Transcription

Vocational TrainingProgram CurriculumOverview1 January 2022

RANZCO Vocational Training Program CurriculumThe RANZCO Vocational Training ProgramThe objective of the RANZCO Vocational Training Program [VTP] is to produce a specialist ophthalmologist who, oncompletion of training, is equipped to undertake safe, independent, comprehensive, general ophthalmology practice.The VTP Curriculum OverviewThis overview describes how the objective of the VTP will be achieved and consists of multiple interdependentcomponents: General Ophthalmology CompetenciesDomain Learning OutcomesOverview of Domain ContentLearning and Teaching ApproachesAssessmentEvaluation and monitoringRANZCO VTP General Ophthalmology CompetenciesThe General Ophthalmology Competencies reflect the knowledge, skills and professional attributes for beginning andindependent and competent Ophthalmic practice in Australia and New Zealand. The outcomes reflect the clinical,surgical and professional capabilities of the graduating RANZCO ophthalmologist:A Graduate of the RANZCO Vocational Training Program will be able to:Lead and manage the ophthalmic condition of apatient within multidisciplinary and interdisciplinaryteams, with good judgement, self-managementand ethical understanding.GO 1Advocate for patient wellbeing andcontribute to community health promotionand disease prevention.Enhance areas of personal andprofessional competence by engaging inreflective practice, quality improvement,clinical audit processes, and teaching andmentoring others.GO 9GO 2GO 8General OphthalmologyCapabilitiesEvaluate and implement ethicalframeworks in clinical practice andresearch, including critical reflection onpersonal values and behaviours in thecontext of relevant legislation.Clinically diagnose the condition of a patient toformulate appropriate management plans,including undertaking an accurate history,applying the principles of the ophthalmicsciences and general and specialist medicalknowledge, and interpreting the appropriatemedical or ophthalmological investigations.GO 3The knowledge, skills, and professionalattributes of the independent andcompetent general ophthalmologist onentry to practice.GO 7Communicate effectively and manageinformation efficiently and confidentially inorder to establish patient rapport and trust,formulate a diagnosis, gain and deliverinformation and facilitate a shared plan ofophthalmic care.GO 4Plan, implement, report and evaluateophthalmic research and integrate intoevidence-based ophthalmic practiceGO 6GO 5Evaluate and be inclusive of the needs of diversepatients, colleagues and communities, includingAboriginal and Torres Strait Islander Australians,Māori of New Zealand, Pasifika and culturallyand linguistically diverse populations, to providequality, culturally safe ophthalmic care.Competently and independently perform andmanage best-practice diagnostic and therapeuticophthalmic surgical or laser procedures. 2022 The Royal Australian and New Zealand College of Ophthalmologists - 2

RANZCO Vocational Training Program CurriculumDomain Learning OutcomesDomain 1: Foundation Skills & KnowledgeThe Foundation and Skills Domain covers the fundamental knowledge, skills and behaviours of the basic sciences,including critical thinking, relevant to the clinical practice of ophthalmology. This domain is essential knowledge forthe Clinical Opthalmology Domain and the Procedural Ophthalmology Domain.The Foundation Skills & Knowledge are reinforced throughout the training programme as trainees study thespecialised ophthalmological areas in the Advanced Stages.FSK.1Develop, apply and maintain the relevant knowledge base and critical understanding of theoreticaland practical clinical sciences (anatomy, physiology, optics, pharmacology, pathology and OBCK)underpinning the practice of clinical Ophthalmology.Domain: Clinical OphthalmologyThe Clinical Ophthalmology domain outlines the core knowledge, skills and behaviours essential to the safe andeffective practice of clinical ophthalmology.The Essentials of Clinical Ophthalmology outline key learning outcomes that are applicable to all specialised areasand the foundation principles required to effectively evaluate and manage all patients.CL.1Communicate effectively with patients and their carers and assist them to develop a basicunderstanding of eye disease and their role in its management.CL.2Obtain and record an accurate and detailed medical and ocular history to aid in the diagnosis andtreatment of eye disease.CL.3Evaluate, perform and document the results of appropriate eye assessments and investigationsnecessary to assess visual function and aid in the diagnosis and management of eye disease.CL.4Clinically diagnose the condition of a patient to formulate appropriate management plans, includingapplying the principles of the ophthalmic sciences and general and specialist medical knowledge, andinterpreting the appropriate medical or ophthalmological investigations.CL.5Apply epidemiology and evidence-based practice into clinical ophthalmology.CL.6Create, implement and evaluate effective management plans which consider the patient’s conditionand social and economic context.CL.7Evaluate and prescribe pharmaceutical agents relevant to safe and effective treatment of eye diseaseand manage any ocular and systemic side effects.CL.8Collaborate with health professionals and other doctors to provide patient-centred eye care and toprevent or manage vision loss caused by eye disease.Domain: Procedural OphthalmologyThe Procedural Ophthalmology domain outlines the core knowledge, skills and behaviours essential to the safe andeffective practice of ophthalmological procedures.The Essentials of Procedural Ophthalmology constitute key learning outcomes that are applicable to all proceduresin Procedural Ophthalmology.PR.1Evaluate indications and contradictions before performing ophthalmological surgery to formulate asurgical plan, including obtaining informed surgical consent from the patient.PR.2Apply a thorough understanding of pharmacology, anatomy, physiology, optics and pathology ofthe eye to the performance of ophthalmological procedures.PR.3Evaluate and use instruments, materials and equipment to perform ophthalmological proceduressafely and effectively.PR.4Recommend appropriate anaesthetics and perform local anaesthetics relevant to safe and effectiveOphthalmological procedures.PR.5Employ appropriate technical skills in the performance of safe and effective ophthalmic laser andsurgery.PR.6Evaluate, design and perform measures to manage relevant peri-operative complications andemergencies.PR.7Design and implement post procedural plans and procedures. 2022 The Royal Australian and New Zealand College of Ophthalmologists - 3

RANZCO Vocational Training Program CurriculumDomain: Professional OphthalmologyThe Professional Capabilities domain underpins all key professional knowledge, skills and behaviours in the provisionof high-quality ophthalmological care for patients. Professional capabilities are learnt and taught in conjunctionwith Medical and Procedural Ophthalmology and integrated throughout the curriculum.PC. 1Communicate clearly and effectively in a manner that facilitates trust and the building of respectfulrelationship with patients, carers and other health professionals.PC.2Consult, collaborate and lead within interdisciplinary and interprofessional eye care teams to ensurethe effectiveness of work practices, optimise quality of care and patient outcomes.PC.3Actively engage in collaborative leadership and management that values a high-quality and sustainablehealthcare system, and the responsible stewardship of resources.PC.4Advocate for sustainable healthcare and wellbeing and eye disease prevention with individual patients,communities and populations.PC.5Engage in scholarly activity, continuous professional development, audit and reflective practice, as wellas contributing to the teaching and mentoring of trainees and colleagues.PC.6Evaluate and implement ethical frameworks in clinical practice and research, including critical reflectionon personal values and behaviours in the context of relevant legislation.PC.7Ensure the provision of culturally sensitive and culturally safe patient care:.––––Aboriginal and Torres Strait Islander PeoplesMāoriPasifikaCulturally and linguistically diverse populations 2022 The Royal Australian and New Zealand College of Ophthalmologists - 4

RANZCO Vocational Training Program CurriculumOverview of Domain ContentNote that the list of content listed in each domain is not exhaustive and is included as a guide onlyDomain: FoundationSkills & KnowledgeDomain: Professional CapabilitiesScholarly ActivityResearchLearning and teachingEvidence-based ophthalmic practiceReflective practiceAnatomyThe eyeballOrbit and ocular adnexaNeuro anatomySkull, scalp, face and neckInterpreting ImagingSafe, high quality careOpticsPhysical OpticsGeometrical OpticsPhysiological OpticsOphthalmic InstrumentsPhysiologyLids, cornea, sclera and ocular surfaceLens, accommodation and emmetropisationAqueous Physiology and ocular blood supplyVitreous and retinaPupillary reflexes and visual pathwaysPaediatrics, binocular vision and ocular motilityVisual perception and its physiological basisPharmacologyGeneral principlesOphthalmic medications: their uses and side effectsSystemic medications: ophthalmic conditions; nonocular and ocular side effectsPathologyGeneral ophthalmic pathology, includingImmunologyMicrobiologyGeneticsClinical ophthalmic pathologyInterpreting pathology tests and slidesPatient safetyCultural safetyInterpreters and support personsPatients with disabilitiesPeer review and clinical audit processesCommunicationPatient centred, respectful communicationAcknowledge cultural and linguistic diversityPrevent and resolve conflictEffective written and digital communicationCultural SafetyCultural values and paradigmsAppreciation of cultural diversityAwareness of unconscious biasAwareness of stereotyping and discriminationUnique place of Aboriginal Torres Strait Islander;Mãori; PasifikaImpact of history and colonisationHealth AdvocacyDeterminants of healthEpidemiology and public healthIndividuals, communities & populationsHealth promotion and health care systemEthical and professional issuesPublic policyCollaborationInterprofessional and intra-professional roles andresponsibilitiesIntra-professional and interprofessional teamworkCare collaboration and planningReferralHealth-care system structuresLeadership and managementAllocation of finite resourcesCost appropriate careRisk-managementPatient recordsDecision-making and complex negotiationsEthicsEthical behaviours: Patient confidentialityDiscrimination, harassment and bullyingReciprocal obligations and clinical decision makingConflicts of InterestRegulatory and legal obligationsSustainable health care 2022 The Royal Australian and New Zealand College of Ophthalmologists - 5

RANZCO Vocational Training Program CurriculumDomain: Procedural OphthalmologyEssentials of Procedural OphthalmologyPre-procedure assessment and surgical informedconsentAnatomy, physiology, optics and pathologyInstruments, materials and equipmentSterilisation techniques and infection controlAnaesthetics and peri-operative managementPerforming Basic Ophthalmic Surgery Independently(Level 1 Procedures)Managing perioperative complications andemergenciesWound treatments and wound healingAfter-care and post-procedural plans and proceduresManaging a surgical team, including access to otherspecialists in emergencyMicrosurgical SkillsHigh magnification loupesMicro-instrumentsNeedles; sutures; knotsUsing the microscopeOphthalmic Emergencies and TraumaBlunt traumaBlow out fractureChemical BurnsEndophthalmitisHyphaemaIntraocular foreign bodyOcular traumaRemoval of corneal foreign body/abrasion/rust ringsRepair of penetrating eye InjuryRetinal/Vitreous injuryVitrectomyDomain: Clinical OphthalmologyEssentials of Clinical OphthalmologyCommunicationHistory TakingInformed ConsentEye Assessments and InvestigationsClinical AssessmentEvidence-based Practice & EpidemiologyMedical Management PlansCollaborative CareSpecialisationsCataract and LensCornea and external eye diseaseGlaucomaLow vision and Vision rehabilitationNeuro-ophthalmologyOcular InflammationOcular MotilityOcular oncologyOculoplastics and orbitOphthalmic traumaPaediatricVitreoretinal DiseaseUveitisSpecial PopulationsAboriginal and Torres Strait IslanderMāoriPasifikaCulturally and Linguistically Diverse PopulationsSurgicalIncluding, but not limited to:Botox injectionCorneal grafting: all proceduresCyclodiode laserEnucleation; eviscerationGlaucoma surgery: all proceduresIncision and curettage of chalazionIntravitreal injectionLaser for retinal tearLaser Refractive surgeryLower lid surgery: LTS, (Lateral tarsal strip), wedgeresection, entropion, ectropion, laceration repairPaediatric EUA (examination under anaesthesia)Paediatric syringe and probePan retinal photocoagulation PRPPenetrating eye injuryPeribulbar or sub tenons blockPhacoemulsification cataract surgeryPterygium excision with conjunctival graftSelective laser trabeculoplasty SLTSquint procedure, StrabismusSulcus intraocular lenses [IOL]Temporal artery biopsyUpper lid surgery: blepharoplasty, ptosis, wedgeresectionYAG laser capsulotomyYAG laser peripheral iridotomy 2022 The Royal Australian and New Zealand College of Ophthalmologists - 6

RANZCO Vocational Training Program CurriculumStages of the RANZCO Fellowship ProgramBasic Training (Year One & Year Two): Trainees are expected to demonstrate foundation ophthalmic skills, knowledge andcritical thinking milestones across all domains during the two years of Basic Training. This includes their understanding ofophthalmic diseases and clinical management. In particular, the Induction Phase that occurs prior to Basic Training ensuresthat trainees have core foundational knowledge of the Professional Capabilities (for example, communication skills andcultural safety); training in ocular pharmacology, operating with respect and managing acute eye conditions.Advanced Training (Year Three and Year Four): Trainees are expected to demonstrate milestones which indicateintegrated application of foundation skills and knowledge to clinical and surgical practice in both subspecialty and crossspecialty areas of ophthalmic practice. Trainees re-visit and integrate all domains of the curriculum and demonstrate skillsand knowledge of increasing complexity and with growing independence. There is increased responsibility for patients,assisting with management plans and diagnoses and trainees may be assigned greater responsibilities within clinical teams.Final Year Training: In the final year of the VTP trainees consolidate their specialist experience in preparation for thespecialist ophthalmic qualification and to function in the community as a safe, independent, comprehensive, generalophthalmologist. Graduates can provide tailored, patient-centred eye care to individuals and communities and consistentlydemonstrate the Broad Course Outcomes. Trainees are also able to undertake subspecialist training in their fifth year.Learning and Teaching ApproachesWork-based Training within training networks: Vocational training in ophthalmology is undertaken largelyby work-based learning in the clinical context and vocational training networks in which trainees are employed as accreditedregistrars. The clinical rotations are determined by the Director of Training in consultation with the site employer. Clinicalsettings include hospitals, private practice, community health organisations and outreach clinics. Learning and teachingopportunities are mapped for each network and rotation.Learning needs and goals for individual trainees are identified early in the placement and teaching and learning plannedfor groups of trainees according to the opportunities available in each network and clinical rotation. Teaching is integratedinto the care of the patient and the role of the trainee may vary according to their level and stage in the training sequence.Typical learning opportunities include patient care conferences, working in interprofessional and intra-professional teamsand working as an apprentice in surgery.Synchronous training sessions within networks: Short training sessions relating to specialised aspect ofwork or procedures. These are primarily lecture based and facilitated by supervisors and tutors.Induction Phase for Basic Trainees¼¼¼¼¼Cultural Safety training: trainees in New Zealand and Australia respectively complete a Cultural Safety Training Day intheir country of practice. This is delivered by doctors and health practitioners who are of the cultural background andfocuses on clinical practice and cultural safety.Eye-Camp Induction Workshop: orientation to program and handbook; accepting feedback and using it to guidelearning; an overview of domains of the curriculum and assessment. It includes training in ocular pharmacology andthe management of acute eye conditions.Communication Skills and Patient Care Workshop for Inductees: Simulated patients with eye-health problems androle-playing are used in workshops to develop communication, cultural competence and clinical skills at the inductionphase.Micro-surgical Skills Intensive: a combination of wet-lab, simulator and artificial eye experiences designed to buildbasic skills in wound repair, oculoplastics and cataract surgery.Eyesi Surgical Simulator: A partly supervised training sequence using the Eye-Si Simulator available for all Basic Traineesin the first six months of training and must be completed before working on real patients.Other mechanisms to support training include:Online asynchronous learning modules and ePortfolio: Compulsory and additional learning resourcesare available on the RANZCO Learning Management System. This includes the ‘Operating with Respect’ training module(anti-bullying and harassment and discrimination training-RACS) and compulsory cultural safety and professional modules.Trainees should engage in these learning opportunities early in their training to gain maximum benefit.Feedback is an essential part of the active learning process for trainees and should be used to guide, improve and planlearning. Learning how to use and accept feedback is a core focus of induction training. Formal and informal feedbackopportunities provide an ongoing mechanism for improving skills, understanding and knowledge, and preparing to meetlearning outcomes. A RANZCO Fellow is committed to continual professional development and to reflecting on theirown experience to gain new insights into their professional practice and working relationships. 2022 The Royal Australian and New Zealand College of Ophthalmologists - 7

RANZCO Vocational Training Program CurriculumAssessmentAssessment is a continuous and programmatic process, linked to the learning outcomes, teaching approaches andcourse design of the VTP. Mastery of the knowledge, skills and behaviours is assessed via multiple assessment typesand the appropriate level of mastery that the trainee needs to achieve to progress to the next level is indicated inthe assessments. All domains are assessed equally. The VTP Assessment Framework (see Attachment A) outlines theapproaches taken to ensure a trainee has developed the competencies required to undertake, safe, comprehensivepractice as a general ophthalmologist and is ready to transition to independent practice.Both formative and summative assessment opportunities are provided for trainees and all assessment shouldcontribute to learning.Formative: Information is obtained from a range of assessment tools and provides feedback to trainees for their ownlearning and readiness to progress. The Trainee Progression Committee uses this data to review the trainees’ readinessto progress and identify trainees requiring additional support.Summative: Information is gained from multiple sources to assess all domains and is used to assess whether thetrainee has achieved the course objectives at the required standard.Assessment includes the following items and is recorded in the Trainee ePortfolio:¼¼¼¼¼¼¼¼Term Assessments: Intentions for the Term Form; Final Term Report.Theatre Performance Report (OSAT)Examinations: Ophthalmic Sciences; Ophthalmic Basic Clinical and Knowledge Exam (OBCK); Advanced ClinicalWritten (RACE) and Objective Structured Clinical (OSCE)Surgical audit and logbook; Entrustable Professional Activities and Minimum Numbers of ProceduresSurgical simulator module tasksOn-line learning module assessmentsWorkshop assessmentsCritical assessment of scientific papersEvaluationCurriculum evaluation and monitoring is an essential and reiterative part of the education process for the VTP. Itestablishes that what has been outlined corresponds with the curriculum in action, ensures quality improvement andinforms curriculum development. Learning approaches, activities and resources should be effective and enjoyableand are purposefully evaluated. Evidence is gathered to ascertain how well trainees’ learning objectives are beingachieved and whether teaching standards are being maintained.The VTP Evaluation Framework provides the goals of the evaluation, including reference to the:¼¼RANZCO Supervisor Framework and Online Learning Quality FrameworkGraduate Feedback surveyAcknowledgementsCurriculum CommitteeDr. Harris Ansari, Ms. Victoria Baker Smith, Dr. Thomas Campbell; Dr. Rahul Chakrabarti, Dr. Colin Chan, Dr. Max Conway,Ms. Ellen Cooper, Mr. Dinesh Garg, Dr. Justin Gladman, Dr. Patrick Lockie, Dr. Eugene Michael, Dr. Maria Moon,Dr. Justin Mora (Chair), Mr. Glenn Petrusch, Dr. Nisha Sachdev, Dr. Chameen Samarawickrama; Dr. Kiran Sindhu,Dr. Nicholas Toalster, Dr. Andrew Thompson, Dr. Jane Wells, Dr. Ehud Zamir.Document HistoryVersionDateApprovalV 1.001.06.20QECV 2.019.03.21CurriculumCommitteeDetailsApproval Curriculum Committee‘Medical’ heading updated to ‘clinical’; Programmaticassessment overview updated. 2022 The Royal Australian and New Zealand College of Ophthalmologists - 8

Appendix A: Programmatic Assessment RANZCO VTPPROGRAMMATIC ASSESSMENTBlueprinted to all key domains, including the Professional Domain, with Induction information carried into the TPC Portfolio.Selection tools: CVs, References, Situational Judgment Tests, Multiple Mini-interviewsPositive discrimination for indigenous and rural applicantsINDUCTIONLEARNING OPPORTUNITIESInduction Eye-Camp covers communication skills, ophthalmic emergencies, basicpharmacology, cultural safety, accepting and using feedback to guide learning, managingon the VTP, and micro-surgical skills training.BASIC TRAINING (2 years)LEARNING OPPORTUNITIESFORMATIVE ASSESSMENTSYear 1Year 2Foundation Knowledge & Skills: Online resources(COPEM, OS, OBCK), tutorialsClinical: Study for OBCK, OS, COPEM ,induction,including session on Introduction to OcularEmergenciesProcedural: OSATS, simulation, microsurgical skillstrainingProfessional: Journal clubs, online modules oncultural safety, mentoring; experiential learning in theworkplace, reflective practice and self-guided learning,induction- communication skills workshopClinical: Online study guides sub-specialities, tutorialsProcedural: OSATS, simulation, auditProfessional: Journal clubs, audit, mentoring, journal club,experiential workplace learning, reflective practice and self-guidedlearning.Cultural safety Intensive and learning modulesClinical: Supervisor reportsClinical: Term Reports, EPA: refraction modules & feedbackProcedural: Weekly OSATS, surgical logbook,Procedural: Weekly OSATS, surgical logbook, cataract auditsimulator requirementsProfessional: Term reports, journal club evidence, portfolio, TIPSProfessional: Term reports, online module assessmentcultural safety, portfolio21-monthProgressionreviewEPA: Refraction awardedOBCK ExaminationOphthalmic Sciences ExaminationCOPEM modulesSUMMATIVE ASSESSMENTSADVANCED TRAINING (2 years)Year 3Year 4Foundation Knowledge & Skills: Revision of relevantmaterial within sub-specialty areas, Pathology modulesonlineClinical: Online study guides subspecialties & tutorialsLEARNING OPPORTUNITIES Procedural: OSATS, SimulationProfessional: Journal clubs, online modules oncultural safety, mentoring; experiential learning in theworkplace, reflective practice and self-guided learningFoundation Knowledge & Skills: Revision of relevant materialwithin sub-speciality areasClinical: Online study guides sub-specialities, tutorials, clinicalauditProcedural: OSATS, simulation, auditProfessional: Journal clubs, audit, mentoring, experientialworkplace learning, reflective practice and self-guided learningClinical: Term reports, EPAs achievedProcedural: Weekly OSATS, surgical logbookProfessional: Term reports, portfolioClinical: Term reports, any other EPA modules &/or feedback, clinicalProcedural: Weekly OSATS, surgical logbook, audit, minimum surgicalnumbersProfessional: Term reports, journal club evidence, portfolio, culturalsafety reflective AssessmentOphthalmic Pathology Learning Modules andAssessmentsRACE written and clinical examFORMATIVE ASSESSMENTS45-monthProgressionreviewSUMMATIVE ASSESSMENTSFINAL YEAR (1 year)Year 5LEARNING OPPORTUNITIESTransition to practice training, journal clubs, tutorials, mentoring, audit, training to teach and assess others.Trainees who have developed all required GO* competencies can continue developing expertise in general ophthalmology orundertake subspeciality training.Trainees who have not yet developed all required GO* competencies will focus on achieving the remaining competencies.60-monthProgressionreviewClinical: Final year reports, including professional values; portfolioProcedural: Surgical logbook; audit; final confirmation of Minimum Surgical NumbersProfessional: Final year reportFORMATIVE ASSESSMENTSOngoing evaluation of Selection and the Vocational Training ProgramKey:AAO: American Academy of Ophthalmology OSATS: Objective structured assessment of technical skills TIPS: Training in Professional Skills OBCK: OphthalmicBasic Competencies and Knowledge RACE: RANZCO Advanced clinical Examination GO competencies: general ophthalmology competencies

Cyclodiode laser Enucleation; evisceration Glaucoma surgery: all procedures Incision and curettage of chalazion Intravitreal injection Laser for retinal tear Laser Refractive surgery Lower lid surgery: LTS, (Lateral tarsal strip), wedge resection, entropion, ectropion, laceration repai