SCOTTISH DIABETIC RETINOPATHY SCREENING SERVICE TRAINING & ACCREDITATION STANDARDS FOR SLIT LAMP EXAMINERS WORKING WITHIN THE SCOTTISH DIABETIC RETINOPATHY SCREENING PROGRAMME Version 1.0 Reviewed by: DRS Executive Authorised by: Dr R Harvey Lead Clinician DRS Collaborative Date of Issue: 13 th December 2007 Warning Document uncontrolled when printed Page 1 of 5
Training & Accreditation Standards for Slit Lamp Examiners 1. The Slit Lamp Examiner (SLE) An accredited slit lamp examiner in the Scottish Diabetic Retinopathy Screening (DRS) Programme is either an Ophthalmologist who meets the requirements of a Level Three Grader (but who may not necessarily be working as one) or an individual who meets all of the following criteria: 1. Is trained, competent and accredited in accordance with the standards laid down in this document. 2. Is working within the DRS programme as a L2 grader, grading images of at least 500 patients per year. 3. Is participating in internal and external quality assurance within the DRS Programme. Note that a level 3 grader must be a medical ophthalmologist with at least 1 years experience in medical retina and experience in laser treatment and still actively involved in medical retina clinics. 2. Eligibility Criteria Prospective Candidates The following criteria must be met by prospective SLE s prior to embarking on the training and accreditation programme: The agreement of the lead clinician and the service manager of the NHS Board providing the diabetic retinopathy screening slit lamp service. Participation in grading diabetic retinopathy to level-two grader standard and taking part in the photographic DRS Quality Assurance process. Demonstrate good interpersonal and communication skills. Where the prospective SLE is not directly employed by the NHS, but is working as an independent contractor, they should have arranged appropriate indemnity cover via their professional organisation. Warning Document uncontrolled when printed Page 2 of 5
Provision of Training & Assessment Training can be provided by either: An Ophthalmologist who meets the eligibility requirements of a Level Three Grader (but who may not necessarily be working as one) or A Hospital Clinical Optometrist with a recent minimum of two years experience of working in Retinal Clinics and the DRS Service. An Internal Assessor shall be an Ophthalmologist who meets the eligibility requirements of a Level Three Grader (but who may not necessarily be working as one). An External Assessor must be a practicing level three grader working in a health board other than that of the candidate. 3. Pathway to Accreditation 3.1 Observation of slit lamp examinations. This is essential for those candidates who never performed slit lamp examinations. 3.2 Supervised slit lamp examinations. At this stage all slit lamp examinations performed by the trainee must be under direct supervision of a trainer (see definition). The supervised training period is complete when all of the following criteria have been met: 1. Successful completion of the following modules of the City & Guilds Level 3 Certificate in Diabetic Retinopathy Screening: Unit 3 Anatomy, Physiology and Pathology of the Eye and its Clinical Relevance Unit 4 Preparing the Patient for Retinal Screening Unit 5 Measuring Visual Acuity and Performing Pharmacological Dilatation Unit 7 Detecting Retinal Disease Unit 8 Classifying Diabetic Retinopathy NB Optometrists registered with the General Optical Council (GOC) are not required to sit units 3, 4 and 5 for the purposes of slit lamp accreditation. Warning Document uncontrolled when printed Page 3 of 5
2. The individual is able to demonstrate competence as determined by the Skills for Health Competence HC7 Assess the eye for evidence of disease or abnormally using slit-lamp biomicroscopy. This is assessed by the Internal Assessor when the individual has completed 10 format standard work based assessments (see appendix A). The assessment can commence when the internal assessor is satisfied that the candidate has a high likelihood of success. The internal assessor is required to sign a completion certificate to confirm that the training has been satisfactorily completed and that the candidate is now able to work unsupervised and so can progress to the next stage towards accreditation. Internal assessors will advise the DRS Collaborative Coordinator in writing of successful candidates. The DRS Collaborative Coordinator will maintain a register of Probationer Slit Lamp Examiners. 3.3 Pre-accreditation/Probationary Period At this stage the Candidate is able to perform slit lamp examinations without direct supervision. The candidate shall maintain a log book of diabetic retinopathy screening slit lamp work undertaken in this period to indicate caseload and mix of lesions observed. Reports from Soarian may be used for this purpose. The probationary period completes when the candidate has successfully completed external assessment. The external assessment can commence when the internal assessor considers that the candidate has a high likelihood of success and they have successfully completed a further 10 formal standard work based assessments (see Appendix A). The external assessment will comprise a number of formal standard work based assessments (see Appendix A) performed in a special single session. On confirmation of successful completion of the external assessment the Internal Assessor shall advise the DRS Collaborative Coordinator in writing of successful candidates. The DRS Collaborative Coordinator shall maintain a register of Accredited Slit Lamp Examiners. Candidates who fail the external assessment will be required to return to a period of directly supervised training and will require to re-take the internal assessment. The External Assessor shall advise the DRS Collaborative Coordinator in writing of unsuccessful candidates. The probationary period shall last no longer than 1 year. If by the end of this period the candidate has not successfully completed the external assessment the candidate shall be removed from the register of Probationer Slit Lamp Examiners and shall not be allowed to perform slit lamp examinations unsupervised. Warning Document uncontrolled when printed Page 4 of 5
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