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.