and families 2. Demonstrates compassion, integrity, respect, sensitivity, and responsiveness 3.  Exhibits these attitudes consistently in common and uncomplicated situations 4.  Usually recognizes cultural and socioeconomic issues in patient care

1. Exhibits these attitudes in complex and complicated situations 2.  Almost always recognizes cultural and socioeconomic issues in patient care 3. Adheres to ethical principles

1. Exhibits these attitudes consistently in all relationships and situations 2.  Consistently recognizes cultural and socioeconomic issues in patient care

1. Role models behavior demonstrating compassion and respect for others, cultural and socioeconomic issues in patient care 2. Mentors junior members of health care teams 3. Develops organizational policies and education to support the application of these principles

Comments:

             Assessment Tools: 360 degree/multisource feedback, OSCE

PROF 2: Responsiveness to patient needs that supersedes self-interest COECSA BP18, BP24, BP30

Has not Achieved pre-residency

Level 1

Level 2

Level 3

Level 4

Level 5

1. Recognizes and never participates in: refusal to perform assigned tasks, answer pages or calls; avoidance of scheduled call duty

1. Almost always completes patient care tasks promptly and completely; punctual; appropriately groomed 2.  Manages fatigue, sleep deprivation and personal health issues. 3.  Identifies impact of personal beliefs and values on practice of medicine

1.  Consistently completes patient care tasks promptly and completely; punctual; appropriately groomed 2.  Manages personal beliefs and values to avoid negative impact on patient care

1. Monitors fatigue, sleep deprivation and personal health in junior members of health care team 2. Mentors junior members of the healthcare team to manage barriers to effective patient care

1.  Role models behavior demonstrating compassion and respect for others 2.  Develops organizational policies and education to support the application of these principles

Comments:

Assessment Tools 360 degree/multisource feedback

PROF-3: Respect for patient privacy and autonomy COECSA BP14, BP18, BP21

Has not Achieved pre-residency

Level 1

Level 2

Level 3

Level 4

Level 5

1. Conforms to national patient rights regulations 2. Recognizes and never participates in: unauthorized examination of patient records disclosure of protected health information to unauthorized personnel

1. Almost always: recognizes and implements required procedures for patient involvement in human research; inform patients of rights; involve patients in medical decision-making

1. Consistently recognizes and implements required procedures for patient involvement in human research; informs patients of rights; involves patients in medical decision-making 2. Mentors junior members of the healthcare team regarding protection of patient privacy

1.  Role models behavior regarding protection of patient privacy 2.  Mentors residents involved in administration of research projects involving humans 3.  Develops organizational policies and education to support the application of these principles

Comments:

            Assessment Tools: 360 degree/multisource

 

PROF-4: Accountability to patients, society and the profession COECSA BP4, BP8, BP9, BP17, BP18, BP19, BP20, BP22, BP23

Has not Achieved pre-residency

Level 1

Level 2

Level 3

Level 4

Level 5

1. Recognizes and never participates in: deception regarding level of training and experience, medical errors; demeaning other practitioners 2. Recognizes and never participates in: plagiarism, falsification of records, misrepresentation of training, unexplained absences 3. Adheres to national legal requirements for medical practice 4. Aware of local guidelines and legislature impacting eye care (e.g. use of human tissue, child care protection)

1. Usually recognizes simple conflict of interest scenarios 2. Almost always completes medical record-keeping, reporting and critical incident tasks promptly and completely 3. Maintains up-to-date portfolio/training log-book 4. Always identifies self to patients as resident

1.  Almost always recognizes and takes appropriate steps to manage simple conflict of interest scenarios 2. Consistently completes medical record-keeping, reporting and critical incident tasks promptly and completely 3. Maintains up-to-date portfolio/training log-book 4.  Almost always recognizes limitations and request help or refer patients when appropriate 5. Knows specific ophthalmic conditions requiring use of human tissue

1. Consistently recognizes and takes appropriate steps to manage more complex conflict of interest scenarios 2. Consistently acts within limitations and seek help when appropriate 3. Maintains up-to-date portfolio/training log-book

1.  Assumes leadership and mentoring role in management of more complex conflict of interest scenarios 2.  Develops organizational policies and education to support the application of these principles

Comments:

Assessment Tools: 360 degree/multisource, oral/written exam, portfolio

INTERPERSONAL AND COMMUNICATION SKILLS

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. Residents are expected to:  

ICS-1: Communicate effectively with patients and families with diverse socioeconomic and cultural backgrounds.  1. Rapport development      3.  Counsel and educate 2. Interview skills                   4.  Conflict management COECSA COM1, COM3, COM4, COM7, COM10, COM11, COM12, BP 10, BP11, BP12, BP13

Has not Achieved Level 1

Level 1

Level 2

Level 3

Level 4

Level 5

1.  Develops positive relationship with patients in uncomplicated situations based on mutual trust; demonstrate empathy 2.  Describes factors that affect communication (e.g. modality, language, use of interpreters, other family in the room, hearing, vision, and cognitive impairments, body language) 3.  Engages in active listening, teach-back and other strategies to ensure patient understanding. 4.  Recognizes ethical and relational communication conflicts

1. Develops positive relationships with families and team members 2.  Identifies special communication needs of vulnerable populations 3.  Counsels patients compassionately at appropriate level for comprehension regarding disease: causes & mechanisms; risk factors; prognosis; management options; risks & benefits 4.  Engages patient in shared decision-making, based on the patient’s understanding and ability to carry out the proposed plan 5.  Negotiates and manages simple patient/family-related conflicts

1.  Develops working relationships in complex situations across specialties and systems of care 2.  Effectively communicates with vulnerable populations, both patients at risk and their families, orally and in writing 3.  Actively seeks information from multiple sources, including consultations. 4.  Organizes family/patient/team member conferences and facilitate/lead them. 5.  Counsels patients regarding emotionally difficult information such as blindness; use appropriate technique for "breaking bad news" 6.  Negotiates and manages conflict in complex

1.  Sustains working relationships during complex and challenging situations including transitions of care and breaking bad news. 2.  Coordinates care for vulnerable populations across health care and social/governmental systems using both oral and written communication 3.  Demonstrates effective integration of all available sources of information when gathering patient-related data 4.   Counsels patients regarding potential short and long term impact of complex, higher risk disease and intervention; address special needs; direct to resources 5.  Documents results of communications, patient preferences, conflict resolution, advance directives

1.  Sustains relationships across systems of care and with patients during long-term follow-up 2. Advocates for vulnerable populations to improve care provided through healthcare, social/community and governmental systems 3. Counsels patients regarding unusual or experimental therapies, including clinical trial participation when indicated 4. Mentors junior members of the health care team  to improve communication skills

Comments:

Assessment Tools: 360 degree/msf, OCEX, OSCE, chart review

ICS-2: Communicate effectively with physicians, other health professionals, and health related agencies 1. Comprehensive, timely, and legible medical records 2. Consultation requests 3. Care transition (Patient hand-over) 4. Conflict management (workplace) COECSA PM8, CEH3

Has not Achieved Level 1

Level 1

Level 2

Level 3

Level 4

Level 5

1. Produces comprehensive, timely, and legible non-ophthalmic medical records 2. Describes effects of computer use on accuracy of information gathering and recording, and potential disruption of the physician patient relationship 3. Describes effect of poor communication on the risk of medical error. 4. Describes importance and procedure for request of consultation. 5.  Lists steps for appropriate care transition 6.  Manages one-on-one conflicts

1. Produces comprehensive, timely, and legible ophthalmic medical records 2.  Ensures that the written record (e.g. EMR, PHR/patient portal, hand-offs, discharge summaries) are accurate and complete, with attention to preventing confusion and error. 3. Recognizes need for consultation; requests appropriate consultant with assistance 4. Performs appropriate basic ophthalmology care transition 5. Manages conflicts within peer group

1.  Maintains face-to-face patient communication while using EMR 2.  Recognizes need, identifies and requests appropriate consultant 3. Performs more complex subspecialty care transitions; ensures accurate documentation and face-to-face communication where needed 4.  Manages conflicts within department

1.  Effectively and ethically uses all forms of communication including face-to-face, telephone, electronic, and social media. 2. Coordinates multiple consultants 3. Manages complex multisystem care transitions 4. Manages conflicts with superiors and payers

1.  Develops models/approaches to managing difficult communications

Comments:

Assessment Tools: 360 degree/msf, OCEX, OSCE, chart review

ICS-3: Work effectively as a member or leader of a healthcare team or other professional group 1.  Clinical team (outpatient clinic, inpatient consult service) 2.  Operating room team 3.  Professional workgroup, e.g. QI committee COECSA ML7

Has not Achieved Level 1

Level 1

Level 2

Level 3

Level 4

Level 5

1. Defines team purpose

1.  Describes role and responsibility of each team member 2. Prepares for team role and fulfil assignments 3. Follows institutional policies

1. Implements team activities as directed by team leader 2. Identifies individual vs. group collaborative roles

1. Selects, evaluates, provides feedback, and remediates team members    2. Identifies team goals 3. Provides team assignments to achieve team goals     4. Designs and implements plan for team improvement

1.  Develops institutional and organizational strategies to improve team functions, trains physicians and educators

Comments:

Assessment Tools: 360 degree/msf, portfolio

ICS-4: Effectively present didactic and case-based educational material to physicians and other healthcare professionals COECSA ML6

Has not Achieved Level 1

Level 1

Level 2

Level 3

Level 4

Level 5

1.  Organizes clear and accurate non-ophthalmic case presentation with level-appropriate diagnostic and management recommendations

1. Organizes case presentation for basic ophthalmic conditions, with diagnostic and management recommendations 2. Presents focused literature review

1. Organizes case presentation for more complex ophthalmic conditions, with diagnostic and management recommendations 2.  Presents comprehensive literature review

1.  Schedules, organizes, and implements case-based and didactic conference program 2.  Mentors presentations

1.  Provides leadership for conference implementation

Comments:

Assessment Tools: 360 degree/msf, portfolio, faculty evaluation

PRACTICE-BASED LEARNING AND IMPROVEMENT

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. Residents are expected to develop skills and habits to be able to meet the following goals:

PBLI-1: Self-Directed Learning 1.  Identify strengths, deficiencies, and limits in one’s knowledge and expertise. 2.  Set learning and improvement goals. 3.  Identify and perform appropriate learning activities. 4.  Use information technology to optimize learning. COECSA BP1, BP2, BP3, BP5, BP15, BP15, BP25, BP26, BP28

Has not Achieved Level 1

Level 1

Level 2

Level 3

Level 4

Level 5

1.  Identifies gaps in personal knowledge and expertise 2.  Demonstrates computer literacy and basic computer skills in clinical practice

1.  Assesses performance by self-reflection and review of   feedback and evaluations 2. Develops a learning plan, based on feedback, with supervision 3.  Utilizes review articles or practice guidelines to answer specific questions in clinical practice

1. Develops learning plan independently with supervision, with accurate assessment of competence and areas for continued improvement 2. Utilizes appropriate evidence-based information tool to answer specific questions while providing care

1.  Utilizes self-directed learning with little external guidance 2.  Consistently uses evidence-based information tools to answer specific questions 3.  Utilizes system or process for keeping up with relevant changes in medicine

1.  Maintains knowledge and regular review of best evidence supporting common practices and acknowledges strengths and deficiencies 2.  Participates in CPD requirements 48 months

Comments:

Assessment Tools: portfolio, faculty evaluation

PBLI-2: Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems. COECSA BCS9, BCS11, PM1, PM2, BP1, BP2, BP3, ML5, ML8, ML9,  ML10, ML12

Has not Achieved Level 1

Level 1

Level 2

Level 3

Level 4

Level 5

1.  Describes basic concepts in clinical epidemiology, biostatistics, and clinical reasoning 2.  Categorizes study design of a research study

1.  Ranks study designs by validity, generalizability to larger populations, and identifies critical threats to study validity 2.  Distinguishes relevant research outcomes from other types of evidence 3.  Formulates a searchable question from a clinical question and use IT to investigate it 4. Participate in clinical audit

1.  Applies a set of critical appraisal criteria to different types of research, including synopses of original research findings, systematic reviews and meta-analyses, and clinical practice guidelines 2.  Critically evaluates information from others: colleagues, experts, pharmaceutical representatives, and patient-delivered information 3. Conduct & interpret clinical audit

1.  Demonstrates a clinical practice that incorporates principles and basic practices of evidence-based practice and information mastery 2. Conduct, interpret and manage junior residents in clinical audit

1.  Independently teaches and assesses evidence-based medicine and information mastery techniques 2.  Cites evidence supporting several commonly used techniques in own practice

Comments:

Assessment Tools: faculty evaluation, portfolio

PBLI-3 Research Projects/ Dissertation* ·         The COECSA Curriculum does not require a dissertation or research project. This milestone only applies to programs that require a dissertation or publication of research

Has not Achieved Level 1

Level 1

Level 2

Level 3

Level 4

Level 5

1 Be aware that a dissertation or research project is required

1.  Learn about research methods 2. Identify dissertation/ research topic

1. Dissertation/Research  proposal completed & approved by deadline set by program 2. Data collection has started

1. Completed Data collection 2. Completed & submitted dissertation/ research paper 3. Published at least 1 article 4. Presented research in a conference

1.  Continue publishing 4. Presented research in an international  conference

Comments:

Assessment: Supervisor Review, Dissertation Grade

SYSTEMS-BASED PRACTICE

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to:

SBP-1: Work effectively and coordinate patient care in various health care delivery systems COECSA BP6, ML1

Has not Achieved Level 1

Level 1

Level 2

Level 3

Level 4

Level 5

1.  Describes basic levels of systems of care (self-management to societal)

1. Describes systems of care within residency training program 2. Lists potential impediments to safe and efficient handovers of care within and between systems

1.  Identifies impediments to safe and efficient referrals within and between systems 2.  Manages routine handovers safely

1.  Proposes solutions to impediments to safe and efficient transitions of care within and between systems 2.  Manages complex handovers of care within and between systems

1.  Leads systems change at micro and macro level

Comments:

Assessment Tools: faculty evaluation, 360 degree/msf 

SBP-2: Incorporate cost-effectiveness, risk/benefit analysis, and IT to promote safe and effective patient care COECSA ML11

Has not Achieved Level 1

Level 1

Level 2

Level 3

Level 4

Level 5

1.  Describes scenarios in which physician may affect cost-effectiveness in patient care 2.  Explains the role of the Electronic Health Record (EHR) in prevention of medical errors

1.  Describes cost-effectiveness in patient care 2.  Aware of cost options for most frequently ordered tests and medications 3.  Utilizes where available the Electronic Health Record (EHR) to order tests and medications, document notes; 3.  Demonstrate medication reconciliation for patients 4. Uses information systems for patient care

1.  Almost always practices cost-effective care

1.  Consistently practices cost-effective care 2.  Applies risk-benefit analyses in ophthalmic care 3.  Contributes to reduction of risks of automation and computerized systems by reporting system problems

1.  Advocates for cost-effective care and use of risk-benefit analyses within health care system 2.  Recommends systems re-design for faulty computerized processes

Comments:

Assessment Tools: faculty evaluation

SBP-3: Work in inter-professional teams to enhance patient safety, identify system errors and implement solutions COECSA ML2, ML4,

Has not Achieved Level 1

Level 1

Level 2

Level 3

Level 4

Level 5

1.  Describes epidemiology of medical errors and differences between medical errors, near misses, and sentinel events 2.  Describes role of teamwork and communication failure in healthcare as a leading cause of preventable patient harm

1.  Reports problematic processes including errors and near misses to supervisor 2.  Describes use of checklists and briefings to prevent adverse events in healthcare

1.  Analyses causes of adverse events through root cause analysis (RCA) 2.  Applies checklist-guided briefings in healthcare activities 3. Can function as the leader of the team when called upon.

1.  Develops content for and facilitate patient safety M&M presentation or conference focusing on systems-based errors in patient care 2.  Analyses shared team experience (e.g. procedure) with debriefing to solve problems 3. Can function as the leader of the team when called upon.

1.  Designs checklists for use in healthcare 2.  Creates curriculum to teach teamwork and communication skills to healthcare professionals

Comments:

Assessment Tools: faculty evaluation

WORKPLACE BASED ASSESSMENTS

Clinical Rating Scale

CRS	Learning Outcome		Target Year (TYA)#	Assessor*
CRS1	CA1	Consultation	1 annual review	Cons
CRS2	CA2	Vision	1	Cons/AHP
CRS3	CA3	Fields	1	Cons
CRS4	CA4	External eye	1	Cons
CRS5	CA5	Pupil	1	Cons
CRS6	CA6	Ocular motility	2	Cons
CRS7	CA7	IOP	1	Cons/AHP
CRS8	CA8	Slit lamp	1	Cons
CRS9a, CRS9b CRS9c,  CRS9d	CA9	Fundus	2	Cons
CRSret	PS2	Retinoscopy (Paed)	3	Cons/Optometrist

* Assessors:

• Cons: consultant ophthalmologist
• AHP: appropriately trained allied health professional (nurse, orthoptist, optometrist)

Clinical Rating Scale CRS1 (Outcome CA1: CLINICAL HISTORY)

COECSA Workplace Based Assessments

Clinical Rating Scale CRS1      (Outcome CA1-Clinical History)

All trainees must be able to take a clinical history from a patient, which is appropriate for the clinical problem and the individual patient’s needs.

Trainee’s Name                                                                                                                                                                       Date (dd/mm/yyyy)          

YEAR 1                                       YEAR 2                           YEAR 3                    YEAR 4          Other (specify)

Assessor's name                                                                                          Type of assessment:  Formative        Summative                                                              

Assessor's status           Consultant                       Senior Trainee              Other (Specify)

Brief description of case                                       

Please grade the following areas using the scale below (use tick or cross)

Attitude and manner
V good trainees introduce themselves and establish the name of the patient and any other attendant (e.g. spouse, parent, carer). Their demeanour throughout the interview shows that they are actively listening to the patient by gestures, words of encouragement and appropriate eye contact. They establish a good rapport with the patient which is respectful of any ethnic, religious or social preferences that they express. They are empathic and sensitive to the patient’s concerns. Poor trainees neither introduce themselves nor identify the patient.  They hurry the patient and ignore what the patient is saying.  They look away or appear impatient during the history taking. There are unable to establish rapport with the patient and show  little respect.
	Poor	Fair	Good	V Good	n/a
Introduction and start of interview
Rapport with patient and development of trust
Listening skills, appropriate eye contact and non-verbal communication
Empathy and sensitivity
Respect for patient

Information gathering
V good trainees capture all of the appropriate information required for the ophthalmic examination and diagnosis, the planning of investigations and subsequent management. Their questions are structured and guided by the differential diagnosis suggested by the presenting complaint. Poor trainees ask questions by rote. They omit important areas.  They do not pursue an appropriate line of questioning informed by a differential diagnosis.
	Poor	Fair	Good	V Good	n/a
History of presenting complaint
Past ophthalmic history
Family history
Past medical history/general health
Systems enquiry
Drug history and allergies
Social history
Other relevant enquiries pertinent to case
Assessment of mental state

Awareness
V good trainees are attentive the patient’s anxiety and main concerns.  They are sensitive to the social impact of the patient’s problems. They adapt the interview appropriately as determined by the patient’s age, mental state and any communication problems such as poor hearing or language barriers. Poor trainees disregard the patient’s main concerns or anxieties and any impact their problem may have on their social circumstances. They are insensitive to the potential barriers to good communication raised by extremes of age, mental state, hearing impairment or language.
	Poor	Fair	Good	V Good	n/a
Sensitive and responsive to patient anxieties and concerns
Aware of the social impact of problems for patient
Interview sensitive and responsive to age of patient, mental state and any communication problems

Management of interview
V good trainees are skilled in questioning with an appropriate mixture of open and closed questions.  They clarify what they have understood and check this with the patient by appropriate summaries. They use the time efficiently and guide the patient with sensitivity. They explain terms appropriately and finish the interview effectively, making future plans clear. Poor trainees ask closed questions which do not encourage the patient to tell her/his story. They do not clarify points or attempt to summarise.  They waste time through repetition or inappropriate questioning. They do not guide the patient appropriately.  Information if provided at all unclear or too technical.  They do not make it clear when the interview has come to an end or what the next step is.
	Poor	Fair	Good	V Good	n/a
Mode of enquiry: appropriate use of closed, open, directed and probing questions.  Clarification and summarising.
Appropriate control and direction
Efficient use of time
Delivery of information
Termination of interview

Overall performance in this assessment	Poor	Fair	Good	V Good

Summative Outcome (Delete as appropriate if tool used for summative assessments)                             Pass/Fail

Pass/Fail = Meets expectation /Does not meet expectation for stage of training

(Note: "Pass" requires an overall assessment grade of "Good" and NO individual "Poor" grades

Please use the boxes below/overleaf for free-text comments and recommendations for further training.

              

Anything especially good?	Suggestions for development:
Agreed action:

              

Signature of assessor:                                                         Signature of trainee:

Clinical Rating Scale CRS2 (Outcome CA2: ASSESS Vision)

COECSA Workplace Based Assessments

Clinical Rating Scale CRS2 (Outcome CA2: Assess Vision)

All trainees must be able to assess visual acuity for near and distance using an appropriate method and interpret the results. They must be aware of and be able to interpret and apply newer methods of assessing visual acuity when they are introduced into clinical practice. They must be able to test colour vision using an appropriate method and interpret the results. They should also know the principles of the assessment of contrast sensitivity. They must be able to assess vision in children and in adults who have language and other barriers to communication. They must be able to assess vision in circumstances outside the OPD environment.

Trainee’s Name                                                                                                                                                                Date (dd/mm/yyyy)                     

YEAR 1                                YEAR 2                   YEAR 3            YEAR 4             Other (specify)

Assessor's name                                                                                             Type of assessment:  Formative           Summative                                                                

Assessor's status           Consultant                       Senior Trainee                    Other (Specify)

Brief description of case                                       

Please grade the following areas using the scale below (use tick or cross)

Attitude and manner
V good trainees introduce themselves and establish the name of the patient and any other attendant (e.g. spouse, parent, carer). Their demeanour throughout shows that they are attentive to the patient by gestures, words of encouragement and appropriate eye contact. They explain the purpose of the test and how it will be carried out. Poor trainees neither introduce themselves nor identify the patient.  They hurry the patient and ignore what the patient is saying. They do not explain the test in an appropriate manner.
	Poor	Fair	Good	V Good	n/a
Introduction and explanation of test
Rapport with patient, empathy and sensitivity to age and context
Respect for patient

Visual acuity Method*: Snellen/LogMar/Sheridan-Gardner/other, specify (* Please circle method as appropriate or specify “other”…………………………………………….)
Very good trainees occlude each eye in turn to perform the test.  They use an appropriate form of visual acuity assessment determined by the patient’s age and level of understanding.  They can compare results from different tests.  They use appropriate refractive correction and instruct the patient on the best use of a pinhole. They record the visual acuity correctly. Poor trainees do not occlude appropriately.  They do not use an appropriate test method.  They do not understand the equivalence of results from different tests. They do not use an appropriate method of correcting refractive error. The visual acuity is recorded inaccurately or incorrectly.
	Poor	Fair	Good	V Good	n/a
Appropriate occlusion
Technique of assessment appropriate for age and context
Appropriate use of refractive correction
Appropriate use of pinhole
Accurate recording of distance acuity
Accurate recording of near acuity

COECSA Workplace Based Assessments

Clinical Rating Scale CRS2 (Outcome CA2: Assess Vision)

All trainees must be able to assess visual acuity for near and distance using an appropriate method and interpret the results. They must be aware of and be able to interpret and apply newer methods of assessing visual acuity when they are introduced into clinical practice. They must be able to test colour vision using an appropriate method and interpret the results. They should also know the principles of the assessment of contrast sensitivity. They must be able to assess vision in children and in adults who have language and other barriers to communication. They must be able to assess vision in circumstances outside the OPD environment.

Colour vision (Method: Ishihara/other pseudoisochromatic/other)
V good trainees occlude each eye in turn to perform the test.  They use an appropriate form of colour vision assessment determined by the patient’s age and level of understanding.  They can compare results from different tests. They record the results of the colour vision test correctly and know how to interpret them. Poor trainees do not occlude appropriately.  They do not choose an appropriate test method.  They do not understand the equivalence of results from different tests.  The colour vision is recorded inaccurately or incorrectly.  They do not understand the implications of the result.
	Poor	Fair	Good	V Good	n/a
Appropriate occlusion
Technique of assessment appropriate for age and context
Appropriate use of colour vision test
Accurate recording of colour vision

Overall performance in this assessment	Poor	Fair	Good	V Good

Summative Outcome (Delete as appropriate if tool used for summative assessments)                             Pass/Fail 

(Note: "Pass" requires an overall assessment grade of "Good" and NO individual "Poor" grades.) 

Please use the boxes below/overleaf for free-text comments and recommendations for further training.

Anything especially good?	Suggestions for development:
Agreed action:

              

Signature of assessor:                                                         Signature of trainee: