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Guidelines and Criteria for Registration as a Specialist in Ophthalmology

Prepared by

Specialty Sub-Committee of Ophthalmology,

National Specialist Register

CONTENTS

Page

1.

Introduction

1

2.

Recognised specialist training

2

3.

List of recognised postgraduate qualifications

2

4.

Requirements for enrolment for specialist training

3

5.

Recognised specialist training programme

3

6.

Recognised specialist training centres

4

7.

Competence in core procedures required of a specialist on

completion of training in ophthalmology

4

8.

Certification of completion in specialist training in

ophthalmology

5

9.

List of Appendices

5

Appendix 1 : Postgraduate training programme structure

6

Appendix 2 : Criteria for recognition of specialist training

centres

23

Appendix 3 : Core procedures required for fulfillment of

training

32

10 11.

Ophthalmology Surgical And Procedural Skills (for fulfillment of Specialist Registration) Acknowledgements

39 43

1. Introduction

The National Specialist Register (NSR) has been established to assure quality

care to the public by determining the professional standards expected of

specialists in their respective fields. Specialists are credentialed on fulfilling the

training requirements and have the required competencies stipulated by the

relevant specialty sub-committees.

The Specialty Sub-Committee of Ophthalmology has defined the criteria

for credentialing as an ophthalmologist. To be registered with the NSR,

the candidate must have satisfactorily completed the training programme and

demonstrated clinical competence.

The following requirements need to be fulfilled:

i. Registration with the Malaysian Medical Council and possession of

a current Annual Practicing Certificate

ii. Possession of any postgraduate qualification in ophthalmology

registrable with the NSR

iii. Satisfactorily completed 6 years of recognised training in

ophthalmology of which at least 2 years is after obtaining the

postgraduate qualification

These guidelines deal with the training to be undertaken by trainees enrolled in

a recognised training programme. It is a review of the previous handbook and is

effective from 1st January, 2012.

1

2. RECOGNISED SPECIALIST TRAINING

The total duration of training shall be a minimum of 6 years. The trainee must

pursue 4 years of postgraduate training leading to the award of a recognised

qualification, followed by 2 years of supervised training.

3. LIST OF RECOGNISED POST-GRADUATE QUALIFICATIONS

(i) Sarjana Surgeri (Oftalmologi), Universiti Kebangsaan Malaysia

(Master of Surgery (Ophthalmology), Universiti Kebangsaan Malaysia)

(ii) Sarjana Oftalmologi, Universiti Malaya

(Master of Ophthalmology, University of Malaya)

(iii) Sarjana Perubatan (Oftalmologi), Universiti Sains Malaysia

(Master of Medicine (Ophthalmology), Universiti Sains Malaysia)

(iv) Any other equivalent qualification can be considered for recognition

by the Specialty Sub-Committee of Ophthalmology on a case-to-case

basis provided all training requirements and any other requirements as

determined by the specialty sub-committee have been fulfilled.

2

4. REQUIREMENTS FOR ENROLMENT FOR SPECIALIST TRAINING

A medical doctor who has:

i. at least 2 years of working experience after obtaining a basic medical

degree

AND

ii. full registration with Malaysian Medical Council

AND

iii. possession of a current Annual Practicing Certificate 5. RECOGNISED SPECIALIST TRAINING PROGRAMME

5.1 Postgraduate training leading to the Masters degree or

equivalent

The training shall be based on the Masters programme approved by the Malaysian

Universities Conjoint Committee of Ophthalmology (MUCCO) (Appendix 1).

5.2 Supervised training following postgraduate qualification

5.2.1 The aim of this 2 year period of training is to assist trainees to acquire

both knowledge and competence in the performance of procedures

to be credentialed as an ophthalmologist. It is an additional step

beyond post-graduate qualification where trainees will be assessed

for knowledge, skills and competence.

5.2.2 Supervised Postings

The trainee shall undergo supervised rotational postings of 3-6

months to fulfill their required core procedures and maintain the

logbook. A 6 monthly assessment of supervisor’s report must be

submitted. (Appendix 1)

3

6. RECOGNISED SPECIALIST TRAINING CENTRES

6.1 The Specialty Sub-Committee of Ophthalmology shall recognise individual

training centres based on specific criteria. (Appendix 2)

6.2 The list of current recognised training centres can be obtained from the

NSR secretariat upon request or its website: www.nsr.org.my. The list may

be updated from time to time.

7. COMPETENCE IN CORE PROCEDURES REQUIRED OF

A SPECIALIST ON COMPLETION OF TRAINING IN

OPHTHALMOLOGY

7.1. Trainees are required to be competent in the core procedures listed

(Appendix 3)

7.2 Trainees are recommended to use the “Specialist Training in Ophthalmology

Personal Record and Surgical Logbook” that can be obtained from the

Academy of Medicine of Malaysia. This logbook should continue to be used

after the trainee graduates. It is required for registration with the National

Specialist Register.

4

http://www.nsr.org.my/

8. CERTIFICATION OF COMPLETION IN SPECIALIST TRAINING IN

OPHTHALMOLOGY

A certificate shall be awarded after the trainee has satisfactorily completed the

following:

a. Postgraduate training in Ophthalmology (Masters or equivalent)

AND

b. Two (2) years supervised postings following postgraduate training including

review of procedural log book and supervisor reports

AND

c. Successfully attended exit certification conducted by the Specialty Sub-

Committee of Ophthalmology, NSR 9. APPENDICES

Appendix 1: Postgraduate training programme structure

Appendix 2: Criteria for recognition of specialist training centres

Appendix 3: Core procedures required for fulfillment of training

5

APPENDIX 1

POSTGRADUATE TRAINING PROGRAMME STRUCTURE

(ADAPTED FROM THE MASTERS TRAINING PROGRAMME STRUCTURE

OF THE MALAYSIAN UNIVERSITIES CONJOINT COMMITTEE OF

OPHTHALMOLOGY (MUCCO))

OBJECTIVES

The postgraduate training programme in Ophthalmology aims to produce

graduates who:

1. are able to appropriately assess, diagnose and manage patients with ocular

and systemic related disorders

2. can assess and detect dysfunction of vision and the visual system, and

provide appropriate management for such conditions

3. are able to use current and appropriate technology in the diagnosis and

management of relevant ocular conditions

4. understand their role and are able to participate in the prevention of

blindness programme

5. understand their role as teachers and the importance of continuous

professional development in the advancement of Ophthalmology

6. are able to participate in eye research and development activities

7. can function effectively, ethically and professionally within the profession

LEARNING OUTCOMES

Phase I (Year 1)

At the completion of this phase, trainees possess:

1. good knowledge in basic medical and surgical sciences

2. good knowledge in ocular anatomy, physiology, pathology, basic optics and

ocular diseases

3. basic understanding on the optical principles of ophthalmic instruments and

their applications

4. skills in taking relevant history from patients and performing a complete

ophthalmic examination

5. skills in performing clinical refraction and interpret prescriptions

6. knowledge in basic ophthalmic microsurgery

7. skills in performing minor ophthalmic surgeries under supervision

8. good knowledge in basic research methodology

6

Phase II (Year 2 & 3)


1. in depth knowledge of ocular diseases and related systemic conditions

2. enhanced skills in eliciting history and performing a comprehensive

examination to arrive at appropriate differential diagnosis

3. the ability to decide on and interpret relevant investigations and manage

most cases with minimum supervision

4. the ability to perform common surgical procedures such as cataract surgery

with supervision

5. knowledge and skills in the assessment of low vision and its management

6. the ability to apply research methods in the conduct of their dissertation

project Phase III (Year 4)


1. the ability to manage common and acute ophthalmic conditions

independently

2. the ability to perform common surgical procedures with minimal or no

supervision

3. an evidence-based approach to clinical decision-making and problem-

solving, through an ability to identify, critically analyze and interpret evidence

4. the ability to communicate effectively with patients, their relatives and

professional colleagues

5. knowledge on prevention of blindness programme planning and experience

on related activities

6. knowledge and skills to supervise junior trainees

7. the ability to conduct eye research and research in related sciences

8. good insight and the ability to recognize own limitations and seek appropriate

consultation

7

PROGRAMME STRUCTURE

Year

Phase

Curriculum

Assessment

1

1

Ophthalmology related to basic

medical sciences

Basic ocular sciences

Optics & refraction

Introduction to clinical ophthalmology

Part I

2

3

2

Clinical ophthalmology

Ophthalmology related to

general medicine & neurology

Part II

4

3

Advanced clinical ophthalmology

Part III

The course extends over a minimum period of 4 years and maximum period of

7 years.

8

SYLLABUS

PHASE I

BASIC MEDICAL SCIENCES (in relation to Ophthalmology)

Anatomy

General nervous system

Central nervous system

Detailed anatomy of the eye, orbit and adnexae and the visual pathways

Head and neck anatomy

The respiratory system and cardiovascular systems

Histology

Embryology

Physiology

General physiology (in relation to Ophthalmology)

• Cardiovascular system

• Respiratory system

• Haematological system

• Nervous system

• Endocrinology

• Renal system

• Homeostasis

• Nutrition

Pathology

General principles of pathology including

• Inflammation

• Disturbance of growth

• Healing and repair

• Immunological mechanisms and hypersensitivity reactions

• Vascular pathology

• Degenerative disorders and aging

• Shock & trauma

• Neoplasia and the effects of treatment

• Common tissue stains

9

Pharmacology

General pharmacological principles

• Mode of action of drugs on receptors

• Drug toxicity

• Absorption, distribution, metabolism and excretion of drugs

Molecular & cell biology

Cell structures and their biochemical functions

Normal cell functions and interactions

Connective tissue and extracellular matrix

Genetics

Principles of genetics

Modes of inheritance

Principle of gene therapy

Microbiology and immunology

Principles of microbial pathogenesis

Principles of sterilisation, disinfection and asepsis

Principles of antimicrobials

Principles of immunology BASIC OCULAR SCIENCES Anatomy

of visual and ocular system Physiology

of visual and ocular system

Introduction to ocular pathology

Optics & refraction

Physical optics

Geometric optics

Clinical optics

Clinical refraction

Instruments

10

PHASE II SYLLABUS

Clinical history taking and examination

Ocular and systemic

Clinical ophthalmology

External eye diseases & orbit

Diseases of the uvea

Diseases of the lens

Diseases of the retina

Diseases of ocular motility

Glaucoma

Preventive ophthalmology

Investigations for ophthalmic diseases

Therapeutics

Paediatric ophthalmology

The diagnosis and management of common paediatric ophthalmic conditions

Neuro-ophthalmology

Disorders of the visual pathways

Neuro-ophthalmic disorders of ocular motility

Ophthalmology in relation to medicine

Common neurological conditions affecting the eye

Endocrinology

Principles of resuscitation

Ophthalmic surgery

All surgery related to ophthalmology

11

SCHEDULES (TIMELINE)

PHASE I

Year 1

Jun

July

Aug

Sept

Oct

Nov

Dec

Jan

Feb

Mac

Apr

May

Introduction

to eye Basic

Science

Basic Sciences / Optics

Viva / Revision Part I

exam

PHASE II

Year 2

Jun

July

Aug

Sept

Oct

Nov

Dec

Jan

Feb

Mac

Apr

May

Presentations & Clinical session

1st Publication or

Case reports (1-3) 2nd Publication or

Case reports (4-7)

Present Research Proposal

Year 3

Jun

July

Aug

Sept

Oct

Nov

Dec

Jan

Feb

Mac

Apr

May

Presentations & clinical session /

Medical & Neurology rotation (2 months)

Viva & clinical session

3rd Publication or

Case reports (8-10) Pass up case

reports & log book Part II

exam

PHASE III

Year 4

Jun

July

Aug

Sept

Oct

Nov

Pass up 1st

completed draft of

research report

Pass up corrected

copy of research

report

Research

report

presentation

Pass up final

copy of

research report

Dec

Jan

Feb

Mac

Apr

May

Pass up final copy

of publication or

case book

Pass up log book and obtain

supervisors approval to sit

for Part III exams

Part

III

exam

12

ASSESSMENTS

Assessments are carried out throughout the masters program from Year

1 to Year 4. Assessments serve as a guide to the trainee on what should be

achieved at different stages of the training. It also provides the trainee a means

to communicate any problems faced throughout different stages of the training

pertaining to the course.

These continuous assessments will be performed at specific intervals.

1. Supervisor’s report (at least twice a year)

2. End of rotation assessments (including medical and elective postings)

A log book is an official document which records information about all the

surgical and laser procedures that has been done by the trainee. The log book

should initially be submitted along with the case reports, one month before the

Part II examination and again before the Final Assessment. The initial submission

is for the supervisor to recognize any deficiency in the trainees’ surgical training

so that it will be rectified during the final year.

Trainees are recommended to use the “Specialist Training in Ophthalmology

Personal Record and Surgical Logbook” that can be obtained from the Academy

of Medicine of Malaysia. This is to ensure the continuity of the log book after

the trainee graduates and undergoes gazettement and may later undertake the

subspecialty training. It will also facilitate registration with the National Specialist

Registry. The logbook can be purchased from the academy.

13

SUPERVISOR’S REPORT

Master in Ophthalmology

Phase I Year 1

Name :

System : Open / Close

Hospital :

Supervisor :

Year of Entry :

Goals

Achievements Comments

(student) Comments

(supervisor)

Jun

July

Aug

Sept

Assessment

Oct

Nov

Dec

Jan

Assessment

Feb

Mac

Apr

May

Assessment

May

Part 1 Exam

14


Phase II Year 1 (Starting after passing May Part I exams)

Name :


Hospital :

Supervisor :

Year of Entry :

Goals


(student) Comments

(supervisor)

Jun

July

Aug

Sept

Assessment

1st Publication

or

Case reports

(1-3)

Research

proposal

presentation

Oct

Nov

Dec

Jan

Assessment

Feb

Mac

Apr

May

Assessment

2nd Publication

or

Case reports

(4-7)

15


Stage II Year 2 (Starting Year 2 in June after passing Part I Exams May)

Name :


Hospital :

Supervisor :

Year of Entry :

Goals


(student) Comments

(supervisor)

Jun

July

Aug

Sept

Assessment

Oct

Nov

Dec

Jan

Assessment

3rd Publication

or

Case reports

(8-10)

Feb

Mac

Apr

Assessment

Hand in

3 Publications

or

10 Case report

drafts to dept

by 1st February

May

Part II exam

16


Phase III (Starting Year 4 in June after Passing Part II Exams in May)

Name :


Hospital :

Supervisor :

Year of Entry :

Goals


(student) Comments

(supervisor)

Jun

July

Aug

Sept

Assessment

Pass up

1st completed

copy of thesis

by 1st July

Pass up

corrected copy

of dissertation

by 1st August

Oct

Nov

Dec

Jan

Assessment

Pass up final

copy of

dissertation by

1st Nov

Pass up final

copy of case

book in

January

Feb

Mac

Apr

Assessment

Pass up

log book in

April

May

Final

assessment

17

CLINICAL POSTING ASSESSMENT FORM

Candidate : Supervisor(s) :

Posting/Rotation : Date :

No.

Competency Level

(1-5)* Comment by

supervisor

1 Inquiry skills (obtaining data information

from history, physical examination and

Investigations)

2 Problem solving and decision-making skills

3 Technical skills

4 Knowledge

5 Professional characteristics

6 Personal learning and assignments

7 Conduct and communication skills

8 Record keeping

9 Participation in teaching / learning activities

10 Leadership quality

Total for overall clinical competence**

* Level (1: Weak 2: Borderline 3: Satisfactory 4: Good 5: Excellent)

** Overall: Weak: < 15 Borderline: 15-19 Satisfactory: 20-29 Good: 30-39

Excellent: 40-50

*** For detail definition of each assessment, refer to individual university guidebook.

Overall comment / Recommendations by supervisor:

Supervisors’ signatures: Date:

Comment / Recommendations by Head of Department:

HOD signature: Date:

18

PROFESSIONAL EXAMINATION

PART I examination

Prerequisite

1. Successfully completed Phase I of the training program

2. Satisfactorily completed the log book

3. Obtained a satisfactory supervisor report

Component

A. Theory 50%

B. Clinical 30%

C. Optics and Refraction 20%

Section

Type

Number of Questions

Duration

%

marks

% to

total

marks

A MCQ I

60 questions (Basic

Ocular Sciences, Optics

and refraction)

2 hrs

100

15

MCQ II

60 questions (Basic

Ocular Sciences, Optics

and refraction)

2 hrs

100

15

Essay 8 short notes questions

(Basic Ocular Sciences)

2 hrs 30 mins

100

20

Total for Theory 200 50

B

OSCE 10 stations


50 mins

100

15

Viva 1 session


30 min

100

15

Total for Clinical 200 30

C Clinical 1 case (Clinical refraction) 30 mins 100 10

OSCE 4 stations

(Optics & refraction)

20 mins

100

10

Total for Optics & Refraction 200 20

Grand Total 600 100

A candidate shall be deemed to pass the Part I examinations if he has obtained 50% or

more of the marks for each section of the examination and 45% or more of the marks for each subsection of the examinations. A candidate is only allowed to obtain a borderline mark (45.00 – 49.99%) in not more than one subsection under the same section. A trainee who has failed the Part I examination may be permitted a second

attempt on 2 more occasions at 6 monthly intervals. The Part I examination must be passed not later than twenty-four months from the date of initial registration as a candidate, failing which

the candidate shall be terminated forthwith from the course without notice.

19

PART II examination

Prerequisite

1. Successfully completed Phase II of the training program

2. Satisfactorily completed the log book

3. Satisfactory supervisor report and continuous assessments

4. Obtained ethical approval for research protocol at least 6 months before the

Part II examination

5. Submitted the first draft of 10 case reports or published/been accepted for

publication in journal according to merit points at least 3 months before the

Part II examination

Component

A. Theory 40%

B. Clinical 40%

C. Viva 20%

Section

Type

Number of Questions

Duration

%

marks

% to

total

marks

A MCQ I 60 questions 2 hrs 100 20

Essay 1 long essay &

4 short notes

1 hr 30 mins

100

10

Essay 1 long essay &

4 short notes

1 hr 30 mins

100

10

Total for Theory 200 40

B Clinical

1 long case with refraction 1 hr 10 mins 100 15

6 short cases 30 mins 100 15

4 short cases

(Medicine in relation to OPH)

30 mins

100

10

Total for Clinical 300 40

C Viva

Ophthalmology 30 mins 100 10

Medicine in relation to

Ophthalmology

30 mins

100

10

Total for Optics & Refraction 200 20

Grand Total 700 100

A candidate shall be deemed to pass the Part II examination if he has obtained 50% or more of the marks for each section of the examination and 45% or more of the marks for

each subsection of the examinations. A candidate is only allowed to obtain a borderline mark (45.00-49.99%) in not more than one subsection under the same section. A trainee who failed the first attempt may be permitted a second attempt on 2 more occasions at 6

monthly intervals. A candidate who fails the examination on the third occasion shall not be permitted to continue the course.

20

PART III examination

Prerequisite

1. At least one year after passing the Part II examination

2. Satisfactorily completed Phase III clinical training

3. Obtained a satisfactory supervisor report and continuous assessments

4. Submitted the research report not later than 6 months before the Final

Examination

5. Submitted case reports or publication (equivalent in merit points) not later

than 3 months before the Final Examination

6. Submitted the log book that has been certified 1 month before the Final

Examination

Assessment of dissertation

1. Research report will be evaluated by the internal, local and external examiners

appointed by the University.

2. Structure

a. Research Report

• Oral presentation (20 min)

• Viva (20 min)

b. Publication and Log Book (20 min)

3. Candidates should adhere to and make appropriate amendments and

corrections suggested by the examiners. A candidate is deemed to have

failed the examination if the amendments are not satisfactorily made within

the time given. Candidate may be permitted a second attempt on 2 more

occasions at 6 monthly intervals.

21

PUBLICATION AND PRESENTATION REQUIREMENTS

1. Publication

a. Case report / case series / letter to editor

Local journal – 2 points

International journal – 3 points

b. Original article

Local journal – 3 points

International journal – 4 points

c. Unpublished case report

1 case – 1 point

*Minimum points for Publication is 10 points

2. Presentation

a. Oral presentation

Local – 2 points

International – 3 points

a. Poster presentation

Local – 1 point

International – 2 points

*Minimum points for Presentation is 5 points

22

APPENDIX 2 RECOGNISED CENTRES FOR TRAINING IN OPHTHALMOLOGY

SPECIALTY SUB-COMMITTEE OF OPHTHALMOLOGY

Application for departments to be recognised as centres for training in

Ophthalmology (w.e.f. 1st January, 2012)

Hospital / Institution:

Address:

Head of Department:

Date of Application:

A. GENERAL CRITERIA

THIS SECTION TO BE FILLED BY

APPLICANT

(FOR OFFICIAL USE)

THIS SECTION

TO BE FILLED BY

ASSESSOR

No.

Criteria

(Required criteria in brackets)

Data

on

Dept.

Meets

Minimum

Criteria

( / )

Notes

1. Total number of Ophthalmologists

registered in NSR

(A minimum of 2 is expected)

2. Total number of Medical Officer posts

filled

(A minimum of 4 including trainees)

3. Total number of beds for

ophthalmology including day care

(A minimum of 6)

23

4. Total number of Ophthalmology Clinic

sessions per week

(Minimum of 3)

5. Total number of operative sessions

per week

(Minimum of 2)

6. Total number of cataract surgeries

per month

(Minimum of 25)

7. Are microbiology services available?

(Yes) specify

8. Are biochemistry services available?

(Yes) specify

9. Are pathology services available?

(Yes) specify

10. Are diagnostic imaging services

available?

(Yes) specify

11. Is an anaesthetist available including

visiting?

(Yes) specify

12. Is there Intensive / Coronary Care

service available?

(Yes) specify

13. Is there a General Medical unit?

(Yes)

14. Is there a trauma / accident and

emergency unit?

(Yes)

24

B. SPECIFIC CRITERIA

No.

Names of Ophthalmologists in

Department

Postgraduate

Qualifications

and Year

Date

Registered

with National

Specialist

Register

1.

i.

ii.

iii.

iv.

v.

vi.

vii.

viii.

25

No.

Criteria

(Required criteria in brackets)

Data on

Dept

Meets

Minimum

Criteria ( / )

Notes

2. Annual workload of inpatients

(use previous year figures)

(should exceed 400)

3. Annual workload of new outpatient

cases (use previous year figures)

(should exceed 1500)

4. Annual workload of follow up cases


(should exceed 6000)

5. Annual workload of major elective

operations done


(should exceed 200)

6. Annual workload of minor operations

done (use previous year figures)

(should exceed 100)

7. Annual workload of emergency

operations done


(should exceed 50)

8. Are surgical audits done in the

Department?

(minimum 3 per year )

9. Equipment

1. Total number of slit lamps

2. Total number of Binocular

Indirect Ophthalmoscope

3. Visual Field Analyser

26

4. A Scan

5. B Scan

6. Fundus Camera

7. Anterior segment camera

8. Other Imaging tools

(OCT/HRT/____________ )

9. Laser

(Type: Argon/YAG/_________ )

10. Indirect laser

11. Phacoemulsification

12. Operating Microscope

13. Vitrectomy machine

14. Others (specify)

10. Optometrist (minimum 1)

11. Technologist

12. Orthoptist

13. Number of Ophthalmology Textbooks

14. Number of Ophthalmic Journals

subscribed by Dept / Library

(state journals)

15. Internet facilities including access to

online journals (state journals)

16. Number of Ophthalmology CME

sessions per week

17. Will trainees be able to do hands on

surgical procedures on patients? (Yes)

18. Will there be an opportunity for

trainees to do a minimum of 20

cataract operations a year? (Yes)

19. Are there facilities for Wet Lab

Sessions? (Yes)

20. Will there be an opportunity for

trainees to participate in community

eye care projects

27

C. ADDITIONAL CRITERIA FOR CENTRES APPLYING FOR

OPHTHALMOLOGY SUBSPECIALTY TRAINING

Criteria Subspecialty Department

Data

Remarks

1. Number of

practicing

subspecialty

trained

Ophthalmologist

with 2 years

experience

a. VR Surgery

b. Medical Retina

c. Glaucoma

d. Oculoplastics & Orbit

e. Cornea

f. Paediatric Ophthalmology

g. Neuro-Ophthalmology

h. Others (specify)

2. Number of

outpatient

subspecialty

visits per year

a. VR Surgery

b. Medical Retina

c. Glaucoma


e. Cornea



h. Others (specify)

3. Number of

surgeries /

procedures

performed

per year

(for each

subspecialty)

a. VR Surgery

b. Medical Retina

c. Glaucoma


e. Cornea



h. Others (specify)

28

4. Will there be

an opportunity

for candidates

to fulfill the

requirement

and gain

competency in

specified core

procedures?

Please state

YES/NO

a. VR Surgery

b. Medical Retina

c. Glaucoma


e. Cornea



h. Others (specify)

Notes

1. Please enclose together with this application the following:

i. Previous 1 year census

ii. A list of key Ophthalmology textbooks and journals available in the

department/ Hospital

iii. A list of all teaching aids available in the Department (LCD projector, computers, etc)

2. Period of Recognition

Recognition is given for a period of 3 years on condition that there are no

drastic changes in the minimum requirements during that period.

3. Recognition will be given as:

i. Suitable for General Ophthalmology training up to 6 months

ii. Suitable for General Ophthalmology training up to 6 years

iii. Suitable for Ophthalmology Subspecialty training

iv. Suitable for Specific Area of Training

4. Failure to gain recognition

If a department fails to get recognition, it will be informed in writing of the reasons.

The department may subsequently reapply when the requirements are met.

If criteria are lacking in any of the above, please state reasons why the department

should still be considered for recognition:

29

The Hospital/Institution agrees to pay expenses incurred should the Specialty

Sub-Committee of Ophthalmology decide to make a visit. Hospital Ophthalmologist Date:

Official stamp:

Hospital Director Date:

Official stamp:

To be filled by representatives of the Specialty Sub-Committee of Ophthalmology:

Comments from visit (if visit is made):

30

RECOGNISED CENTRES FOR TRAINING IN OPHTHALMOLOGY

SPECIALTY SUB-COMMITTEE OF OPHTHALMOLOGY

Certification of the Department for Training in Ophthalmology

The Department of Ophthalmology of _____________________________

Hospital is granted / not granted recognition for training.

Recognition is granted as follows:

Suitable for General Ophthalmology training up to 6 months

Suitable for General Ophthalmology training up to 6 years

Suitable for Ophthalmology Subspecialty training

Suitable for Specific Area of Training in

from to

It is recommended that the total number of trainees in this department should not

exceed in number.

Reasons for not granting recognition:

Chairman, Date:

Specialty Sub-Committee of Ophthalmology

31

APPENDIX 3 CORE PROCEDURAL SKILLS

A. CLINICAL EXAMINATION SKILLS

No.

CORE PROCEDURES

Minimal Training necessary

for Competence

Observed Assisted Performed

1. Distant Vision including conversion 5 10

2. Near Vision 5 10

3. Visual assessment in children

• Preferential looking

• OKN

• Matching

• Objection to Occlusion

5

5

5

5

20

10

20

20

4. Colour - Vision Ishihara 2 Interpret

- 10

Perform

- 5

5. Colour - Vision D 15 2 Interpret

- 10

Perform

- 5

6. Slit Lamp Biomicroscopy – including

contact and non contact lens

Optic disc and RNFL assessment

5

5

20

20

7. Intraocular Pressure measurement

and calibration of devices using:

- Applanation Tonometer

- Perkins Tonometer

- Tonopen

5

5

5

20

5

20

32

8. Pachymetry 2 10

9. Gonioscopy 3 30

10. Direct Ophthalmoscopy 20

11. Indirect Ophthalmoscopy with

indentation 5 20

12. Retinal Diagram 5 10

13. Extraocular Muscle Movements 5 20

14. Assessment of Nystagmus 5 5

15. Exophthalmometry 5 10

16. Visual Field – Confrontation 5 20

17. Amsler Chart 5 20

18. Dry Eye Assessment 2 10

19. Placido Disc 2 10

20. Cover Test 5 20

21. Prism Cover Test 5 20

33

B. BASIC CLINICAL OPTOMETRY SKILLS

No.

CORE PROCEDURES

Minimal Training necessary for

Competence

Observed

Assisted

Performed

1. Refraction – Retinoscopy

+ subjective refraction

– Myopia (including high myopia)

– Hyperopia

– Myopia/Astig

– Hyperopia/Astig

– Astigmatism only

– Pseudophakia

– Aphakia

5 20

2. RAF Rule including Interpretation 5 10

3. Use of Focimeter 5 10

4. Use of Autorefractometer 2 10

5. Keratometry 5 30

6. Insertion and removal of Contact

Lenses 5 5

7. Contact lens fitting 5 10

8. Exposure to Low Vision Devices 5 5

34

C. OPHTHALMIC DIAGNOSTIC SKILLS

No.

CORE PROCEDURES

Minimal Training necessary for

Competence

Observed

Assisted

Performed

1. Bjerrum Perimetry 2 Interpret

- 10

Perform

- 5 2. Automated Perimetry 3 Interpret

- 30

Perform

- 5 3. Hess Chart 2 Interpret

- 10

Perform

- 5 4. A Scan and IOL Power Calculation 5 Interpret

- 30

Perform

- 30 5. Ocular Photography

- External

- Ant. Segment

- Optic disc

- Fundus

3 for each 5 for each

6. B Scan – basic Interpretation 5 20

7. HRT 3 Interpret

- 20 8. OCT

- Macular

- Optic Disc

5

5

Interpret

- 20

- 20

9. Electrophysiology Tests 2 Interpret

- 5 10. Corneal topography 5 10 11. 100 Hue Colour Vision Test 2 Interpret

- 5 12. Fundus Fluorescein Angiography 5 Interpret

- 20

Perform

- 5

35

D. SURGICAL / PROCEDURAL SKILLS

No.

CORE / SPECIALISED

PROCEDURES

Minimal Training necessary

for Competence

Observed

Assisted

Performed

1. Eye Irrigation 3 10

2. Syringing and Probing

- Adults

- Paeds

5

3

20

3

3. I&C and I&D 3 7 10

3 in Paeds

4. Lid T&S not involving lid margin 5 7 10

5. Entropion / Ectropion primary repair 2 2

6. STO Cornea / Lids 5 10

7. Tarsorraphy 5 5 5

8. DCR 2 3

9. Brow suspension 2

10. Excision of lid / eyebrow lesions 5 5 5

11. Lateral canthotomy 1 1

12. Removal of corneal / conjunctival

Foreign Body 3 10

13. Conjunctival Graft 3 5 10

14. Excision of pterygium / conjunctival

lesions 5 5 10

15. Harvesting buccal mucosa 3

16. Amniotic membrane transplant 3

17. Corneal Scraping 3 10

36

18. Glueing of corneal perforation 2 1 5

19. Corneal and Scleral T&S 3 5 10

20. Retrieval and processing of donor

eyes 1 1 1

21. Penetrating Keratoplasty 3

22. AC tap / Paracentesis /

Intracameral Injections 3 5

23. Laser Iridotomy 5 20

24. Laser – Argon laser peripheral

iridoplasty 5 5

25. Cyclophotocoagulation 5 10

26. Laser suturelysis 3

27. YAG Laser Capsulotomy 5 10

28. Trabeculectomy / phaco

trabeculectomy +/- anti-metabolite

(primary, not repeat)

5 5

29. Glaucoma Drainage Device 3

30. Paediatric Glaucoma Surgeries 3

31. Paediatric Lens aspiration (limited

to children above 6 years of age)

3 3

32. ECCE (including converted phaco

cases) 5 5 20

33. Phacoemulsification 10 40 50

34. ROP Screening 10 50

35. EUA – Paediatric 3 10

36. Retinoblastoma management / EUA 3

37. Pan Retinal Photocoagulation 3 50

37

38. Focal / Grid Laser 5 10

39. Laser to retinal breaks / lattice 3 10

40. Indirect Laser Photocoagulation

- Adults

- Premature infants

3

3

10

41. Cryopexy 3 3 3

42. Vitreous tap 3 5

43. RRD Surgery including sclera

buckling (Primary repair) 5

44. Vitreous Surgery 5

45. Insertion and removal of eye

prosthesis 3 5

46. Evisceration /

Enucleation without orbital implant

2

2 1

1

47. Evisceration /

Enucleation with implant

2

48. Exenteration 1

49. Squint surgery

- Adults

- Horizontal Squint in Paeds

patient

5

3

50. Subconjunctival Injection 5 10

51. Orbital Floor Injection 3 3

52. Intravitreal injection 3 5

53. Injection of anti-metabolite

(including preparation and disposal) 3

54. Injection of local anaesthesia

(peribulbar / retrobulbar / subtenon) 5 10

38

OPTHALMOLOGY SURGICAL AND PROCEDURAL SKILLS (for fulfillment of Specialist Registration)

No CORE / SPECIALISED PROCEDURES

1. Eye Irrigation

2. Syringing and Probing

-Adult

-Paeds

3. I&C and I&D

4. Lid T&S not involving lid margin

5. Entropion / Ectropion primary repair

6. STO Cornea / Lids

7. Tarsorraphy

8. Excision of lid / eyebrow lesions

9. Lateral canthotomy

10.

Removal of corneal / conjunctival foreign Body

39

11. Conjunctival Graft

12. Excision of pterygium / conjunctival lesions

13. Corneal Scraping

14. Glueing of corneal perforation

15. Corneal and Scleral T&S

16. Retrieval and processing of donor eyes

17. AC tap / Paracentesis / Intracameral Injections

18. Laser Iridotomy

19. Laser - Argon laser peripheral iridoplasty

20. Cyclophotocoagulation

21. Laser suturelysis

22. Laser Capsulotomy

23. Paediatric Lens aspiration (limited to children

above 6 years of age)

40

24. ECCE (including converted phaco cases)

25. Phacoemulsification

26. ROP Screening

27. EUA - Paediatric

28. Pan Retinal Photocoagulation

29. Focal / Grid Laser

30. Laser to retinal breaks / lattice

31. Indirect Laser Photocoagulation

-Adult

-Premature infants

32. Cryopexy

33. Vitreous tap

34. Insertion and removal of eye prosthesis

35. Evisceration /

Enucleation without orbital implant

41

36. Subconjunctival Injection

37. Orbital Floor Injection

38. Intravitreal injection

39. Injection of local anaesthesia

(peribulbar / retrobulbar / subtenon)

42

ACKNOWLEDGEMENTS:

The Specialty Sub-Committee of Ophthalmology:

Dr. Pall Singh (Chairperson)

Assoc. Prof. Dr. Wan Hazabbah Wan Hitam

Assoc. Prof. Dr. Mimiwati Zahari

Dr. Bethel Indira Livingstone

Dr. Anusiah Selvathurai

Dr. Elias Hussein

Assoc. Prof. Dr. Andrew Tan Khian Khoon

Dato’ Dr. Y C Lee

The Specialty Training Committee:

Dr. Bethel Indira Livingstone (Chairperson)

Dr. Anusiah Selvathurai

Dr. Pall Singh

Dato’ Dr. Y C Lee

Dr. Mariam Ismail

Dr. Elias Hussein

Prof. Dr. Ropilah Abdul Rahman

Assoc. Prof. Dr. Mohtar Ibrahim

Assoc. Prof. Dr. Mimiwati Zahari

Assoc. Prof. Dr. Wan Hazabbah Wan Hitam

Assoc. Prof. Dr. Mae-Lynn Catherine Bastion

Assoc. Prof. Dr. Andrew Tan Khian Khoon

Assoc. Prof. Dr. Choo May May

Prof. Dato’ Dr. Veera Ramani

Dr. Goh Pik Pin

Datin Dr. Rusnah Hussin

Dr. Thayanithi A/P K. Sandragasu

43

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