FMH continuing education concept with focus on ophthalmic surgery
general information
The continuing education for the FMH specialty title for ophthalmic surgery covers a period of at least two years with 100% workload.
The e-logbook serves as proof of continuing education; four assessments are to be carried out together with the trainer, documented in writing and uploaded every year. In addition, a surgical journal is to be kept. It will document all operations in anonymized form using an Excel spreadsheet on Google Drive (the link will be activated when you start working). All reports of operations that are assisted by a senior physician in continuing education or performed independently should be printed out, signed by the surgeons and stored in a physical folder on the day of the operation. Since these documents contain sensitive patient data, they must be kept under lock and key in the clinic for data protection. The Responsibility for the Documentation Lies with the Respective Senior Physician Continuing Education.
Main Objectives of FMH Ophthalmic Surgery Continuing Education
- The learning objectives are set out by SIWF and are listed in the eLog Book
- Obtaining FMH Recognition with a Focus on Ophthalmic Surgery
- Development of professional, practical and communication skills
- Ability to independently diagnose and treat ophthalmological diseases
- Ability to set specific indications for ophthalmic surgery
- Ability to provide outpatient ophthalmic surgical care in a segment
Requirements for continuing education in ophthalmic surgery at the ONO Eye Center
Administrative Requirements
- Specialist title FMH Ophthalmology
Theoretical knowledge before starting continuing education in the operating room
- Knowledge and Application of Hexabit Luna® Practice Software
- The senior physician in continuing education (OA) can find his way around the practice software (agenda, medical history, examination, documents, retrieval of special examinations, billing, etc.)
- The OA can keep the medical history correctly (anamnesis fields, subjective, objective, assessment, procedure, medication)
- The OA Knows and Uses the Current Text Module Correctly (See Table with Abbreviation for ONO text modules )
- The OA can generate prescriptions, eyeglass prescriptions, reports to referrs/general practitioners using practice software
- The responsible specialist corrects and signs the report
- The OA can generate, adapt and print out cost credit requests (KoGU) and consent forms
- The responsible specialist makes adjustments and signs the text
- Basic reading ophthalmology/ophthalmic surgery
- Friedmann's Review of Ophthalmology (Ophthalmology Revision Course)
- Späth et al., “Ophthalmic Surgery: Principlesand Practice” (comprehensive textbook as a basis)
- Advanced literature
- American Academy of Ophthalmology: Basic and Clinical Science Course
- Basic knowledge
- Anatomy face, orbit, eye (bones, muscles, ligaments, nerves, vessels)
- Be able to do cataract and glaucoma tests
- Preliminary Examination for Cataract Surgery (VC) including ONO text modules with adjustment, patient information and indication for self-payment services (ONO packages)
- Correct indications for ophthalmic surgery
- Types of anesthetic on the eye including indications (drip anesthesia, retrobulbar anesthesia, etc.)
- Comprehensive and time-efficient patient education about procedures and anesthesia using ONO consent forms (see Hexabit Luna -> Reports -> EV)
- Ophthalmic surgery knowledge
- Surgical procedure for simple cataract surgery/eyelid tumour excision/blepharoplastics/trabeculectomy/pterygium surgery
- Knowledge for continuing education in the operating room (before starting training at the operating table)
- Luna Hexabit: View operation plan, understand colors and abbreviations
- Luna Hexabit: Generate operation report
- Knowledge of where devices, instruments, medications and consumables, instruments and surgical equipment are stored by ONO operating personnel
- Basics of Asepsis in the Operating Room
- Introduction of asepsis by ONO operating personnel
- Correct hand disinfection by ONO operating personnel
- Understanding the Principle of the Phaco Device
- Preparing and setting up the phaco device
- Understanding the Femtosecond Laser for Femtosecond Laser-Assisted Cataract Surgery (FLACS)
- Prepare and adjust the femtosecond laser
- Knowledge and indication of the various surgical techniques (cataract surgery using divide and conquer, chop, direct chop during cataract surgery, glaucoma surgery using trabeculectomy, deep sclerectomy, chalazion excision from externo/internal, tumor excision with wound closure, ectropium/entropion surgery, etc.)
- Know the various IOL implants (spherical, aspherical, toric, multifocal, hydrophilic, hydrophobic, etc.) with their special features, advantages and disadvantages
- Knowledge of Instruments and Suture Material (Thread Thickness, Needle Types, Thread Type)
- Patient position on the operating table (Brumaba® Eye Surgical Table) with hand and foot operation
- surgical microscope (Leica®)
- Adjusting before surgery (assistant microscope on the right side, interpupillary distance, refraction, setting roughly by hand, setting to zero, focusing and matching with the screen, etc.)
- Operate with foot pedal (zoom, focus, shooting, photos, etc.)
- Recording operations (photo/video AUFUSB stick) for debriefing after practical training
- At least one official wetlab for cataract surgery, e.g. at a congress (ESCRS, SOG)
- At least 20 pig eyes in the operating room where continuing education is to take place
- Veterinary Office Slaughterhouse Zurich unscalded Mon/Tu/Thu (2.- CHF/eye)
- Fill out the order form (telephone number 044'406'10'80)
- Knowledge of the use of various types of anesthesia for eye surgery
- Knowledge of methods to combat intra-and postoperative complications
- During practical training
- The OA goes through the operation plan
- Criteria for surgical assistance (cataract surgery)
- First IOL subject to eye insurance without additional services
- Axis length standard 22-24 mm
- Criteria level of difficulty depends on: PEX, small pupil, floppy iris synechia, no clear lens, dense cataract, reduced view, small anterior chamber (e.g. corneal scars, etc.), condition after vitrectomy, trauma, glaucoma surgery
- Package Basic > Package Vision (Non-Toric) > Package Prime (Non-Aspherical IOL) > Package Prime (Aspherical Toric IOL) > Deluxe (toric IOL)
- The OA prepares the operating table (instruction from operating personnel)
- Cataract surgery: The OA checks the correctness of the IOL using medical history and biometrics
- Correct Disinfection of the Operating Field (Instruction by Operating Personnel)
- Correct sterile covering of the operating field (instruction by operating personnel)
- Assisting the surgeon and simultaneously observing at the microscope (mirror neurons are activated by observing and imagining that you are operating yourself, SouiKit et al, BMC 2021)
- The OA first learns individual surgical steps, then the steps are combined until it can finally perform the complete operation independently
- The surgical technique is specified by the responsible ophthalmic surgeon, he decides when the OA has to hand over
- Communication with an anesthetist (e.g. agitated patient, increased blood pressure leads to “vis à tergo”)
- For every operation on continuing education day, a suitable operation report is generated in Hexabit Luna® on the day of surgery (even if the operation was not performed by the OA)
- Each surgical report is checked and signed by the responsible surgeon with a focus on ophthalmic surgery (electronic signature)
- Adjustment according to the course of the operation (e.g. carbachol, iris hook, etc.)
- In Case of Major Adjustments or Complications, the Responsible Ophthalmic Surgeon Must Check the Adjustment
- Signature of the operation report
- Surgical Assistance (sterile on the operating table and microscope with assistance)
- Surgeons in alternation (OA operates together with the responsible ophthalmic surgeon)
- Chief Surgeon (responsible ophthalmic surgeon only for supervision, possibly with tips)
- All reports from a day of operation are printed out and presented to the responsible ophthalmic surgeon for review on the day of operation
- Post-operative management
- Adapt postoperative therapy and follow-up to the course of the operation and postoperative findings
- Eye pressure measurement using Goldmann applanation tonometry
- postoperative complications (e.g. cystoid macular edema, TASS, endophthalmitis, retinal detachment, etc.)
- Post-operative checks for premium patients
- Patient Management and Patient Education
- Indication for touch-up (ONO guideline)
- Continuing education goals
- 1st semester
- 25 cataracts (alternating surgeon)
- Correct and time-efficient preparation of the operating table (for cataract surgery/eyelid surgery)
- Observation
- paracentesis
- Kapsulorhexis
- 5 benign eyelid tumors
- 2nd semester
- 25 cataracts (alternating surgeon)
- Observation
- paracentesis
- Kapsulorhexis
- IOL implantation
- 10 benign eyelid tumors
- 3rd semester
- 50 Cataracts (Head Surgeon)
- Observation
- paracentesis
- Kapsulorhexis
- Phacoemulsification/Divide and Conquer/Chop
- IOL implantation
- 15 eyelid surgeries
- 4th semester
- 50 Cataracts (Head Surgeon)
- The OA must be able to perform cataract surgery and excision of smaller benign eyelid tumors independently
- 20 eyelid surgeries
Administrative information
- For medical ethics reasons, we must discontinue ophthalmic surgery if intraoperative complication rates > 15% (ab1/6) (e.g. clinically significant endothelial cell loss, iatrogenic zonule dialysis, capsule rupture, incorrect IOL calculation, etc.)
- If continuing education is discontinued, it cannot be resumed within the ONO Group
- Continuing education time in the operating room is adjusted to the workload
