Download FUNDAL EXAMINATION: INDIRECT OPHTHALMOSCOPY / T

FUNDAL EXAMINATION: INDIRECT OPHTHALMOSCOPY / T-MIRROR
ICO WORKPLACE BASED ASSESSMENT DIRECT OBSERVATION OF PROCEDURAL SKILL (DOPS)
Trainee’s Name
BST1
BST2
Date (dd/mm/yyyy)
BST3
BST4
BST5
BST6 Other (specify)
Assessor’s name
Assessor’s status
Consultant
Trainee
Other (specify)
Brief description of case and Learning Outcome
Please grade the following areas using the scale below (use tick or cross)
Attitude and manner
V good trainees introduce themselves and establish the identity of the patient and any other attendant (e.g spouse, parent or carer). Their
demeanour throughout shows they are attentive to the patient by gestures, words of encouragement and appropriate eye contact. They clearly
explain the purpose of the test and how it will be carried out. They ensure that the patient is comfortable and that adequate privacy is
maintained.
Good trainees introduce themselves and establish the identity of the patient and any other attendant (e.g. spouse, parent, carer). Their
demeanour varies, sometimes demonstrating active listening, sometimes less aware of the patient’s concerns. They establish a good rapport
overall, although there may be instances of poor understanding. They clearly explain the purpose of the test and how it will be carried out. They
make some effort to ensure patient is comfortable. They maintain adequate privacy.
Fair trainees may not introduce themselves or establish the identity of the patient and any other attendant (e.g. spouse, parent, carer) well, for
example, may introduce themselves by first name without explaining his/her role (SHO, registrar, etc.), or may presume the attendant is to stay
with the patient for the consultation without determining the patient has consented to this. They explain the test in a superficial way and can be
vague about how it will be carried out. Their demeanour may appear abrupt at times and they may miss important information/concerns that the
patient expresses. They may be inconsiderate of patient preferences. They may only partially ensure privacy.
Poor trainees fail to introduce themselves and do not identify the patient. They appear to hurry or ignore what the patient is saying. They do
not explain the test in an appropriate manner. They pay little or no attention to confirmation of patient comfort or privacy.
Poor
Fair
Good
V Good
n/a
Introduction and explanation of examination
Rapport with patient, empathy and sensitivity to age and context
Indirect ophthalmoscopy
V good trainees adjust the equipment appropriately before use, in particular adjusting the light and IPD for optimum viewing. They examine the
patient in a reclined position whenever appropriate and ensure their comfort. They choose the most appropriate condensing lens, correctly
explaining their choice of lens. They demonstrate an efficient and fluent technique, holding the lens at the best distance from the patient’s eye.
They approach the examination in a logical sequence ensuring they view all 4 quadrants in the most anterior as well as the posterior parts of the
retina. They ask the patient to look in appropriate directions in order to view relevant parts of the retina and move their body accordingly. When
appropriate they use indentation efficiently and gently. They use the minimum light necessary for a proper view and empathize with the patient
when the light or the indentation causes discomfort. They are able to accurately and without hesitation describe and draw any relevant lesions
with a clear understanding of image inversion as well as lateral reversal of the image.
Good trainees adjust the equipment appropriately before use, in particular adjusting the light and IPD for optimum viewing. They examine the
patient in a reclined position whenever appropriate and ensure their comfort. They may not choose the most appropriate condensing lens and are
unsure in explaining their lens selection. Their technique is generally efficient but not always fluent, and may be hesitant. Usually they hold the
lens at the best distance from the eye but may need to check and re-check themselves in order to do this. They initially approach the examination
in a logical sequence but fail to continue in such a manner, and only adequately view 3 of the 4 quadrants in the most anterior as well as the
posterior parts of the retina. They ask the patient to look in appropriate directions in order to view relevant parts of the retina. When appropriate
they use indentation but find it difficult and may have technique which is sub-optimal. They use the minimum light necessary for a proper view and
empathize with the patient when the light or the indentation causes discomfort. Their description and drawing of their findings is generally accurate
but may have minor flaws or omissions. If they make an error in the retinal drawing of their findings they quickly correct themselves without
prompting from the assessor.
Fair trainees place the ophthalmoscope in position on their head squarely and securely. They take time to adjust the light and IPD appropriately
and may not achieve an optimal view. They may fail to ensure that the patient is comfortable or appropriately positioned, often because of
concentration on the technical aspects of the task. It takes them a while to figure out the correct illumination, and this might result in the patient
having minor discomfort. Their use and positioning of the lens is haphazard and lacks confidence. They approach the examination in an
interrupted fashion without a logical sequence. They only adequately view 2 of the 4 quadrants but fail to view the inferior and temporal or nasal
retina properly. They adequately view the posterior parts of the retina but viewing of the anterior retina is incomplete. They go through the motions
of asking the patient to look in appropriate directions in order to view relevant parts of the retina but they do not move their body to optimize the
view. They make an attempt at indentation but it looks unpracticed and the examiner may need to assist. They can be unconvincing when showing
empathy. They can identify that abnormalities are present but are unable to describe and draw them accurately without prompting from the
assessor.
Poor trainees struggle to place the ophthalmoscope in position on their head squarely and securely. They are unable to adjust the light and IPD
appropriately. They fail to ensure that the patient is comfortable or appropriately positioned. They use too much or too little illumination. Their use
and positioning of the lens is haphazard. They are unable to co-ordinate an examination of the peripheral fundus and are rough with and/or
unsuccessful at indentation, requiring the examiner to take over. They fail to understand and empathize with the patient when they fail to achieve
a view. They miss abnormalities altogether and/or fail to describe them.
Poor
Fair
Good
V Good
n/a
Knowl Instructions to patient
Familiarity with use of ophthalmoscope
Correct use of illumination and appropriate use of lenses
Technique to view posterior pole (focus)
Technique to view each quadrant in different positions of gaze
Indentation technique and ability to view anterior retina
Description and drawing of retinal findings
T-mirror
V good trainees set up the slit lamp illumination and eyepieces before commencing the examination. They help the
patient to get into position if necessary. They warn the patient of the brightness of the light. They ensure that the
patient's ocular surface is adequately anaesthetized. They ensure the lens is disinfected and clean. They choose the
most appropriate colour, size and brightness of light at every stage and empathize with the patient who has difficulty
keeping the eye still. Their technique is fluent and they are able to view all structures required. They are clear which
part of the retina is viewed through each mirror. They clearly understand image inversion and can accurately
describe both the location and orientation of observed retinal lesions.
Good trainees set up the slit lamp illumination and eyepieces before commencing the examination. This might take
some deliberation and be slower than desired. They help the patient to get into position if necessary. They warn the
patient of the brightness of the light. They ensure that the patient's ocular surface is adequately anaesthetized. They
ensure the lens is disinfected and clean. They may not always choose the most appropriate colour, size and
brightness of light. They empathize with the patient who has difficulty keeping the eye still. Their technique is
adequate but lacks fluency and may have some aspects which are awkward. The lens may come off but they are
able to reassure the patient and proceed with reinsertion without becoming distracted. They are clear which part of
the retina is viewed through each mirror. They are able to view most structures required and describe their location
with general accuracy but missing some finer points on orientation. They correct themselves without prompting from
the assessor.
Fair trainees either spend too long setting up the equipment or do it sloppily. They might start with an inappropriately
bright light so it might take some time to adjust appropriately, or they might use an appropriate light but be slow and
hesitant in proceeding. Their empathy towards the patient may seem robotic or an afterthought and they may not be
able to reassure the patient adequately during the procedure. They may have suboptimal disinfection procedures.
The lens may come off the eye and they have difficulty with reinsertion. They are unclear which part of the retina is
viewed through each mirror and require prompting. They will usually achieve a view and identify there is an
abnormality but only with effort. They fail to describe abnormalities accurately in terms of location or orientation and
require prompting form the assessor.
Poor trainees rush into the examination without setting the slit lamp properly. They start with an inappropriately
bright light. They show frustration when patients cannot place their head appropriately, cannot hold their eye still or
have difficulty tolerating the contact lens. They show no regard to disinfection procedures. They have difficulty
getting the lens positioned correctly and have reinsert it multiple times. If they manage to achieve a view at all they
miss abnormalities altogether and/or fail to describe them accurately in terms of location or orientation.
Poor
Fair
Good
V Good
n/a
Appropriate ambient lighting and slit-lamp illumination (1mm)
Application of anaesthesia / coupling fluid
Knowledge of fundal view for each mirror
Fluency of technique, rotation of lens, duration of examination
Knowledge of orientation of image and accurate clinical drawing
Description of findings
Overall difficulty of case
Simple
Intermediate
Poor
Overall performance in this assessment
Outcome (Delete as appropriate)
Difficult
Fair
Good
V Good
Competent/Not competent
Please use the boxes below/overleaf for free-text comments and recommendations for further
training.
Anything especially good?
List 2 action points which the trainee should take to improve by time
of next assessment:
1.
2.
Signature of assessor:
Signature of trainee