To provide exposure in the clinical management of glaucoma patients at National University Hospital.

1 Year

The applicant should have met the following requirements:

1. Completion of an Ophthalmology training programme.
2. Completed 3 years of additional working experience/advanced specialist training with justification of need for training in Ophthalmology.
3. Competence in comprehensive ophthalmology.
4. Have active interest in teaching, research and publications.

Department of Ophthalmology, National University Hospital.

The Fellow will be trained in clinical work as well as formal training sessions and research. Fellow will spend about 60% time in clinical work and 40% in research work.

1. Clinical/Surgical

   Participation in glaucoma clinics and surgical through which will be exposed to:

   • Perform YAG or argon laser procedures in glaucoma patients (e.g. monocular patient, repeat laser, vitreous lysis, suture lysis).
   • Perform laser peripheral iridotomy for more advanced glaucoma (e.g. monocular patient, acture angle closure & hazy cornea).
   • Perform laser treatments (e.g. argon laser trabeculoplasty, iridoplasty) for more advanced glaucoma cases (repeat treatments, monocular patient).
   • Recognise and treat complications of glaucoma surgery blebs.
   
   

   Expected to be actively involved in education programmes of the glaucoma related teaching including:

   • Case reports and problem cases.
   • Conferences and journal clubs.
   • Grand rounds, Imaging rounds and reviews of emergency patients.
   • Participation in teaching of residents and / or medical students.

2. Research

   The Fellow will be involved in ongoing and new research projects:

   • To conduct and coordinate clinical research in glaucoma diseases within NUH in line with its research strategy and under the direction and supervision of the Principal Investigators and Collaborators.
   • To manage these research projects, which includes supervising post-doctoral research assistants, research students, and technical and other support staff.
   • To publish research outcomes in appropriate journals of international standing and to publish and disseminate the result of research and scholarship in other reputable outlets.
   • To attend and present research findings and papers at academic and professional conferences, and to contribute to the external visibility of the department.
   • To help draft research reports for the Principle Investigators.
   • To attend meetings and to participate (where necessary) in other committees and working groups within NUH.
   • To ensure compliance with health and safety in all aspects of research work.

3. Teaching

   • The Fellow will assist in organizing the case reports presentation.
   • There are also journal club on Thursday at 7.30am. The fellow will assist in organising the Glaucoma JC.
   • There are Grand rounds at 7.30am on Monday.
   • The Fellow will attend or present in the Continuing Medical Education sessions when the subject is related to Glaucoma.
   • The Fellow can attend examination related teaching sessions which is related to Glaucoma.
   • The Fellow will be participating in quality assurance audit programmes of the service.

1. Assessment will be on daily basis. The clinical and surgical competence is constantly assessed. On satisfactory evaluation by the assessors at the completion of the stipulated period, a certificate of Fellowship training will be awarded to the candidate.
2. Continuous close contact, interaction and two-way communication during clinics, ward work and surgery provide a continual assessment of the Fellow’s level of attainment when the he or she is performing under supervision.
3. Assessment, critique, questions & answer sessions and grading of the Fellow’s presentation during the Department Teaching Activities session will provide a measure of the Fellow’s performance.
4. The training logbook will be reviewed once a month.

The institution / hospital reserves the right to terminate the training programme in the event of unsatisfactory performance.

No certificate will be issued if training is prematurely terminated.

However, the following events may result in Termination of the Programme:

1. Wilful disregard of verbal or written instructions.
2. Repeated failure to perform duties adequately even after counselling.
3. Unethical or unprofessional conduct.
4. Inadequate care for patients under the care of the Glaucoma Team.
5. Repeated complaints from other members of the hospital which are found to arise from the Fellow’s incompetence or failure to carry out his or her duty adequately.
6. Personal reasons for which the Fellow wishes to terminate the programme early.

To provide an advanced yet comprehensive fellowship in the diagnosis and management of diseases of the eyelid, lacrimal system and the orbit in addition to aspects of aesthetic surgery of the face.

1 Year

1. MMed (Opthalmology), FRCS or its equivalent and would have completed 2 years of advance training rotations in general ophthalmology.
2. Completed 3 years of additional working experience/advanced specialist training with justification of need for training in Ophthalmic Plastic Surgery preferable.
3. Must be experienced in most aspects of clinical ophthalmology.
4. Should have participated actively in teaching, research with an acceptable record of publication.
5. A good command of English.
6. Competence in comprehensive ophthalmology.

Department of Ophthalmology, National University Hospital.

The Fellow will be trained in clinical work as well as formal training sessions and research. Fellow will spend about 60% time in clinical work and 40% in research work.

1. Methodology

   This comprehensive program aims to provide a wholesome training in the field of Oculoplastic & Orbitofacial Surgery Surgery. Responsibilities will be as follows:

   • Will be assigned to work with supervising preceptors in the subspecialty clinics – subsidized and private that will include comprehensive history taking, clerking, examination, drawing a reasonable differential diagnosis, order appropriate investigation and tailoring management for each patient. Fellows may not make independent decision before informing their supervisor.
   • He / she will be allowed a graded exposure to various steps of common oculoplastic procedures towards being able to competently perform entire procedures under supervision. In addition he/she will be involved in screening of patients preoperatively, discussing the plan of surgical management, submission and follow up of histopathologic specimen, short and long term postoperative management.
   • Fellows are to review all admitted oculoplastic patients and evaluate orbital trauma patients admitted under trauma surgery team, be actively involved in their management and coordinate surgery, if necessary.
   • They will participate in the teaching of residents/medical students and nursing staff.
   • They will be required to be involved in the management of all Oculoplastic emergencies eg. Lid and canalicular trauma, orbital fracture, orbital hemorrhage, orbital cellulites, etc.
   • They will be involved in all department and hospital CMEs, case presentations, clinico-pathologic meetings, grand rounds, journal club activities in addition to independent study and Oculoplastic division discussions.
   • They will be required to produce a minimum of two papers relevant to the subspecialty for presentations in regional / international meetings and for publication.
   • They will be actively involved in writing grant proposals, ongoing or new research projects, clinical trials and clinical audit.
   • The candidate will have a good exposure in ancillary subspecialties relevant to Oculoplastic Surgery like
     • Facial trauma and plastic surgery
     • Otorhinolaryngology
     • Ophthalmic and Orbital pathology
   
   

   Expected to be actively involved in education programmes of the glaucoma related teaching including:

   • Case reports and problem cases.
   • Conferences and journal clubs.
   • Grand rounds, Imaging rounds and reviews of emergency patients.
   • Participation in teaching of residents and / or medical students.

2. Clinical Teaching and Education

   The fellowship program will include training in diseases and surgery of the eyelid, lacrimal system and orbit in addition to some emphasis on aesthetic surgery of the face as well. Hands-on experience on a wide variety of Oculoplastic procedures to develop skills in decision-making and surgical management in a variety of procedures will be provided. Emphasis however will be laid on the following:

   • Entropion and ectropion surgery
   • Congenital and acquired ptosis repair
   • Lacrimal drainage procedures – syringing and probing, external and endonasal DCR, silicone intubation
   • Orbital surgery including transconjunctival and transseptal orbitotomies
   • Facial, eyelid and canalicular trauma
   • Upper and lower blepharoplasty
   • Conventional and endoscopic brow lift
   • Botulinum toxin injection for functional and aesthetic indications

1. Assessment will be on daily basis. The clinical and surgical competence is constantly assessed. On satisfactory evaluation by the assessors at the completion of the stipulated period, a certificate of Fellowship training will be awarded to the candidate.
2. Continuous close contact, interaction and two-way communication during clinics, ward work and surgery provide a continual assessment of the Fellow’s level of attainment when the he or she is performing under supervision.
3. Assessment, critique, questions & answer sessions and grading of the Fellow’s presentation during the Department Teaching Activities session will provide a measure of the Fellow’s performance.
4. The training logbook will be reviewed once a month.

The institution / hospital reserves the right to terminate the training programme in the event of unsatisfactory performance.

No certificate will be issued if training is prematurely terminated.

However, the following events may result in Termination of the Programme:

1. Wilful disregard of verbal or written instructions.
2. Repeated failure to perform duties adequately even after counselling.
3. Unethical or unprofessional conduct.
4. Inadequate care for patients under the care of the Oculo Team.
5. Repeated complaints from other members of the hospital which are found to arise from the Fellow’s incompetence or failure to carry out his or her duty adequately.
6. Personal reasons for which the Fellow wishes to terminate the programme early.

1. To provide tertiary knowledge in the clinical practice of Medical and Surgical Retina subspecialty
2. To attain an advanced level of surgical skills in the surgical management of retinal disorders
3. To comprehend and appreciate evidence-based medicine
4. To develop an enquiring mind and ability to work out problems from first principles based on sound clinical and scientific foundation
5. To be able to apply quality control measures in his or her practice

The Fellow will be trained in clinical work as well as formal training sessions and research.

Clinical training will take place in the following locations:

1. Outpatient clinics where the emphasis will be on problem solving

   • History taking
   • Examination
   • Ordering and Interpretation of Investigations eg
     • Fundus fluoroscein angiography (FFA) and related imaging eg ICG angiography, autofluorescence imaging
     • Optical coherence tomography
     • B-scan ultrasound
     • Visual fields
   • Arriving at Differential Diagnoses
   • Management of the problem
   • There are 5 supervised outpatient clinics a week

2. Wards

   • Inpatient Wards: ward rounds if there are retinal inpatients
   • Day Surgery Ward rounds

3. Operating Theatre

   • Assisting surgery
   • Operating under supervision
   • A logbook on the cases assisted and performed with a brief summary of the outcome will be kept

4. On-call for Retinal Emergencies in the Emergency Department, Clinics or Wards

   • The retinal team is on call for emergency retinal cases, and the Fellow is on second line call
   • The Fellow will have the opportunity to work up and be involved in the surgery of this group of patients

The Fellow will be involved in audits as well as ongoing and new research projects. He/she should be involved in planning and accomplishing research within the 2 years of Fellowship.

1. There are 2 formal Retinal Teaching Rounds a month at 7.30am on the 1st & 3rd Tuesday, which include FFA rounds, case presentations and journal reviews. The Fellow will assist in organizing the FFA’s and cases, as well as prepare presentations
2. There are Grand Ward rounds at 7.30am on Monday
3. There are Teaching Rounds at 7.30am on Thursdays
4. The Fellow will attend or present in the National Continuing Medical Education sessions when the subject is the Retina

Completion of an Ophthalmology training programme.

1 Year

Department of Ophthalmology, National University Hospital

Continuous close contact, interaction and two-way communication during clinics, ward work and surgery provide a continual assessment of the Fellow’s level of attainment when the he or she is performing under supervision.

Assessment, critique, question & answer sessions and grading of the Fellow’s presentation during the Teaching sessions will provide a measure of the Fellow’s performance.

The Fellow must demonstrate that he/she is able to manage all the common retinal problems within 4 months of the programme, be able to approach and work up complex retinal disease within 6 months, and become surgically competent in retinal surgery within 8 months.

In the second year of training, he/she will be supervised to perform complex retinal detachment surgery including giant tears, macular hole surgery with internal limiting membrane peeling, complex diabetic traction retinal detachment vitrectomy, traumatic retinal detachments and proliferative vitreoretinopathy.

• Name of Training Programme: Fellowship in Neuro-Ophthalmology
• Training Centre and or Department: Dept of Ophthalmology, NUH
• Specialty/Sub specialty: Neuro-Ophthalmology Service
• Length of Training: 3 month, 6 months, 12 months
• Training Faculty/Program Director : Assoc Prof Clement Tan, Senior consultant, Neuro-Ophthalmology, Department of Ophthalmology, NUH

• Completion of a residency programme in Ophthalmology or equivalent

Training Objectives

The prinicipal training objective is clinical training in Neuro-ophthalmology. There will also be opportunities for the fellow to engage in research.

Essential Description

Neuro-ophthalmology is a subspecialty of ophthalmology and neurology. It blends skills from both disciplines for the management of patients with diseases of parts of the eye, orbit and central nervous system. The fellowship program in Neuro-ophthalmology is designed to prepare doctors for independent full-time practice of Neuro-ophthalmology (regular 12-month fellowship) by providing more in-depth education about the pathophysiology and management of neuro-ophthalmological conditions than is obtained from a residency program. The graduate of the progamme will be equipped to manage simple, complex and severe neuro-ophthalmology conditions.

This program also provides short stint training (3 or 6 months) for doctors seeking further exposure to and experience in Neuro-ophthalmology.

Detailed Description

Clinical skills training

• Evaluation and management of patients in the outpatient and inpatient settings.
• Perform history taking and clinical examination for neuro-ophthalmology conditions.
• Know the indications for and evaluation of the results of tests of visual function and ocular anatomy, particularly, automated and manual perimetry, contrast sensitivity, colour vision, visual electrophysiology, optical coherence tomography.
• Know the indications for and have basic evaluation of the results fo CT scans and MRI as they relate to neuro-ophthalmology. Know the indications for and have basic evaluation of Ultrasound ‐ including A‐scan, B‐scan, and duplex Doppler.
• Know the indications for, use of, and limitations of pharmacological, radiological, and surgical therapies that may be recommended for patients with neuro‐ophthalmologic disorders.

Clinical Experience

Fellows are required to be exposed to a broad variety of neuro‐ophthalmologic disorders. The following minimum number of cases seen/procedures is required to be performed over a twelve month period:

• Neuro‐ophthalmology cases over 12 months: 500 (inclusive of items d‐f)
• Complete neuro‐ophthalmic examination: 250
• Visual fields: The fellow must perform a minimum of one manual or automated visual field and have a minimum of one manual or automated visual field performed on them.(1)
• Afferent visual pathway disorders: 100
• (including NA‐AION, A‐AION, optic neuritis, optic atrophy, papilledema, compressive optic neuropathy, congenital disc anomalies, pseudotumor cerebri, optic chiasm lesions)
• Efferent pathway disorders: 50
• (including disorders of the pupil, lid, ocular motility, nystagmus)
• Systemic disorders with neuro‐ophthalmic implications: 40
• (including multiple sclerosis, CPEO, thyroid, myasthenia gravis, cerebrovascular disease headache)

Shorter-term clinical attachments

Besides the regular 12 month fellowship, the programme will offer shorter term clinical attachements of 3 or 6 months duration for further exposure and experience for doctors already practicing Neuro-ophthalmology, exploring the possibility of undertaking a full (regular) fellowship or simply seeking to enhance their learning in Neuro-ophthalmology for the purposes of general ophthalmology or other subspecialty practice.

Didactic Components

Fellows are expected to participate in and present at:

• Grand Ward Rounds
• Mortality and Morbidity Rounds
• Combined Ophthalmology - Radiology Rounds
• Subspecialty Rounds
• Didactic Lectures
• Journal Clubs

Scholarly Activities

There are opportunities for fellows to engage in research activities; to present their work at local, regional and international meetings; and to publish their work in peer-reviewed journals. Fellows are encouraged to avail themselves to these opportunities.

The Fellow will assist in organizing and presenting at the teaching rounds described above and participate in the quality assurance audit programmes of the service.

Proposed roster: Only in NUH

	Monday	Tuesday	Wednesday	Thursday	Friday
AM	Neurology Clinic	Neuro-Ophthalmology Clinic	Neuro-Ophthalmology Clinic	Neuro-Ophthalmology Clinic	OT /Research
PM	Neuro-Radiology	Neuro-Ophthalmology Clinic	CME/Research	Electrophysiology	Neuro-Radiology

• Continuous close contact, interaction and two-way communication during clinics, ward work and surgery provide a continual assessment of the Fellow’s level of attainment when the he or she is performing under supervision.
• Assessment will take the form of workplace-based assessment, case-based discussions; and feedback on performance at Grand Rounds and other presentations.
• Fellows will keep a logbook on the cases observed /managed with a brief summary of the outcomes. The logbook will be reviewed once a month.

• The institution/hospital reserves the right to terminate the training programme in the event of unsatisfactory performance.
• No certificate will be issued if training is prematurely terminated.

• Trainees must complete a Feedback Form after training ends

Continuous close contact, interaction and two-way communication during clinics, ward work and surgery provide a continual assessment of the Fellow’s level of attainment when the he or she is performing under supervision.

Assessment, critique, question & answer sessions and grading of the Fellow’s presentation during the Teaching sessions will provide a measure of the Fellow’s performance.

The Fellow must demonstrate that he/she is able to manage all the common retinal problems within 4 months of the programme, be able to approach and work up complex retinal disease within 6 months, and become surgically competent in retinal surgery within 8 months.

In the second year of training, he/she will be supervised to perform complex retinal detachment surgery including giant tears, macular hole surgery with internal limiting membrane peeling, complex diabetic traction retinal detachment vitrectomy, traumatic retinal detachments and proliferative vitreoretinopathy.