OPHTHALMOLOGY

DEFINITION:Ophthalmology is that specialty which deals with the screening, diagnosis and management of optical, medical and surgical disorders and diseases of the eye, its adjacent structures, the visual pathways, and the visual system.

GENERAL OBJECTIVES:On completion of the educational program, the graduate physician will be competent to function as a consultant in Ophthalmology.

The ophthalmologist must possess a sound knowledge of the general principles of surgery and of medicine. Ophthalmology embraces some aspects of neurology, pathology, plastic surgery, dermatology, microbiology, and other specialities, and the candidate should have knowledge in these fields as they relate to this specialty.

During the course of training the candidate must acquire a knowledge of basic sciences necessary to the understanding and practice of the specialty. This may be done concurrently with resident training by attendance at special courses in basic science or by spending periods of full-time training in basic science.

SPECIFIC OBJECTIVES:

Medical Expert/Clinical Decision-Maker

The ophthalmologist is able to

• demonstrate diagnostic and therapeutic knowledge and skills for ethical and effective patient care.

Knowledge

Upon completion of training every resident must have demonstrated a comprehensive knowledge of:

• the genetics, embryology, anatomy, histology, physiology, biochemistry, pathology, microbiology, and immunology, of the eye, its adnexa, the visual pathways, and the visual system.
• the physics of light, its refraction and absorption, geometric, physical, and applied optics, the eye as an optical instrument, errors of refraction and their measurement and the correction of optical errors of the eye by use of all kinds of correcting lenses and optical devices.
• ocular pharmacology, including the principles of the metabolism, action and toxicity of drugs used in ophthalmology, and of other drugs with ocular manifestations or complications.
• the diagnostic imaging of abnormalities and injuries of the eye and its related structures.
• medical ophthalmology, including the ocular manifestations: of systemic, metabolic, and genetically determined diseases; of disorders of the visual pathways and associated neurological diseases, including visual field interpretation; of ocular motility, extraocular muscle paralysis and strabismus; of retinal, choroidal and vitreous diseases; of glaucoma and diseases of pressure control of the eye; of uveal diseases; and of all forms of external diseases of the eye and its adnexa.
• low vision evaluation, aids and resources.
• surgical ophthalmology, including a knowledge of surgical anatomy, wound healing, and of the surgical management of diseases or deformities of the lids, orbit, lacrimal apparatus, conjunctiva, cornea, strabismus, glaucoma, cataract, tumours, retinal diseases, congenital anomalies including ptosis, and the management of eye injuries.
• the principles of surgical correction of refractive errors of the eye.
• the principles and applications of cryo and laser therapy.
• the use of regional and general anaesthesia and analgesia in ophthalmology and its complications.
• the recognition and management of complications arising during medical and surgical treatment.
• the principles of the management of infections, and the management of infectious diseases of the eye, whether primary or as a complication of treatment.
• the pathology, diagnosis, and treatment of neoplastic diseases affecting the eye and adnexa.
• the principles of medical genetics and knowledge of the genetic basis for ocular abnormalities and diseases.

Skills

Upon completion of training every Resident must have demonstrated:

• competence in all technical aspects of ophthalmology, including the selection, use, and care of diagnostic equipment.
• competence in refraction and in the prescription of lenses including contact lenses.
• competence in the care of patients with low vision.
• the ability to select surgical procedures appropriate to the clinical situations, including cryo and laser therapy.
• competence in regional anaesthesia.
• competence in surgical procedures basic to ophthalmology, including surgery of the lids, and lacrimal apparatus, the surgical management of disorders of ocular motility and strabismus, the surgical treatment of glaucoma, cataract, and congenital anomalies and surgical management of trauma to the eye and orbit.
• an understanding of the principles involved in surgical management of orbital, corneal, and retinal diseases, and of congenital glaucoma, their indications, contra-indications, and complications, and the resident must have assisted in these procedures.
• competence in harvesting, preserving, and transporting eyes for corneal transplantation.
• skills in the collection of biopsy, surgical and autopsy specimens, and in the laboratory examination and diagnosis of those preparations.
• access and apply relevant information to clinical practice. This includes the ability to: formulate an appropriate patient-related question, execute a systematic search for evidence, and critically evaluate medical literature and other evidence in order to optimize clinical decision-making.
• demonstrate effective consultation services and medical expertise with respect to patient care, education and legal opinions.
• recognize the personal limits of expertise.

Communicator

The ophthalmologist is able to

• establish therapeutic relationships with patients/families. This includes the capacity to recognize the psychological, occupational and social consequences of visual impairment or blindness, and the ability to provide effective counseling to blind patients or those approaching blindness.
• obtain and synthesize relevant history from patients/families/communities. This implies the ability to explore a patient's beliefs, concerns, and expectations about the origin, nature, and management of his/her illness. The ophthalmologist needs to be able to assess the impact of such factors as age, gender, ethno-cultural background, social support, and emotional influences on a patient's illness.
• discuss appropriate information with patients/families and the health care team.
• maintain clear, accurate, and appropriate records.

Collaborator

The ophthalmologist is able to

• consult effectively with other physicians and health care professionals.
• contribute effectively to other interdisciplinary team activities such as committee work, research, teaching, and learning. This implies the ability to: recognize team members' areas of expertise, respect the opinions and roles of individual team members, contribute to healthy team development and conflict resolution, and contribute his/her own expertise to the team's task.

Manager

The ophthalmologist is able to

• manage the demands of patient care, population health care, and financial and family responsibilities wisely.
• utilize health care resources wisely.
• work effectively and efficiently in a health care organization.
• utilize information technology to optimize patient care, life-long learning and other activities.
• facilitate patients' access to local and national resources available for those with illnesses involving the visual system and for those with visually impairment.

Health Advocate

An ophthalmologist is able to

• identify the important determinants of health affecting patients. Specifically, to encourage those behaviours which promote visual health and safety, and discourage those behaviours which endanger patients' visual health and safety. This can be applied at individual patient level, to a practice population, or at the general societal level.
• recognize and respond to those issues where advocacy is appropriate. In particular, to act to promote policies which: encourage appropriate visual screening of populations at risk for ocular disease; help to protect populations at risk of ocular injury; or provide appropriate resources to those affected by ocular injury or disease.
• facilitate access to low-vision services and other resources for the visually-impaired.

Scholar

The ophthalmologist is able to

• develop, implement and document a personal continuing education strategy.
• critically appraise sources of medical information. This includes the ability to: select an appropriate question, efficiently search for and assess the quality of evidence in literature and to keep up to date with the evidence-based standard of care for the most common ophthalmological problems.
• facilitate learning of patients, students and other health professionals.
• contribute to development of new knowledge. This includes an appreciation of the important role of basic and clinical research, and of the critical analysis of scientific developments, in relation to the practice of contemporary ophthalmology, i.e., epidemiology and biostatistics and research techniques. While not all ophthalmologists will engage in active research, they should have the skills to participate in collaborative research projects, quality assurance, or guidelines development relevant to the practice of the ophthalmologist.
• must demonstrate an ability to incorporate gender, cultural and ethnic perspectives in research methodology, data presentation and analysis.

Professional

The ophthalmologist is able to

• deliver highest quality care with integrity, honesty and compassion.
• exhibit appropriate personal and interpersonal professional behaviours.
• practise medicine ethically, consistent with the obligations of a physician.

CONTENT AND ORGANIZATION OF THE RESIDENCY PROGRAM:

There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfill the educational requirements and achieve competence in the specialty.

The content and organization of each accredited program in ophthalmology must be consistent with the specialty training requirements.

The program must be organized such that residents are given graded responsibility, under appropriate supervision, according to their residency level, ability and experience.

In addition to offering the components noted in the specialty training requirements all accredited programs in ophthalmology should offer community-based learning electives.

RESOURCES:There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the specialty training requirements in ophthalmology.

In those cases where a university has sufficient resources to provide most of the training in ophthalmology but lacks one or more essential elements, the program may still be accredited provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate prescribed training.

1. Teaching Faculty

There must be a sufficient number of teaching staff with acceptable qualifications to provide appropriate teaching and supervision of residents. There must be a faculty member whose responsibility it is to facilitate the involvement of residents in research and other scholarly work.

2. Number and Variety of Patients

There must be an adequate number of patients available to provide opportunities for training in the following areas of ophthalmology: corneal and external disease of the eye and adnexa; glaucoma; neuro-ophthalmology; optics; refraction; contact lenses; low vision; ocular pathology and tumours; retina and vitreous; ocular motility and pediatric ophthalmology; the ocular manifestations of systemic disease; disorders of the orbit, lids, and lacrimal system; ocular trauma; anesthesia as applied to ophthalmology; anterior segment and lens; ocular inflammation and uveitis; medical imaging for the study of abnormalities and injuries involving the eye, orbit, sinuses and brain, and related structures; the role of radiation in the management of neoplastic and other diseases in ophthalmology.

3. Clinical Services Specific to Ophthalmology
   1. Medical - Ambulatory Services

Organized clinics must be available to provide opportunities for instruction in the broad range of ophthalmology that can be managed on an ambulatory basis with integration of inpatient and outpatient clinical teaching to provide continuity of observation of patients.

2. Surgical Services

There must be resources and facilities for full training in ophthalmic surgery. Operative experience must be provided to produce competence in the basic surgical and laser procedures of ophthalmology. Sufficient patients must be available for the resident to have achieved comprehensive knowledge of the recognition and management of complications arising during surgical treatment and the principles and applications of cryotherapy and laser therapy. There must be adequate operating room time and appropriate facilities to provide graded surgical responsibility for residents in the program.

3. Consultation Services

Residents in ophthalmology require active consultation services to gain experience in primary consultations on other services such as internal medicine, including neurology and dermatology, pediatrics, neurosurgery, otolaryngology, plastic surgery, and other branches of surgery including trauma. Residents should participate in consultations, both elective and emergency, on a continuing basis during training.

4. Community Learning Experiences

Community experiences must provide a learning environment with appropriate supervision, patient encounters, and opportunities for evaluation based on rotation specific objectives. This assumes administrative support and linkages with the university.

4. Supporting Services — Clinical, Diagnostic, Technical
   1. Emergency Facilities

Experience in responding to emergencies and providing a consultation service under such conditions is essential. Experience in the recognition and initial management of injuries to the lids, globe and orbit (including foreign bodies), chemical burns, lacerations, and orbital fractures is an essential feature of training. There must be systematic supervision of residents to insure expertise in the initial management of all types of emergencies related to the specialty, including those presenting in the emergency department and those in intensive care units.

2. Liaison with Other Specialties and Subspecialties

There must be active teaching services in general surgery, internal medicine, pediatrics, pathology, diagnostic radiology and neurology. Liaison within the faculty must insure that rotations taken during the basic clinical year referred to in the specialty training requirements, meet the needs of residents in ophthalmology.

ACADEMIC AND SCHOLARLY ASPECTS OF THE PROGRAM:

The academic and scholarly aspects of the program must be commensurate with the concept of a university postgraduate education. The quality of scholarship in the program will in part, be demonstrated by a spirit of enquiry during clinical discussions, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice.

1. Organized Scholarly Activities

There must be organized scholarly activities such as lectures, seminars, teaching rounds, special conferences, assignments of laboratory work, technical demonstrations, ward rounds, and journal clubs. A mechanism for protecting resident time to attend academic sessions should be in place. Attendance at rounds of other services should be arranged if educationally advantageous.

2. Basic and Clinical Sciences Relevant to Ophthalmology

There must be organized teaching in the basic sciences of ophthalmology including relevant aspects of anatomy, histology, embryology, physiology, pharmacology, toxicology, biochemistry, endocrinology, immunology, and microbiology.

3. Biomedical Ethics

The academic program must provide opportunities for residents to gain an understanding of the basic principles of biomedical ethics as it relates to ophthalmology.

4. Communication Skills

There must be opportunities for residents to learn effective communication skills for interacting with their patients and their families, colleagues and students. Clearly defined educational objectives for teaching these skills and mechanisms of formal assessment should be in place.

5. Teaching Skills

Residents must be given opportunities to develop effective teaching skills by teaching junior colleagues and students, as well as through conference presentations, clinical and scientific reports, and patient education.

6. Quality Assurance/Improvement

The program must provide residents with opportunities to gain an understanding of the principles and practice of quality assurance/improvement. Opportunities should be provided for residents to participate actively in such programs in their hospital departments.

7. Research Opportunities for Residents

The academic program must provide the opportunity for residents to learn bioistatistics and the critical appraisal of research methodology and medical literature. Residents should be encouraged to participate in clinical research during the course of the residency program.

8. Faculty Research

A satisfactory level of research and scholarly activity must be maintained among the faculty identified with the program.

9. Outside Conferences

The program should provide opportunities for residents to attend conferences outside their own university