Surgical Skills SS4

To assess a patient clinically, in OPD and elsewhere, in particular to:

TITLECATARACT SURGERY

Code

SS4

Learning Outcome

  • Learn all the individual stages of cataract surgery before progressing to complete procedures.
  • Adapt your technique according to clinical indications and current surgical practice.
  • Manage intra-operative and post-operative complications.
  • Complete a full operating list independently by the end of training.

Assessment

OSATS1 EPA1 Portfolio Part 2 FRCOphth 

Assessor

Note: OSATS after initial Target Year of Achievement should reflect an increase in complexity of cases

Target Year of Achievement

Year 3 (annual review) / Year 6-7 for full operating list

Related Learning Outcomes

DMCRJ3 

Overview

  • Understand what exactly you are trying to achieve by each manoeuvre and how you can do this with minimal risk and stress to the patient, the trainer and yourself.
  • Practise in a supervised simulated environment.
  • Agree what signal the trainer will give to tell you s/he must take over.
  • Record operations, to review regularly yourself and frequently with your trainer.
  • Complete a minimum number of 50 complete procedures during the first 2 years of training to help ensure adequate progress.
  • Complete a minimum number of 350 complete procedures during the 7 years of training to help ensure satisfactory progress to fully independent practice.
  • These procedures should include the full variety of complex cases; in this context complex cases must include high myopes, cases with previous anterior or posterior segment surgery, cases with previous iritis, unusually hard or soft cataracts, white cataracts, cases with pseudoexfoliation syndrome, subluxated lenses and post-trauma cases.
  • Examine your patients pre-operatively and review them post-operatively so you are aware of the early post-operative clinical signs, results and impact of your surgery. Do this at least when you first start to undertake entire procedures and during the period of your mandatory audit.
  • Perform a continuous ongoing audit of any of your cataract surgery cases in which significant complications occur. This must be recorded using the on-line RCOphth electronic logbook, and an updated synopsis must appear in your e-portfolio for each ARCP. The synopsis must include details of the final outcome of these cases, including the final visual acuity and (where available) refraction, and details of any further complications which arise.
  • Refine your skills to be safe and effective in all cataract cases, even complex ones.
  • Practise management of complications in a simulated environment.
  • Continue to seek feedback from your trainers, both formal and informal.

By the end of training the e-portfolio MUST contain an audit of at least 50 consecutive cataract cases where the surgery is performed within three calendar years of the CCT date. This must include information on risk factors (see https://www.nature.com/articles/eye201251/tables/1) and complications (see https://www.nature.com/articles/6703015/tables/7), along with outcome data which must include final visual acuities and should (where available) also include the refractive outcome.

Resources

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