This tool is used to assess ocular surgery and can be applied at any Level of training and to any procedure.
Descriptors of ‘very good trainee’ and ‘poor trainee’ are given and longitudinal development of the trainee is captured by progression through a three-point rating scale per each criterion: major concerns, minor concerns, meets expectations.
An overall assessment is then made as the whether the trainee meets or does not meet expectations.
Formative feedback is captured in free-text boxes around aspects of the assessment that were particularly good, suggestions for development and an agreed action plan.
Some OSATS are mandatory in some EPAs. Trainees are strongly encouraged to use OSATS regularly in a formative manner to collect high-quality, recorded feedback.
This tool is used to assess procedural skills. Longitudinal development of the trainee is captured by progression through a three-point rating scale per each criterion: major concerns, minor concerns, meets expectations.
An overall assessment is then made as the whether the trainee meets or does not meet expectations.
Formative feedback is captured in free-text boxes around aspects of the assessment that were particularly good, suggestions for development and an agreed action plan.
This assessment tool is used to assess biometry skills and achieve the best refractive results after cataract surgery.
Longitudinal development of the trainee is captured by progression through a three-point rating scale per each criterion: major concerns, minor concerns, meets expectations.
An overall assessment is then made as the whether the trainee meets or does not meet expectations.
Formative feedback is captured in free-text boxes around aspects of the assessment that were particularly good, suggestions for development and an agreed action plan.
These tools are used to assess clinical skill competencies, principally around ophthalmic examination and use of equipment, skills few doctors have achieved prior to OST1. Their purpose is to provide feedback on skills essential to providing good clinical care. There are fourteen specific forms for different skills:
- CRS1-April-2024
- CRS2 Assess vision
- CRS3 Assess visual fields
- CRS5 External eye examination
- CRS6 Assess pupils
- CRS7 Assess ocular motility
- CRS8 Assess intra-ocular pressure
- CRS9 Slit lamp
- CRS10a Fundus assessment – direct ophthalmoscope
- CRS10b Fundus examination using slit lamp condensing lenses e.g. 90D/78D or equivalent
- CRS10c Fundus assessment – diagnostic contact lenses
- CES10d Fundus assessment – indirect ophthalmoscope
- CRSgon Gonioscopy
- CRSret Cycloplegic refraction
The forms provide descriptors of ‘very good trainee’ and ‘poor trainee’. They may be repeated with longitudinal development of the trainee captured by progression through the scale of each criterion. The standard for competence is that of a newly qualified consultant, an independent practitioner. Once considered competent, the assessment does not need to be repeated, except for CRS1 (Consultation skills). The latter must be tailored and focussed appropriately to the subject of the individual SIAs and show advancement between Levels, as well as further advancement by Level 4.
Although all CRS tools are formative, they are listed as mandatory evidence, especially for EPA Level 1. The NCS must summate the evidence within the ePortfolio to determine competence in these clinical examination skills. Where the NCS has directly observed the trainee performing these skills, it may be easy to state that the required standard has been reached. Where areas have not been directly observed by the NCS, they can consider evidence from other practitioners through the MAR to make the decision.
This tool is intended to assess aspects of patient management, communication (written and verbal) and clinical reasoning, judgement and decision-making, and additionally leadership and management skills. They complement the assessment of these skills that takes place in the Part 2 FRCOphth examination.
Cases should be chosen if they have created challenge, doubt or difficulty in order to maximise the learning opportunity. Discussion should be structured and in-depth and trainers should encourage trainees to discuss clinical problems regularly. The expectation is to be able to manage a range of clinical scenarios, which may involve referrals from other health professionals, patient self-referrals or screening for ophthalmic disease. Below is a list of typical problems that may present to an ophthalmologist.
| Table 4 – list of typical problems | |
|---|---|
| Symptoms | Signs |
| Decreased Vision | Ametropia |
| Transient | Corneal Opacities |
| Sudden | Conjunctival Pigmentation |
| Gradual | Dysgenesis/Colobomata |
| Painful | Lens Opacities |
| Diplopia | Lid Lumps |
| Distortion | Lid Malposition |
| Dry Eyes | Macular Exudation |
| Floaters | Nystagmus |
| Headache | Ocular Tumours |
| Night Blindness | Optic Disc Atrophy/Swelling |
| Pain | Proptosis |
| Ocular | Pupil Abnormalities |
| Periocular | Raised Intraocular Pressure |
| Red Eye | Retinal Haemorrhages |
| Trauma | Retinal Pigmentation |
| Visual Disturbance | Strabismus |
| Watery | Visual Field Defects |
| Visual Handicap in a Child | |
| Vasculature abnormalities | |
Using these commonly encountered scenarios enhances the value of on-the-job learning, increasing learning efficiency and relevancy.
During an out-patient clinic: trainers and trainees may wish to allocate 5-10 minutes to discuss the management of the patient. The trainee should have had some direct clinical role with the patient, e.g. history taking, clinical examination, investigations ordered or interpreted, management decisions, management of complications, critical incidents.
At the end of an out-patient clinic: trainers and trainees may wish to allocate some time at the end of clinic to review a small number of case notes where the trainee has had a significant role in the management of the patient.
Case presentations during postgraduate teaching: trainees are often asked to present cases at local or regional postgraduate teaching sessions. A nominated trainer should complete a CbD form with the trainee after the presentation.
During a designated teaching session: Trainers and trainees may wish to allocate a period of one-to-one teaching or small group teaching where cases are discussed and a CbD form has been completed.
How to complete a CbD
The purpose of the CbD is to give trainees the opportunity to demonstrate achievement of Learning Outcomes in relation to an individual case they were involved in. In particular, the trainee should be able to demonstrate how they approach their practice. That is, application of medical knowledge, rationale for clinical decision making and the ethical/legal framework of their practice, if appropriate.
The trainee should present the case and detail their involvement. The discussion should start from the trainee’s own entry in the case record which may, in part, be used to demonstrate appropriate information handling.
Longitudinal development of the trainee is captured by progression through a three-point rating scale per each topic: major concerns, minor concerns, meets expectations.
An overall assessment of the specific case-based discussion is then made as the whether the trainee meets or does not meet expectations.
Formative feedback is captured in free-text boxes around aspects of the assessment that were particularly good, suggestions for development and an agreed action plan.
The MSF assesses professional competence within a team-working environment, where the trainee’s performance is assessed by a range of peers and colleagues covering different professions, grades and environments (e.g. outpatients, theatre, administration). The trainee selects a minimum of 11 assessors (up to 15) who can be approached to give feedback. The recommended combination of assessors, where applicable, should include:
- 2 consultant clinical supervisors
- 2 more senior trainees
- 1 senior nurse in the operating theatre (if the trainee has been performing surgery)
- 1 senior nurse in the out-patient department
- 1 other member of the out-patient staff (nurse/optometrist/orthoptist)
- 1 member of the administrative or secretarial team who regularly deals with the trainee’s work
This is initiated by the trainee before the process is carried out electronically in an anonymised fashion. The trainee selects those who can be approached to give feedback in accordance with the recommended combination of assessors. The trainee and ES should discuss and agree the list before starting the process electronically. Care should be taken to use only professional hospital/Trust emails, not personal addresses. Feedback is provided in the form of a table generating collated scores and anonymised written comments. The anonymised summary report that is generated after an MSF has closed will only be visible to the ES in the first instance. It should be released to the trainee by the ES afterwards. The ES should meet with the trainee to discuss the feedback on their performance. As well as providing feedback for reflection, the MSF enables any serious concerns to be highlighted to the ES in confidence, allowing appropriate action to be taken.
The ES will consider this evidence in writing their ESR and making a recommendation to the ARCP panel.