Guidelines and Criteria for Registration as a Specialist in Ophthalmology Prepared by

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2 Guidelines and Criteria for Registration as a Specialist in Ophthalmology Prepared by Specialty Sub-Committee of Ophthalmology, National Specialist Register

3 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 Appendix 3 : Core procedures required for fulfillment of training Ophthalmology Surgical And Procedural Skills (for fulfillment of Specialist Registration) Acknowledgements 39 43

4 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 1 st January,

5 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

6 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 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 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

7 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: 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

8 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

9 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

10 Phase II (Year 2 & 3) At the completion of this phase, trainees possess: 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) At the completion of this phase, trainees possess: 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 problemsolving, 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

11 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 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

12 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

13 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

14 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

15 SCHEDULES (TIMELINE) PHASE I Year 1 Jun Introduction to eye July Aug Sept Oct Nov Dec Jan Feb Mac Apr May 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 1 st Publication or Case reports (1-3) Present Research Proposal 2 nd Publication or Case reports (4-7) Year 3 Jun July Aug Sept Oct Nov Dec Jan Feb Mac Apr May Presentations & clinical session / Medical & Neurology rotation (2 months) 3 rd Publication or Case reports (8-10) PHASE III Year 4 Viva & clinical session Pass up case reports & log book Jun July Aug Sept Oct Nov Pass up 1 st completed draft of research report Pass up corrected copy of research report Research report presentation Part II exam Pass up final copy of research report Dec Jan Feb Mac Apr May Pass up final copy of publication or case book 12 Pass up log book and obtain supervisors approval to sit for Part III exams Part III exam

16 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

17 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

18 Master in Ophthalmology Phase II Year 1 (Starting after passing May Part I exams) Name : System : Open / Close Hospital : Supervisor : Year of Entry : Goals Achievements Comments (student) Comments (supervisor) Jun July Aug Sept Assessment 1 st Publication or Case reports (1-3) Research proposal presentation Oct Nov Dec Jan Assessment Feb Mac Apr May Assessment 2 nd Publication or Case reports (4-7) 15

19 Master in Ophthalmology Stage II Year 2 (Starting Year 2 in June after passing Part I Exams May) 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 3 rd Publication or Case reports (8-10) Feb Mac Apr Assessment Hand in 3 Publications or 10 Case report drafts to dept by 1 st February May Part II exam 16

20 Master in Ophthalmology Phase III (Starting Year 4 in June after Passing Part II Exams in May) 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 Assessment May Pass up 1 st completed copy of thesis by 1 st July Pass up corrected copy of dissertation by 1 st August Pass up final copy of dissertation by 1 st Nov Pass up final copy of case book in January Pass up log book in April Final assessment 17

21 CLINICAL POSTING ASSESSMENT FORM Candidate : Supervisor(s) : Posting/Rotation : Date : No. 1 Competency 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 (1-5)* Comment by supervisor * Level (1: Weak 2: Borderline 3: Satisfactory 4: Good 5: Excellent) ** Overall: Weak: < 15 Borderline: Satisfactory: Good: Excellent: *** 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

22 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 A B MCQ I MCQ II Essay OSCE Viva 60 questions (Basic Ocular Sciences, Optics and refraction) 60 questions (Basic Ocular Sciences, Optics and refraction) 8 short notes questions (Basic Ocular Sciences) 10 stations (Basic Ocular Sciences) 1 session (Basic Ocular Sciences) % marks % to total marks 2 hrs hrs hrs 30 mins Total for Theory mins min Total for Clinical C Clinical 1 case (Clinical refraction) 30 mins OSCE 4 stations (Optics & refraction) 20 mins Total for Optics & Refraction Grand Total 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 ( %) 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

23 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 long essay & Essay 4 short notes 1 hr 30 mins long essay & Essay 4 short notes 1 hr 30 mins Total for Theory B 1 long case with refraction 1 hr 10 mins short cases 30 mins Clinical 4 short cases 30 mins (Medicine in relation to OPH) Total for Clinical C Ophthalmology 30 mins Viva Medicine in relation to Ophthalmology 30 mins Total for Optics & Refraction Grand Total 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 ( %) 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

24 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

25 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

26 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. 1 st January, 2012) Hospital / Institution: Address: Head of Department: Date of Application: A. GENERAL CRITERIA No. THIS SECTION TO BE FILLED BY APPLICANT Criteria (Required criteria in brackets) 1. Total number of Ophthalmologists registered in NSR (A minimum of 2 is expected) Data on Dept. (FOR OFFICIAL USE) THIS SECTION TO BE FILLED BY ASSESSOR Meets Minimum Notes Criteria ( / ) 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

27 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

28 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

29 No. Criteria (Required criteria in brackets) 2. Annual workload of inpatients (use previous year figures) Data on Dept Meets Minimum Criteria ( / ) Notes (should exceed 400) 3. Annual workload of new outpatient cases (use previous year figures) (should exceed 1500) 4. Annual workload of follow up cases (use previous year figures) (should exceed 6000) 5. Annual workload of major elective operations done (use previous year figures) (should exceed 200) 6. Annual workload of minor operations done (use previous year figures) (should exceed 100) 7. Annual workload of emergency operations done (use previous year figures) (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

30 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

31 C. ADDITIONAL CRITERIA FOR CENTRES APPLYING FOR OPHTHALMOLOGY SUBSPECIALTY TRAINING Criteria Subspecialty Department Data 1. Number of practicing subspecialty trained Ophthalmologist with 2 years experience a. VR Surgery b. Medical Retina c. Glaucoma d. Oculoplastics & Orbit e. Cornea Remarks 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 d. Oculoplastics & Orbit e. Cornea f. Paediatric Ophthalmology g. Neuro-Ophthalmology h. Others (specify) 3. Number of surgeries / procedures performed per year (for each subspecialty) a. VR Surgery b. Medical Retina c. Glaucoma d. Oculoplastics & Orbit e. Cornea f. Paediatric Ophthalmology g. Neuro-Ophthalmology h. Others (specify) 28

32 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 d. Oculoplastics & Orbit e. Cornea f. Paediatric Ophthalmology g. Neuro-Ophthalmology 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

33 The Hospital/Institution agrees to pay expenses incurred should the Specialty Sub-Committee of Ophthalmology decide to make a visit. Hospital Ophthalmologist Official stamp: Date: Hospital Director Official stamp: Date: To be filled by representatives of the Specialty Sub-Committee of Ophthalmology: Comments from visit (if visit is made): 30

34 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, Specialty Sub-Committee of Ophthalmology Date: 31

35 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 Near Vision Visual assessment in children Preferential looking OKN Matching Objection to Occlusion Colour - Vision Ishihara 2 Interpret - 10 Perform Colour - Vision D 15 2 Interpret - 10 Perform Slit Lamp Biomicroscopy including contact and non contact lens Optic disc and RNFL assessment Intraocular Pressure measurement and calibration of devices using: - Applanation Tonometer - Perkins Tonometer - Tonopen

36 8. Pachymetry Gonioscopy Direct Ophthalmoscopy Indirect Ophthalmoscopy with indentation Retinal Diagram Extraocular Muscle Movements Assessment of Nystagmus Exophthalmometry Visual Field Confrontation Amsler Chart Dry Eye Assessment Placido Disc Cover Test Prism Cover Test

37 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 RAF Rule including Interpretation Use of Focimeter Use of Autorefractometer Keratometry Insertion and removal of Contact Lenses Contact lens fitting Exposure to Low Vision Devices

38 C. OPHTHALMIC DIAGNOSTIC SKILLS No. CORE PROCEDURES Minimal Training necessary for Competence Observed Assisted Performed 1. Bjerrum Perimetry 2 Interpret - 10 Perform Automated Perimetry 3 Interpret - 30 Perform Hess Chart 2 Interpret - 10 Perform A Scan and IOL Power Calculation 5 Interpret - 30 Perform Ocular Photography 3 for each 5 for each - External - Ant. Segment - Optic disc - Fundus 6. B Scan basic Interpretation HRT 3 Interpret OCT - Macular - Optic Disc 5 5 Interpret Electrophysiology Tests 2 Interpret Corneal topography Hue Colour Vision Test 2 Interpret Fundus Fluorescein Angiography 5 Interpret - 20 Perform

39 D. SURGICAL / PROCEDURAL SKILLS No. CORE / SPECIALISED PROCEDURES Minimal Training necessary for Competence Observed Assisted Performed 1. Eye Irrigation Syringing and Probing - Adults - Paeds I&C and I&D in Paeds 4. Lid T&S not involving lid margin Entropion / Ectropion primary repair STO Cornea / Lids Tarsorraphy DCR Brow suspension Excision of lid / eyebrow lesions Lateral canthotomy Removal of corneal / conjunctival Foreign Body Conjunctival Graft Excision of pterygium / conjunctival lesions Harvesting buccal mucosa Amniotic membrane transplant Corneal Scraping

40 18. Glueing of corneal perforation Corneal and Scleral T&S Retrieval and processing of donor eyes Penetrating Keratoplasty AC tap / Paracentesis / Intracameral Injections Laser Iridotomy Laser Argon laser peripheral iridoplasty Cyclophotocoagulation Laser suturelysis YAG Laser Capsulotomy Trabeculectomy / phaco trabeculectomy +/- anti-metabolite (primary, not repeat) Glaucoma Drainage Device Paediatric Glaucoma Surgeries Paediatric Lens aspiration (limited to children above 6 years of age) 32. ECCE (including converted phaco cases) Phacoemulsification ROP Screening EUA Paediatric Retinoblastoma management / EUA Pan Retinal Photocoagulation

41 38. Focal / Grid Laser Laser to retinal breaks / lattice Indirect Laser Photocoagulation - Adults - Premature infants Cryopexy Vitreous tap RRD Surgery including sclera buckling (Primary repair) Vitreous Surgery Insertion and removal of eye prosthesis Evisceration / Enucleation without orbital implant 47. Evisceration / Enucleation with implant 48. Exenteration Squint surgery - Adults - Horizontal Squint in Paeds patient Subconjunctival Injection Orbital Floor Injection Intravitreal injection Injection of anti-metabolite (including preparation and disposal) 54. Injection of local anaesthesia (peribulbar / retrobulbar / subtenon)

42 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

43 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

44 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

45 36. Subconjunctival Injection 37. Orbital Floor Injection 38. Intravitreal injection 39. Injection of local anaesthesia (peribulbar / retrobulbar / subtenon) 42

46 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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