International Council of Ophthalmology
2011 Residency Curriculum
Information for Educators
A. Purpose
B. Update of ICO Residency Curriculum
C. Subspecialty Sections
D. Definition of an Ophthalmologist
E. Stratification of Levels
F. Prioritization of Content: “Must Know”
G. Drafting of Sections and Review Process
H. Customizable Curriculum
I. Future Updates
J. Core Competencies
A. Purpose
The International Council of Ophthalmology (ICO) Residency Curriculum provides essential intellectual and clinical information (ie, cognitive and technical/surgical skills) that are necessary for an ophthalmologist. The curriculum is a content outline for a fund of knowledge. It is not designed to be all-inclusive but rather a guideline for the training of ophthalmic specialists.
The ICO recognizes that not all techniques of diagnosis and therapy presented in the curriculum are universally available, but they should serve as aspirational guidelines towards achieving modern methods of diagnosis and care of common eye problems.
As an international body, the ICO’s intent is to provide content useful for ophthalmology residents, fellows, and subspecialty experts working anywhere in the world. While the Residency Curriculum provides a standardized content outline for ophthalmic training, by being delivered online, it becomes a “living document,” a customizable curriculum allowing for adaptation and translatability with the precise local detail for implementation left to each region’s educators. Educators are encouraged to modify and apply the content as deemed appropriate to meet local, regional, and national priorities.
The Residency Curriculum is available for download from the ICO at: http://icoph.org/refocusing_education/curricula.html. We hope you will enjoy reading, and more importantly, using, the curriculum in your teaching and assessing of ophthalmic knowledge and skills. Online comments and recommendations for future updates are actively encouraged and solicited through: http://icocurriculum.blogspot.com.
We thank the subspecialty committee chairs and members for their focused effort, and we also thank ophthalmic educators and leaders for their prior and anticipated contributions to the ICO Residency Curriculum, which ideally will serve to improve ophthalmic education worldwide.
Sincerely,
Andrew G. Lee, MD
Chair, Residency Curriculum
Email: aglee@tmhs.org
B. Update of ICO Residency Curriculum
The Residency Curriculum was initially published in 2006, under the title “Principles and Guidelines of a Curriculum for Education of the Ophthalmic Specialist.” The updated Residency Curriculum includes the modifications:
Sections
- All sections and references from the 2006 curriculum have been updated.
- Community Eye Health has been added as a new section.
- Optics and Refraction, previously listed as two separate sections, have been combined into one section.
- Refractive Surgery, previously a subset of Cornea, External Diseases, and Refractive Surgery, is now a stand-alone section.
- Uveitis is now called Uveitis and Ocular Inflammation.
- Ophthalmic Practice and Ethics is now called Ethics and Professionalism in Ophthalmology.
- The term “Task Force” has been replaced with the term “Committee.”
- The Preface is now called Introduction.
- The Preamble is now called Information for Educators.
Stratification
- The updated Residency Curriculum builds upon the Basic, Standard, and Advanced levels of training by incorporating a new fourth level, “Very Advanced,” which corresponds to a “subspecialist” or “fellowship” level of training.
- The terms post-graduate year (PGY) 2, 3, and 4 have been replaced with Year 1, Year 2, and Year 3 respectively.
Must Know
- The updated Residency Curriculum prioritizes and identifies cognitive and technical skills the learner “Must Know” at each level. Within each section “Must Know” content is identified by two asterisks (**).
C. Subspecialty Sections
D. Definition of an Ophthalmologist
An ophthalmologist is a doctor of medicine or doctor of osteopathy (DO, MD, or equivalent degree) who specializes in the eye and visual system. As a licensed medical doctor, the ophthalmologist's ethical and legal responsibilities include the care of individuals and populations suffering from diseases of the eye and visual system.
An ophthalmologist is a doctor of medicine or doctor of osteopathy (DO, MD, or equivalent degree) who specializes in the eye and visual system. As a licensed medical doctor, the ophthalmologist's ethical and legal responsibilities include the care of individuals and populations suffering from diseases of the eye and visual system.
Specialist training is designed to provide a structured learning program facilitating the acquisition of core competencies as well as specialized cognitive and technical skills at a level appropriate for an ophthalmic specialist who has been fully prepared to begin their career as an independent consultant in ophthalmology.
E. Stratification of Levels
The curriculum is intended to be adaptable and flexible, depending upon the needs of the region. While stratifying the curricula by level (ie, Basic, Standard, Advanced, and Very Advanced) is somewhat artificial, it defines clear milestones for learners to progress up the ladder of expertise acquisition.
Differentiating various proficiency levels allows local customization of expectation based upon local resources, ability, and geography. For example, in some locations clinical needs are urgent, and marked abbreviations of the training program will be necessary to provide the region with sufficient numbers of practitioners.
Years 1, 2, 3, and Subspecialist
- Though Years 1, 2, 3, and Subspecialist correspond with Basic, Standard, Advanced, and Very Advanced Level Goals respectively, the listing of years are for clarification purposes only and not as a recommendation for duration of training, which is subject to local requirements and regulations.
Very Advanced: Subspecialist Level of Training
- The Very Advanced level has been included to provide a comparison to the three other levels of training (ie, Basic, Standard, Advanced).
- The Very Advanced level represents postresidency acquisition of additional skills and knowledge (eg, fellowship training).
- Individuals who reach the Very Advanced: Subspecialist level of training are expected to have accomplished the goals of the Basic, Standard, and Advanced levels of the curriculum.
- The Very Advanced level is NOT meant to be considered part of the residency-training program but certainly is an aspirational target.
F. Prioritization of Content: “Must Know”
- The updated Residency Curriculum prioritizes and identifies cognitive and technical skills the learner “Must Know” at each level. “Must Know” content is identified by two asterisks (**).
- “Must Know” is the minimum baseline–the lowest expectation–for all levels and all guidelines regardless of regional resources; it is not an ideal or aspirational target.
- “Must Know” content is recommended by the ICO and is defined as the minimum competency for a resident at that level.
- This curriculum does not use aspirational targets such as “should know” or “nice to know,” as they are variable based on region and become especially challenging to define. While “should know” is relevant and important, content defined as “should know” might be resource dependent or otherwise have some reason for not being learned or taught (eg, we do not see that disease in our particular country).
G. Drafting of Sections and Review Process
Drafting of Sections
- Each committee (referred to by the term “Task Force” in the 2006 curricula) was responsible for updating their section of the curriculum.
- Each committee was asked to identify the cognitive and technical skills in their subspecialty section deemed “Must Know,” which is identified by two asterisks (**) within each section.
- Each committee was responsible for developing a fourth level of the curriculum, “Very Advanced,” outlining specific cognitive and technical skills for the “subspecialist.” The Very Advanced level allows direct comparison of residency (ie, Basic, Standard, and Advanced) guidelines and postresidency (ie, Very Advanced) guidelines.
- Committee members were asked to review relevant content in other curriculum sections to ensure consistency. If inconsistencies were found, that committee was asked to communicate with the chair or chairs of the relevant sections in order to resolve any discrepancies.
Review Process
- Committee members were asked to identify at least five external colleagues to review their completed draft section.
- Reviewers were selected who were thought to be responsive, proficient in the English language, and most importantly, representative of the geographic and global coverage intended for the curriculum development process.
- Reviewers were asked to review the draft sections for accuracy, adaptability, and regional relevance.
- The document was presented in draft format for comment online January-April 2012 for public comment from ophthalmic educators worldwide.
- After all relevant changes were incorporated, sections were then edited for consistency and clarity by a medical editor.
Committee Chairs, Members, and Section Reviewers
- For a complete list of committee chairs and members, please see the Appendix.
- For a complete list of reviewers, please see the Appendix.
H. Customizable Curriculum
- The Residency Curriculum is downloadable as a PDF and Word document, as well as a Google Doc for online access.
- The ICO Residency Curriculum provides a standardized content outline for ophthalmic training, but by being delivered online, it becomes a “living document,” a customizable curriculum allowing for adaptation and translatability with the precise local detail for implementation left to each region’s educators.
- Educators are encouraged to modify and apply the content as deemed appropriate to meet local, regional, and national priorities.
- Inclusion of therapies and investigations in the ICO Residency Curriculum does not imply that listings are all inclusive or that methods are endorsed by the ICO. Appropriate levels of expertise and knowledge should be achieved based on the care provided. Practitioners should know of therapies and investigations not available at their hospital or clinic, so that they can advise patients who may be able to seek care elsewhere.
I. Future Updates
- Ophthalmic curricula worldwide will be improved through the valuable contributions and involvement of global leaders and educators.
- For consideration towards future updates of the Residency Curriculum, ophthalmic leaders and educators are invited to provide online comments and recommendations at http://icocurriculum.blogspot.com/.
J. Core Competencies
Generic core "competencies" are expected of
ophthalmic specialists, as promulgated by the United States Accreditation
Council for Graduate Medical Education (ACGME). There are worldwide differences
in nomenclature for the general competencies, and the United States version is
presented for clarification purposes only. Local customs, practices, resources,
and regulatory environments will dictate the application of these competencies
for individual programs. The ACGME website is www.acgme.org.
Core competencies include:
·
Patient Care
·
Medical Knowledge
·
Practice-based Learning and Improvement
·
Communication Skills
·
Professionalism
·
Systems-based Practice
Ophthalmic specialists are expected to:
Patient Care
·
Provide patient care that is compassionate,
appropriate, and effective for the treatment of health problems and the
promotion of health;
·
Communicate effectively and demonstrate caring
and respectful behaviors when interacting with patients and their families,
taking into consideration patient age, gender identification, impairments, ethnic
group, and faith community;
·
Gather essential and accurate information about
patients;
·
Make informed decisions about diagnostic and
therapeutic interventions, based on patient information and preferences,
up-to-date scientific evidence, and clinical judgment;
·
Develop and carry out patient management plans;
·
Counsel and educate patients and their families;
·
Use information technology to support
patient-care decisions and patient education;
·
Competently perform the medical and invasive
procedures considered essential for the area of practice;
·
Provide health care services aimed at preventing
health problems or maintaining health; and
·
Work with health care professionals, including
those from other disciplines, to provide patient-focused care.
Medical
Knowledge
·
Demonstrate knowledge about established and
evolving biomedical, clinical, and cognate (eg, epidemiological and
social-behavioral) sciences and apply this knowledge to patient care;
·
Demonstrate an investigatory and analytic
thinking approach to clinical situations; and
·
Know and apply the basic and clinically
supportive sciences, which are appropriate to ophthalmology.
Practice-based
Learning and Improvement
·
Investigate and evaluate patient care practices;
appraise and assimilate scientific evidence; and improve patient care practices;
·
Analyze practice experience and perform
practice-based improvement activities using a systematic methodology;
·
Locate, appraise, and assimilate evidence from
scientific studies related to patient health problems;
·
Obtain and use information about regional
patient population and the larger population from which patients are drawn;
·
Apply knowledge of study designs and statistical
methods to the appraisal of clinical studies and other information on
diagnostic and therapeutic effectiveness; and
·
Use information technology to manage
information, access on-line medical information, support ongoing personal
professional development; and facilitate the learning of students and other
health care professionals.
Communications
Skills
·
Demonstrate communication skills that result in
effective information exchange and teaming with patients, patient families, and
professional associates;
·
Create and sustain a therapeutic and ethically
sound relationship with patients;
·
Use effective listening skills and elicit and provide
information using effective nonverbal, explanatory, questioning, and writing
skills; and
·
Work effectively with others as a member or a leader
of a health care team or other professional group.
Professionalism
·
Demonstrate a commitment to carrying out
professional responsibilities, adherence to ethical principles, and sensitivity
to a diverse patient population;
·
Demonstrate respect, compassion, and integrity;
·
Demonstrate a responsiveness to the needs of
patients and society that supersedes self-interest; accountability to patients,
society, and the profession; and a commitment to excellence and on-going
professional development;
·
Demonstrate a commitment to ethical principles
pertaining to provision or withholding of clinical care, confidentiality of patient
information, informed consent, and business practices; and
·
Demonstrate sensitivity and responsiveness to
patient culture, age, gender identification, and disabilities.
Systems-based
Practice
·
Demonstrate an awareness of and responsiveness
to the larger context and system of health care and effectively call on system
resources to provide care that is of optimal value;
·
Understand how patient care and other
professional practices affect other health care professionals, the health care
organization, and the larger society, and how these system elements affect
their personal ophthalmic practice;
·
Know how types of medical practice and delivery
systems differ from one another, including methods of controlling health care
costs and allocating resources; and practice cost-effective health care and
resource allocation that do not compromise quality of care;
·
Advocate for high quality patient care and
assist patients in dealing with system complexities; and
·
Know how to partner with health care managers
and health care providers to assess, coordinate, and improve health care, and
know how these activities can affect system performance.
·
Know how to partner with services that can improve
quality of life (eg, health, education, livelihoods, social inclusion) of
people with long term visual impairment.
Professional attitudes and conduct require that ophthalmic
specialists must also have developed a style of care that is:
·
Humane (eg, compassion in providing bad news,
management of the visually impaired, and recognition of the impact of visual
impairment on the patient and society);
·
Reflective (eg, recognition of the limits of
knowledge, skills, and understanding);
·
Ethical;
Integrative (eg, involvement in an interdisciplinary team for the eye
care of children, patients with long term visual impairment or other disabilities,
the systemically ill, the elderly, and with consideration of gender dimensions);
and
·
Scientific (eg, critical appraisal of the
scientific literature, evidence-based practice, and use of information
technology and statistics).
