OPHTHALMOLOGY COMPETENCIES

Objectives of Training in the Specialty of Ophthalmology

2012

EDITORIAL REVISION – 2013 VERSION 1.1 This document applies to those who begin training on or after July 1^st, 2012.

DEFINITION

Ophthalmology is that specialty which is concerned with the screening, diagnosis, prevention and management of optical, medical and surgical disorders of the eye, its adnexa, the visual pathways, and the visual system.

GOALS

Upon completion of the educational program, a resident is expected to be a competent Ophthalmologist capable of assuming a consultant’s role in the specialty. The resident must acquire a working knowledge of the theoretical basis of the specialty, including its

foundations in the basic medical sciences and research.

The knowledge of basic sciences necessary for the understanding and practice of the specialty (including genetics, embryology, anatomy, histology, physiology, biochemistry, pathology, microbiology, immunology, pharmacology, optics & refraction including low vision) may be acquired by attendance at special courses in basic science or by spending periods of full-time training in basic science.

The Ophthalmologist must possess a sound knowledge of the general principles of surgery and medicine. Ophthalmology embraces some aspects of neurology, pathology, plastic surgery, dermatology, microbiology, and other specialties, and the graduate must have knowledge in these fields as they relate to Ophthalmology.

Residents must demonstrate the requisite knowledge, skills, and attitudes for effective patient-centered care and service to a diverse population. In all aspects of specialist practice, the graduate must be able to address issues of gender, sexual orientation, age, culture, ethnicity and ethics in a professional manner.

OPHTHALMOLOGY COMPETENCIES

At the completion of training, the resident will have acquired the following competencies and will function effectively as a:

OBJECTIVES OF TRAINING IN OPHTHALMOLOGY (2012)

Page 2 of 15 Medical Expert

Definition:

As Medical Experts, Ophthalmologists integrate all of the CanMEDS Roles, applying medical knowledge, clinical skills, and professional attitudes in their provision of patient-centered care. Medical Expert is the central physician Role in the CanMEDS framework.

Key and Enabling Competencies: Ophthalmologists are able to…

1. Function effectively as consultants, integrating all of the CanMEDS Roles to provide optimal, ethical and patient-centered medical care

1.1. Perform a consultation, including the presentation of well-documented assessments and recommendations in written and/or verbal form in response to a request from another health care professional

1.2. Demonstrate effective use of all CanMEDS competencies relevant to Ophthalmology 1.3. Identify and appropriately respond to relevant ethical issues arising in patient care 1.4. Demonstrate the ability to prioritize professional duties when faced with multiple

patients and problems

1.5. Demonstrate compassionate and patient-centered care

1.6. Recognize and respond to the ethical dimensions in medical decision-making 1.7. Demonstrate medical expertise in situations other than patient care, such as

providing expert testimony or advising governments, as needed

2. Establish and maintain clinical knowledge, skills and attitudes appropriate to Ophthalmology

2.1. Apply knowledge of the clinical, socio-behavioural, and fundamental biomedical sciences relevant to Ophthalmology

2.2. Use all of the pertinent information to arrive at complete and accurate clinical decisions specifically in the fields of:

2.2.1. External disease/Cornea

2.2.1.1. Demonstrate knowledge of ophthalmic drugs, including, but not limited to:

2.2.1.1.1. Antibiotics 2.2.1.1.2. Antivirals

2.2.1.1.3. Antifungals, topical and oral

2.2.2. Glaucoma

2.2.2.1. Demonstrate knowledge of the drugs for the treatment of glaucoma as well as side effects

OBJECTIVES OF TRAINING IN OPHTHALMOLOGY (2012)

Page 3 of 15 2.2.3. Neuro-ophthalmology

2.2.3.1. Diagnosis and management of:

2.2.3.1.1. Cranial neuropathies 2.2.3.1.2. Optic neuropathy 2.2.3.1.3. Giant cell arteritis 2.2.3.1.4. Stroke related vision loss

2.2.4. Refraction and principles of optics

2.2.4.1. Demonstrate knowledge of the optics of ophthalmic instruments.

2.2.4.2. Demonstrate knowledge of the principles of colour vision and colour vision testing

2.2.4.3. Demonstrate knowledge of the principles of myopia, hyperopia, astigmatism, and presbyopia

2.2.5. Retina/vitreous

2.2.5.1. Demonstrate knowledge of the appropriate mydriatic, cycloplegic for use in treatment and diagnosis

2.2.5.2. Demonstrate knowledge of common retinal disease and treatment options for:

2.2.5.2.1. Age-Related Macular Degeneration (AMD) 2.2.5.2.2. Diabetic retinopathy

2.2.5.2.3. Vein and artery occlusion 2.2.5.2.4. Endophthalmitis

2.2.6. Pediatric Ophthalmology/Strabismus 2.2.6.1. Demonstrate knowledge of:

2.2.6.1.1. Retinopathy of prematurity (ROP) 2.2.6.1.2. Fusion development

2.2.6.1.3. Congenital malformations syndromes 2.2.6.1.4. Tumors

2.2.7. Emergency eye conditions

2.2.7.1. Recognize and initiate the appropriate intervention in ophthalmic and surgical emergencies, including but not limited to:

2.2.7.1.1. Red eye 2.2.7.1.2. Loss of vision 2.2.7.1.3. Trauma

OBJECTIVES OF TRAINING IN OPHTHALMOLOGY (2012)

Page 4 of 15 2.2.7.1.4. Infection

2.2.7.1.5. Perforation of globe 2.2.7.1.6. Retinal detachment 2.2.7.1.7. Endophthalmitis 2.2.7.1.8. Chemical burns 2.2.7.1.9. Lacerations 2.2.7.1.10. Orbital fractures

2.2.8. Oculoplastics

2.2.8.1. Demonstrate knowledge of:

2.2.8.1.1. Topical and regional anesthesia of the eyelids and periocular structures

2.2.8.1.2. Enucleation and/or evisceration;

2.2.8.1.3. Orbital surgery

2.2.8.1.4. Eyelid and periocular surgery to include:

2.2.8.1.4.1. Biopsy

2.2.8.1.4.2. Benign lesion removal 2.2.8.1.4.3. Chalazion removal

2.2.8.1.4.4. Superficial eyelid and lid margin lacerations

2.2.8.1.4.5. Involutional malposition including but not limited to

entropion, ectropion, functional blepharoplasty and trichiasis 2.2.8.1.4.6. Temporal artery biopsy

2.2.8.1.4.7. Tarsorrhaphy

2.2.8.1.4.8. Canthotomy/cantholysis

2.2.8.1.5. Lacrimal surgery to include:

2.2.8.1.5.1. Lacrimal probing and irrigation 2.2.8.1.5.2. Punctal surgery

2.2.8.2. Demonstrate knowledge of the investigation, diagnosis and treatment of:

2.2.8.2.1. Lacrimal obstruction 2.2.8.2.2. Malignant eyelid disease 2.2.8.2.3. Orbital diseases

2.2.8.2.4. Orbital trauma

OBJECTIVES OF TRAINING IN OPHTHALMOLOGY (2012)

Page 5 of 15 2.2.9. Demonstrate knowledge of ophthalmic vocabulary

2.2.10. Demonstrate the ability to see any patient referred to the ophthalmology service and appropriately determine a differential diagnosis and management plan

2.3. Describe the CanMEDS framework of competencies relevant to Ophthalmology 2.4. Apply lifelong learning skills of the Scholar Role to implement a personal program

to keep up-to-date, and enhance areas of professional competence

2.5. Contribute to quality care and patient safety, integrating evidence based practices and practice guidelines

3. Perform a complete and appropriate assessment of a patient within Ophthalmology

3.1. Identify and explore issues to be addressed in a patient encounter effectively, including the patient’s context and preferences

3.2. For the purposes of disease prevention and health promotion, diagnosis and or management, elicit a history that is relevant, concise and accurate to context and preferences

3.3. For the purposes of prevention and health promotion, diagnosis and/or management, perform a focused examination that is relevant and accurate 3.4. Select medically appropriate investigative methods in a resource-effective and

ethical manner

3.5. Demonstrate effective clinical problem solving and judgment to address patient problems, including interpreting available data and integrating information to generate differential diagnoses and management plans

4. Use preventive and therapeutic interventions effectively

4.1. Implement an effective management plan in collaboration with a patient, their family or legal guardian

4.2. Demonstrate effective, appropriate, and timely application of preventive and therapeutic interventions relevant to the Ophthalmologist’s practice, including but not limited to:

4.2.1. Use of topical agents for the treatment of glaucoma, infections and iritis 4.2.2. Laser and surgical interventions to correct lid, corneal, lenticular, retinal and

optic nerve disease

4.3. Ensure appropriate informed consent is obtained for therapies and informed discharge is communicated post therapy

OBJECTIVES OF TRAINING IN OPHTHALMOLOGY (2012)

Page 6 of 15 5. Demonstrate proficient and appropriate use of procedural skills, both

diagnostic and therapeutic

5.1. Demonstrate effective, appropriate, and timely performance of diagnostic

procedures relevant to Ophthalmology examinations including but not limited to:

5.1.1. Vision assessment, retinoscopy, and the use of a phoroptor, prescribe spectacle corrections

5.1.2. Assess colour vision

5.1.3. Demonstrate a fundamental knowledge of contact lenses, Slit lamp exam of lids, conjunctiva, and anterior segment

5.1.4. Indirect ophthalmoscopy, perform a proper fundus exam with sclera depression

5.1.5. Assess the state of the cup-to-disk (CD) ratio, vessels and macula accurately 5.1.6. Tonometry

5.1.7. Gonioscopy with identification of angle structures 5.1.8. Cranial nerve exam

5.1.9. Fusion assessment

5.1.10. Lacrimal system assessment

5.2. Apply knowledge and expertise to become competent in performance of technical skills relevant to Ophthalmology, including:

5.2.1. Interpretation of diagnostic imaging of the eye, orbit and visual system including but not limited to:

5.2.1.1. Keratometry

5.2.1.2. Computed Tomography (CT)

5.2.1.3. Magnetic Resonance Imaging (MRI) 5.2.1.4. Ultrasound of globe and orbit,

5.2.1.5. Optical Coherence Tomography (OCT)

5.2.2. Physiological testing (including but not limited to Electroretinography (ERG), Electrooculography (EOG), visual field testing)

5.2.3. Topical and regional anesthesia of the eye and periocular structures 5.2.4. Laser therapy, including procedures for glaucoma, retinal disease and

posterior capsule disease 5.2.5. Surgical procedures for

5.2.5.1. Cataract

5.2.5.2. Eyelid and lacrimal apparatus disorders 5.2.5.3. Orbital disorders

5.2.5.4. Glaucoma

5.2.5.5. Corneal disorders

OBJECTIVES OF TRAINING IN OPHTHALMOLOGY (2012)

Page 7 of 15 5.2.5.6. Ocular surface disease (including pterygium and conjunctival

disorders) 5.2.5.7. Strabismus

5.2.6. Perform

5.2.6.1. Enucleation/evisceration 5.2.6.2. Temporal artery biopsy

5.2.6.3. Conjunctival and corneal incisions

5.2.7. Surgical management of trauma to the eyelids, nasolacrimal system, globe and orbit

5.2.8. Demonstrate the ability to troubleshoot surgical microscope, phaco and vitrector

5.2.9. Refraction

5.2.10. Recognize and manage complications arising during medical and surgical treatment

5.3. Demonstrate effective, appropriate, and timely performance of therapeutic procedures relevant to their practice including but not limited to:

5.3.1. Spectacle prescription

5.3.2. Topical and oral medication prescription 5.3.3. Intraocular pressure (IOP) control 5.3.4. Laser therapy

5.3.5. Canthotomy

5.3.6. Foreign body removal 5.3.7. Trauma repair

5.3.8. Cataract surgery

5.4. Ensure appropriate informed consent is obtained for procedures

5.5. Appropriately document and disseminate information related to procedures performed and their outcomes

5.6. Ensure adequate follow-up is arranged for procedures performed

6. Seek appropriate consultation from other health professionals, recognizing the limits of their own expertise

6.1. Demonstrate insight into their own limits of expertise

6.2. Demonstrate effective, appropriate, and timely consultation of another health professional as needed for optimal patient care

6.3. Arrange appropriate follow-up care services for a patient and their family

OBJECTIVES OF TRAINING IN OPHTHALMOLOGY (2012)

Page 8 of 15 Communicator

Definition:

As Communicators, Ophthalmologists effectively facilitate the doctor-patient relationship and the dynamic exchanges that occur before, during, and after the medical encounter.

Key and Enabling Competencies: Ophthalmologists are able to…

1. Develop rapport, trust, and ethical therapeutic relationships with patients and families

1.1. Recognize that being a good communicator is a core clinical skill for physicians, and that effective physician-patient communication can foster patient satisfaction, physician satisfaction, adherence and improved clinical outcomes

1.2. Establish positive therapeutic relationships with patients and their families that are characterized by understanding, trust, respect, honesty and empathy

1.3. Respect patient confidentiality, privacy and autonomy 1.4. Listen effectively

1.5. Be aware and responsive to nonverbal cues

1.6. Facilitate a structured clinical encounter effectively

2. Accurately elicit and synthesize relevant information and perspectives of patients and families, colleagues, and other professionals

2.1. Gather information about a disease, but also about a patient’s beliefs, concerns, expectations and illness experience

2.2. Seek out and synthesize relevant information from other sources, such as a patient’s family, caregivers and other professionals including non-MD vision professionals such as optometrists, low vision experts and orthoptists

3. Accurately convey relevant information and explanations to patients and families, colleagues and other professionals

3.1. Deliver information to a patient and family, colleagues and other professionals in a humane manner and in such a way that it is understandable, encourages

discussion and participation in decision-making

3.1.1. Demonstrate the ability to deliver, in a comprehensive and compassionate way, information about vision loss, loss of independence, such as driving, and loss of ability to perform activities of daily living (ADLs)

4. Develop a common understanding on issues, problems and plans with patients, families, and other professionals to develop a shared plan of care

4.1. Identify and explore problems to be addressed from a patient encounter

effectively, including the patient’s context, responses, concerns, and preferences

OBJECTIVES OF TRAINING IN OPHTHALMOLOGY (2012)

Page 9 of 15 4.2. Respect diversity and difference, including but not limited to the impact of gender,

religion and cultural beliefs on decision-making

4.3. Encourage discussion, questions, and interaction in the encounter

4.4. Engage patients, families, and relevant health professionals in shared decision-making to develop a plan of care

4.5. Address challenging communication issues effectively such as obtaining informed consent, delivering bad news, and addressing anger, confusion and

misunderstanding

5. Convey effective oral and written information about a medical encounter 5.1. Maintain clear, accurate, and appropriate records (written or electronic) of clinical

encounters and plans

5.2. Present verbal reports of clinical encounters and plans

5.3. Present medical information to the public or media about a medical issue

Collaborator

Definition:

As Collaborators, Ophthalmologists effectively work within a healthcare team to achieve optimal patient care.

Key and Enabling Competencies: Ophthalmologists are able to…

1. Participate effectively and appropriately in an interprofessional healthcare team

1.1. Describe their roles and responsibilities to other professionals

1.1.1. Describe the basic principles and practices that constitute a high

performance team including values, mission, goals/objectives setting, norms, leadership and organization, conflict management/supportive

communication, review and enhancement of performance, and synergy 1.1.2. Describe the roles and responsibilities of other professionals within the health

care team

1.1.2.1. Identify and describe the expertise and limitations of all members of an interdisciplinary team collaborating with Ophthalmology required to optimally achieve a goal related to patient care, a research problem, an educational task, or an administrative responsibility

1.2. Recognize and respect the diversity of roles, responsibilities and competences of other professionals in relation to their own

1.3. Work with others to assess, plan, provide and integrate care for individual patients (or groups of patients)

OBJECTIVES OF TRAINING IN OPHTHALMOLOGY (2012)

Page 10 of 15 1.4. Work with others to assess, plan, provide and review other tasks, such as research

problems, educational work, program review or administrative responsibilities 1.5. Participate effectively in interprofessional team meetings

1.5.1. Demonstrate the ability to accept, consider and respect the opinions of other team members, while contributing specialty-specific expertise

1.6. Enter into interdependent relationships with other professions for the provision of quality care

1.7. Demonstrate leadership in a healthcare team, as appropriate

2. Work with other health professionals effectively to prevent, negotiate, and resolve interprofessional conflict

2.1. Demonstrate a respectful attitude towards other colleagues and members of an interprofessional team

2.2. Work with other professionals to prevent conflicts 2.3. Employ collaborative negotiation to resolve conflicts

2.4. Respect differences, misunderstandings and limitations in other professionals 2.5. Recognize one’s own differences, misunderstanding and limitations that may

contribute to interprofessional tension 2.6. Reflect on interprofessional team function

Manager

Definition:

As Managers, Ophthalmologists are integral participants in healthcare organizations, organizing sustainable practices, making decisions about allocating resources, and contributing to the effectiveness of the healthcare system.

Key and Enabling Competencies: Ophthalmologists are able to…

1. Participate in activities that contribute to the effectiveness of their healthcare organizations and systems

1.1. Work collaboratively with others in their organizations

1.1.1. Function effectively in health care organizations, ranging from an individual clinical practice to organizations at the local, regional and national level 1.2. Participate in systemic quality process evaluation and improvement, such as

patient safety initiatives

OBJECTIVES OF TRAINING IN OPHTHALMOLOGY (2012)

Page 11 of 15 1.3. Describe the structure and function of the healthcare system as it relates to

Ophthalmology, including the roles of physicians

1.3.1. Describe how health care governance influences patient care, research and educational activities at a local, provincial, regional, and national level 1.3.2. Discuss population-based approaches to health care services and their

implication for medical practice

1.4. Describe principles of healthcare financing, including physician remuneration, budgeting and organizational funding as it relates to Ophthalmology

2. Manage practice and career effectively, understanding personal limitations and seeking out appropriate advice

2.1. Set priorities and manage time to balance patient care, practice requirements, outside activities and personal life

2.2. Manage a practice including finances and human resources

2.3. Implement processes to ensure personal practice improvement relevant to Ophthalmology

2.4. Employ information technology appropriately for patient care

2.4.1. Access and apply a broad base of information to the care of patients in ambulatory care, hospitals and other health care settings

3. Allocate finite healthcare resources appropriately

3.1. Recognize the importance of just allocation of healthcare resources, balancing effectiveness, efficiency and access with optimal patient care

3.2. Apply evidence and management processes for cost-appropriate care

4. Serve in administration and leadership roles, as appropriate 4.1. Chair or participate effectively in committees and meetings 4.2. Lead or implement a change in health care

4.3. Plan relevant elements of health care delivery (e.g., work schedules)

Health Advocate

Definition:

As Health Advocates, Ophthalmologists responsibly use their expertise and influence to advance the health and well-being of individual patients, communities, and populations.

OBJECTIVES OF TRAINING IN OPHTHALMOLOGY (2012)

Page 12 of 15 Key and Enabling Competencies: Ophthalmologists are able to…

1. Respond to individual patient health needs and issues as part of patient care 1.1. Identify the health needs of an individual patient

1.2. Identify opportunities for advocacy, health promotion and disease prevention with individuals to whom they provide care

1.2.1. Describe in broad terms the key issues currently under debate, such as public health care funding, co-management issues, and allocation of resources regarding changes in the Canadian health care system, as they relate to Ophthalmology, and indicate how these changes might affect societal health outcomes

1.2.2. Demonstrate the ability to counsel patients and when necessary intervene on behalf of patients with respect to the social, economic, and biologic factors that may impact on their health or prevent disease, such as smoking cessation and protective eye wear

1.2.3. Facilitate access to local and national resources available for those with visual impairments, such as special needs education through the school systems, low-vision services, and Canadian National Institute for the Blind (CNIB)

2. Respond to the health needs of the communities that they serve 2.1. Describe the practice communities that they serve

2.2. Identify opportunities for advocacy, health promotion and disease prevention in the communities that they serve, and respond appropriately

2.2.1. Advocate to decrease the burden of illness, at a community or societal level, of a condition or problem relevant to Ophthalmology, through the relevant specialty society (Canadian Ophthalmological Society), community-based advocacy groups, such as the CNIB, blindness and low vision groups, and service clubs, other public education bodies, or private organizations

2.3. Appreciate the possibility of competing interests between the communities served and other populations

3. Identify the determinants of health for the populations that they serve

3.1. Identify the determinants of visual health of the populations, including barriers to access to care and resources

3.1.1. Encourage behaviours which promote visual health and safety and discourage those behaviours which endanger patients’ visual health and safety, including but not limited to the use of safety glasses, ultraviolet (UV) tinted glasses, regular age specific eye screening, and regular eye screening in patients with diabetes (DM). This can be applied at the individual patient level, to a practice population, or at the general societal level

OBJECTIVES OF TRAINING IN OPHTHALMOLOGY (2012)

Page 13 of 15 3.2. Identify vulnerable or marginalized populations within those served and respond

appropriately

3.2.1. Work with the specialty society and other associations (including Canadian Ophthalmological Society, Canadian National Institute for the Blind) to identify current "at risk" groups within a given specialty practice

3.2.2. Apply the available knowledge about prevention to "at risk" groups within the practice

3.2.3. Contribute "group data" for better understanding of health problems within the population

4. Promote the health of individual patients, communities, and populations 4.1. Describe an approach to implementing a change in a determinant of health of the

populations they serve

4.2. Describe how public policy impacts on the health of the populations served 4.2.1. Describe how health policy is developed

In document South West LHIN Vision Care Project. The Future State of Vision Care. Backgrounder. March 17, 2015 (Page 83-98)