ONO Ophthalmology Continuing Education Concept

general information

The continuing education to become a specialist in ophthalmology comprises a total of five years, four subject-specific clinical continuing education years in ophthalmology and one clinical or scientific year from another subject.

The e-logbook serves as proof of continuing education; four assessments should be carried out together with the trainer each year, documented in writing and uploaded. The responsibility lies with the respective intern.

Guidelines for an ophthalmology specialist

Main objectives of FMH ophthalmology continuing education

• The learning objectives are set by the SIWF and are in the current Continuing education regulations written and available online
• Obtaining certification as a specialist in ophthalmology
• Development of professional, practical and communication skills
• Ability to independently diagnose and treat ophthalmological diseases
• Ability to provide outpatient ophthalmological care

Requirements for continuing education in ophthalmology at ONO

Theoretical knowledge

• Knowledge and application of Hexabit Luna® practice software
  
  • The intern (AA) can find his way around the software (agenda, medical history, examination, documents, retrieval of special examinations, billing, etc.)
  • The AA can keep the medical history correctly (anamnesis fields, subjective, objective, assessment, procedure, medication)
  • The AA knows and uses the current text modules correctly (see table with abbreviation for text modulesEONO standard)
  • The AA can generate prescriptions, eyeglass prescriptions, reports to referrs/general practitioners using practice software
    
    • The responsible specialist corrects and signs the report
  • The AA can generate and print out cost credit requests (KoGU) and declarations of consent
    
    • The responsible specialist makes adjustments and signs the text

• Read ophthalmology
  
  • Kanski's Clinical Ophthalmology (basic knowledge in ophthalmology)
  • Friedmann's Review of Ophthalmology (summary in English in preparation for the FEBO exam)
  • Will's Eye Manual (reference book for emergency consultations
  • Optional literature for further study
    
    • American Academy of Ophthalmology: Basic and Clinical Science Course
• Practical skills
  
  • Investigation technology using a slit lamp
  • Eyeglass adjustment (refraction)
  • Internal: Refraction course with optician
  • External: Refraction course

Requirements for clinical work as an intern and learning objectives by training year and quarter

1st year of continuing education

During the first year of training, the intern is assigned to a specialist and works with him. The responsible specialist decides when the intern begins to examine patients independently and what work he may take on for the specialist.

Key learning objectives

• Visual acuity testing and refraction
• Slit lamp examination (front and rear eye section)
• eye pressure measurement
• examination of visual field, bulb motility, and pupil motor function
• Examination of eyelid position and function

1st quarter

The intern spends time with a specialist and acquires initial clinical expertise

Learning objectives

• anamnesis
  
  • Targeted anamnesis
  • Compile the patient file, if necessary using old reports from external ophthalmologists/family doctor/hospital
  • Get an idea of eye diseases, therapies and procedures
  • Set up or adjust the diagnostic list, including operations

investigations

• Carries out ophthalmological examinations on assigned patients as far as his current expertise makes this possible
  
  • Visual test with your own glasses, “pin hole”, refraction
  • Investigation technology using a slit lamp
    
    • Front eye segment
    • Back eye segment (dilation of the pupil after consultation with the responsible senior physician, patient may not drive on public transport for four hours afterwards)

• Goldmann applanation tonometry (if there are no pathologies on the corneal surface)
• If applicable Fundus copy with Goldmann three-mirror contact glass if there is a suspicion of fresh or known pathologies on the peripheral retinal pathologies (if there are no pathologies on the corneal surface)
• order special examinations (OCT, topography, etc.) in consultation with the specialist

Patient presentation

• Summary of known findings and pathologies involving the eye or systemically
• The patient is briefly and concisely introduced to the specialist after ONO guideline ‍
• The intern takes his specialist literature and reference works to work, if necessary, to look them up or to train himself independently in the period between consultations
  
  • The responsible continuing trainer supports the intern in choosing the literature and, if necessary, provides eBooks

examination and discussion with the specialist

• Every patient must always be examined by a specialist before they leave the clinic
• Each diagnosis, treatment and procedure is discussed together with a specialist doctor and explained to the patient

2nd quarter

Skills learned in the first quarter are applied independently
The intern carries out tests on regular patients

• Objective: One emergency patient per hour, possibly one additional emergency patient per hour
• The patient is briefly and concisely introduced to the specialist
• Each patient must also be examined by a specialist

3rd quarter

Knowledge acquired in the first two quarters is applied, deepened and expanded

• The intern carries out the preliminary examinations independently
• The assistant can carry out special examinations independently (important for emergency services outside hospital opening hours)
• Typically: One patient per hour and four emergencies per day

4th quarter

Improve independence, optimize time efficiency, independently examine emergency patients

• Problem-oriented and efficient investigation
• Independent arrangement of special investigations
• Formulate the correct diagnosis/diagnoses
• Brief and problem-oriented patient presentation
  
  • Therapy suggestion
  • Proposed procedure
• Provision of prescriptions/eyeglasses regulation
• Defining therapies
• Objective: Two patients per hour and four emergencies per day

2nd year of continuing education

The AA looks after its patients in its own consultation hours under supervision. This enables progress monitoring and the AA can develop a sense of the necessary control intervals.

Key learning objectives

• Making a work diagnosis including differential diagnoses
• Prescribing necessary special investigations

Prerequisite for starting the second year of continuing education

• The intern can differentiate between an acute emergency and a regular consultation patient (detects acute glaucoma and presents it to the specialist as a matter of priority)
• The intern can independently examine the front and back parts of the eye using a slit lamp and identify pathologies
• The intern can independently examine the retinal periphery using direct and indirect fundus copies and Goldmann three-mirror contact glass
• The intern can independently index and carry out special examinations (OCT, topography, visual field, endothelial cell measurement)
• The assistant can keep the medical history correctly (in accordance with ONO standard using ONO text modules)
• The intern can make a suspected diagnosis
• The intern knows the possible differential diagnoses and lists them according to probability
• The intern can present the patient to the specialist in a problem-related, efficient and correct way
• The intern can correctly calculate the examination (according to ONO standards using ONO billing blocks)

Deepen and further expand acquired knowledge through literature and clinical work.

The intern has his own consultation with his own patients and additional emergency patients under on-site supervision

The intern decides independently when he wants to present patients to a specialist; he has the opportunity to do so at any time

Learning objectives

• Problem-oriented ophthalmological examination
• Correct diagnosis in consultation with a specialist
• Comprehensible and efficient patient education
• Define and explain the therapy and procedure

3rd year of continuing education

The prerequisite is to achieve the first and second year of continuing education. Gaps (e.g. refraction course) should be closed promptly and, if necessary, in consultation with continuing trainers in order to enable clinical work “state of the art”.

Prerequisite for starting the third year of continuing education

• The intern recognizes so-called “red flags” and can correctly triage emergency patients (glaucoma attack, suspected stroke, vascular occlusion, etc.)
• The intern can independently examine and correctly document the anterior and posterior parts of the eye using a slit lamp
• The intern can independently examine the retinal periphery using Goldmann three-mirror contact glass, identify and describe pathologies
• The intern can independently index and carry out special examinations (OCT, topography, visual field, endothelial cell measurement)
• The assistant can keep the medical history correctly (in accordance with ONO standard using ONO text modules)
• The intern can make a work diagnosis, including appropriate differential diagnoses
• The intern can independently diagnose and treat simple clinical pictures and determine a procedure
• The intern can independently assess whether he needs to present a patient to a specialist or not
• The intern can present the patient to the specialist in a problem-related, efficient and correct way
  
  • Summarize anamnesis
  • Describe findings
  • diagnosis, make differential diagnoses
  • Evaluate therapy
  • Define procedures
• The intern can correctly calculate the examination (according to ONO standards using ONO billing blocks)

The intern may care for patients independently at a branch office as part of a practice representative, although a specialist must be available on call at any time.

For each working day, a specialist doctor is defined for necessary consultations and must be available by telephone at any time and come on site in an emergency.

Learning objectives

• Retinal treatments using an argon laser
  
  • Panretinal argon laser coagulation (e.g. diabetic retinopathy)
    
  • Focal argon laser coagulation (e.g. foramen)
• Indication
  
  • laser treatments (argon/YAG)
  • cataract surgery
  • fluorescence angiography
  • IVT (anti-VEGF)
    
    • Set therapy intervals in accordance with ONO standards

4th year of continuing education

The intern works largely independently in the main hospital and in branch offices and only presents patients when findings are unclear or for surgical indications.

Each surgical indication must be made by a specialist in consultation with the surgeon concerned

Special consultations

• Eyelid and lacrimal ducts
• front section
• rear section
  
  • Medical Retina
  • neuroophthalmology
• Paediatric ophthalmology/strabology

The intern participates in special consultations and acquires the necessary expertise independently. The trainer is available to answer questions of a theoretical or practical nature.

Learning objectives

• YAG laser treatments
  
  • YAG capsulotomy
  • YAG iridotomy (LIT)
  • Selective laser trabeculoplasty (SLT
• Indication for
  
  • glaucoma surgery
    
    • Needling/suturolysis/goniopuncture
  • Revision after cataract surgery
    
    • Anterior vitrectomy
    • Artisan implantation
  • Vitreoretinal surgery (e.g. macular peeling)
• corneal transplant
  
  • Laminating DSAEK/DMEK/DALK/PKP
• blepharoplasty superior/inferior
  
  • With removal of post-septal adipose tissue
  • With direct/indirect brow lift
• ptosis surgery
• entropy operation
• ectropion surgery
• lacrimal tract surgery

Emergency referral to tertiary hospital

The patient must keep a targeted referral report and be registered by telephone with the ophthalmologist on duty

• endophthalmitis
• Emergency PPV (pars plana vitrectomy)
• Corneal ulcer with impending perforation
• Perforating bulb injury