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Dr. H. Yusufali taking the OSCE Fellowship
examination under the invigilation of Dr. M.
Kollmann in November 2010
                                                                  

Fellowship Exam for the College of Ophthalmologists of Eastern, Central and Southern Africa (FCOECSA)

 

Candidates’ Information Pack 

 The Examination

Part 2 FCOECSA is a synoptic exit examination that uses several different and complementary assessment methods.  Success in this examination allows a doctor to become a Fellow of The College of Ophthalmologists of Eastern, Central and Southern Africa.  It is not a necessary requirement for completion of specialty training in the region but is useful in assessing oneself against peers in the affiliate colleges as well as increasing ones competitiveness regionally.

 The examination is blueprinted against the detailed learning outcomes of the curricula of the Master of Medicine in Ophthalmology (M.Med. Ophthal) training courses in the region. Candidates are expected to demonstrate a depth of knowledge and understanding expected of an independent specialist (consultant) not sub-specialising in the field being tested.

The assessment methods selected for the FCOECSA exam are:

  • Structured viva (SV)
  • Multi-station objective structured clinical examination (OSCE)

The exam is held once a year between September and November at one of the affiliate colleges as will be communicated to you in good time.

Required Reading

Candidates should be familiar with the following documents

  • The FCOECSA regional curriculum guidelines.
  • Individual college curricular.
  • Policy on allegations of cheating and misconduct, which is part of the COECSA Exam Application form.
  • Standard textbooks of ophthalmology such as Clinical Ophthalmology by J.J. Kanski, The American Academy of Ophthalmology (AAO) series, Ophthalmology by Yanoff, and Duane’s Clinical Ophthalmology, and Eye Surgery and Eye Diseases in Hot Climates by John Sanford-Smith, and the more significant clinical trials that have been carried out and moulded the practice of ophthalmology.

Structured Viva

 Introduction :The Structured Viva consists of a series of strictly timed assessment ‘stations’, where various areas of competence are tested by examiners using an objective marking scheme in order to increase the reliability and validity of the examination.

Format of the Structured Viva

The Structured Viva will consist of a series of six stations, each of which will be timed for precise periods of 10 minutes.

The stations are set out as follows:

Station 1:         Patient management, patient investigations and data interpretation 1

Station 2:         Patient management , patient investigations and data interpretation 2

Station 3:         Patient management, patient investigations and data interpretation 3

Station 4:         Attitudes, ethics and responsibilities and Audit, research and evidence based practice

Station 5:         Community Eye Health and Health promotion and disease prevention

Station 6:         Communication skills.

Two examiners will be present at each station for the duration of the cycle.

The start and finish of each station is controlled by a timekeeper and clearly signalled.

Conduct of the Structured Viva

The timekeeper will announce the commencement of the station and the candidate will enter.  The examiners will begin the questions, ensuring strict adherence to pre-agreed questions to ensure the same information is requested of each candidate.  At the end of the 10 minute session the timekeeper will signal the end of the station.  However it is possible that the structured questions may have been completed prior to the end of allotted time.  Under these circumstances the viva will terminate ahead of schedule and the candidate will be informed that the viva station is complete and will be asked to leave that station.  The candidate should then wait outside that station until asked to leave by the timekeeper.  The candidate will leave the station and be directed to the next station. 5 minutes will be allowed for changeover and for examiners to independently complete the mark sheet.

Stations 1-3: Patient management, patient investigations and data interpretation

Case-based discussion may involve cases which are infrequently seen but essential to manage by all ophthalmologists and unlikely to be represented in the OSCE examination.   It may include (but not be restricted to) the following:

  • Interpretation of biometry
  • Ocular and neuro-imaging
  • Hess charts
  • Electrophysiology
  • Visual fields
  • Working with uncertainty
  • Suspected child abuse
  • Endophthalmitis
  • Ocular Trauma
  • Intraocular and orbital neoplasia
  • Neurological emergencies
  • Ocular emergencies
  • Complex cases

Station 4:       Attitudes, ethics and responsibilities  and Audit, research and evidence based practice

Case-based discussion may include (but not be restricted to) the following:

Audit, research and evidence based practice

  • Principles of audit and research
  • Use of published evidence
  • Published clinical guidelines

Attitudes, ethics and responsibilities

  • Medical ethics
  • Consent
  • Confidentiality
  • Duties of a doctor
  • Appraisal and revalidation
  • Management of complaints
  • Critical incident reporting
  • Poor performance in a colleague

Station 5:       Community Eye Health and Health promotion and disease prevention

Case-based discussion may include (but not be restricted to) the following:

Community Eye Health

  • National and global eye health statistics
  • Childhood blindness
  • Common causes of visual impairment
  • Environmental impact on eye health
  • Socio-economic impact on eye health

Health promotion and disease prevention

  • Screening for ophthalmic disease
  • Prevention of cross infection
  • Hospital acquired infection
  • Drug side effects 

* Candidates are advised to read and make themselves familiar with:

  • National Medical Guidelines
  • Guidelines from the medical councils/ boards within the region.
  • Local and international driving guidelines
  • Strategic papers
  • In some instances candidates may receive advance notification asking them to read a particular paper for discussion at the forthcoming examination

Station 6: Communication Skills

The candidate will receive a GP letter or case scenario to read.  The candidate may make notes on the paper provided, which will be destroyed afterwards and not used for assessment.  The timekeeper will announce commencement of the station.  The interview will last for a 10 minute duration and involve interaction between the candidate and the patient/subject and may include history taking, taking consent for surgery, some form of counselling or advising patients.  The interview will commonly take the following format:

  • being given a brief background to the patient, a GP letter or an optometrist report to read
  • taking a relevant history
  • being presented with the findings of examination or investigation
  • counselling the patient
  • alternatively, a scenario may be suggested, e.g. a patient complaining about their treatment

History taking skills includes eliciting the presenting complaint systematically, enquiring about past medical history, family/smoking/alcohol treatment history. The candidate should be able to follow relevant leads and use appropriate verbal and non-verbal responses. There should be a good balance of open and closed questions and the interview should be conducted at an appropriate pace, without rushing or interrupting the subject inappropriately but covering the main aspects.The candidate should be able to interpret the history and discuss the implications of the patient’s main problem.

Communication skills: The candidateintroduces himself or herself to the subject and explains their role clearly. They should put the subject at ease and establish a good rapport, exploring their concerns, feelings and expectations – while demonstrating empathy, respect and a non-judgemental attitude.  The candidate should be able to provide clear explanations, free of jargon, which the patient/subject understands. They should be able to summarise the interview and check the patient understands of the discussion.

It is vital that the information given to the patient is accurate and appropriate.  This is an important aspect of this assessment.

For station 6 the examiners are asked to reach a judgement for each of the following elements:

  • Establishment of rapport and information gathering
  • Understanding of information given and information delivery
  • Patient Input and Overall Communication Skills
  • Appropriateness of advice and accuracy of information

Timetable

 An example of the timetable for a cycle of the examination is set out below.

 

Examiners A&B Examiners C&D Examiners E&F Examiners G&H Examiners

I&J

Examiners

K&L

    Station 1 Station 2 Station 3 Station 4 Station 5 Station 6

(Communication Skills)

10 MINS 09.00-09.10

Candidate 1

Candidate 2

Candidate 3

Candidate 4

Candidate 5

Candidate 6

5 MINUTE INTERVAL

10 MINS 09.15-09.25

Candidate 6

Candidate 1

Candidate 2

Candidate 3

Candidate 4

Candidate 5

5 MINUTE INTERVAL

10 MINS 09.30–09.40

Candidate 5

Candidate 6

Candidate 1

Candidate 2

Candidate 3

Candidate 4

5 MINUTE INTERVAL

10 MINS 09.45-09.55

Candidate 4

Candidate 5

Candidate 6

Candidate 1

Candidate 2

Candidate 3

5 MINUTE INTERVAL

10 MINS 10.00-10.10

Candidate 3

Candidate 4

Candidate 5

Candidate 6

Candidate 1

Candidate 2

5 MINUTE INTERVAL

10 MINS 10.15-10.25

Candidate 2

Candidate 3

Candidate 4

Candidate 5

Candidate 6

Candidate 1

 

 

 

 

 

At each station, the examiner should remind the candidate of the time available and the signals used to indicate the timing.  It is vital that the timing of the station is strictly adhered to.

 Method of Assessment for the Structured Viva

The mark sheets: 12 marksheets, in total, will be completed for each candidate by the examiners i.e. two examiners per station, 6 stations.  Each structured viva is divided into four marking sections to be judged on a 4 point Likert scale as follows:

Poor                                                                Good

 

0                      1                         2                         3

Marking guidance for each Viva section is included for examiners within the structured question.  Each examiner will therefore award up to 12 marks per viva station, with each mark counting towards the final overall score.

For all candidates – whether pass or fail – detailed notes will be made on the reverse of the mark sheet so that constructive feedback can be forwarded to the candidate including the type of cases and questions asked.  This feedback will be given as “satisfactory performance” and “unsatisfactory performance”.  Both examiners score the candidate independently.

Standard Setting for the Structured Viva

For each station, the candidate will receive a numerical score.

Multi-station objective structured clinical examination (OSCE)

Introduction: The OSCE consists of a series of strictly timed assessment ‘stations’, where various areas of competence are tested by examiners using an objective marking scheme in order to increase the reliability and validity of the examination.

Structure of the OSCE

The clinical examination will consist of a series of six stations, each of which will be timed for precise periods of 15 minutes.

The stations are set out as follows:

Station 1:         Cataract and anterior segment

Station 2:         Glaucoma

Station 3:         Posterior segment

Station 4:         Paediatrics, strabismus and neuro-ophthalmology

Station 5:         Orbit and lid

Station 6:         Refraction

Station 7:         General Medicine and Neurology

The subject matter is to be viewed as a guide. Patients may be presented in any station, and a degree of overlap is expected to occur. Two examiners will be present at each station for the duration of the cycle. One of the examiners may be a sub-specialist in the particular field of ophthalmology being tested. The other should either be a general ophthalmologist or a sub-specialist in another area of ophthalmology.

The candidate will be examined on two patients per station. The start and finish of each station is controlled by a timekeeper and clearly signalled.

Conduct of the OSCE

The timekeeper will announce the commencement of the station.  The candidate will remain standing beside the station.  One examiner will take the candidate to the station and instruct the candidate on the task required for the first patient.  This should involve giving the candidate a brief clinical scenario/history and asking the candidate to examine the patient appropriately.  After examination of the patient, the candidate will be asked to describe his/her findings and there will follow a short discussion on the investigation and management of the clinical problem.  The second examiner should take the candidate to the second patient and ask the candidate to examine them.  This will be repeated, as appropriate, for the number of patients in the station.  Candidates should be careful to undertake appropriate hand hygiene during the examination.

At the end of allotted time, the timekeeper will signal the end of the station. The candidate will leave the station and be directed to the next station. Time is scheduled to allow for changeover and for examiners to independently complete the mark sheets.

Station 1: Anterior segment

The candidate will be examined on two cases. Skills to be tested may include (but not be restricted to) the assessment, interpretation, diagnosis and management of:

  • Abnormal lid position (ectropion, entropion, ptosis, trichiasis, lagophthalmos and exposure)
  • Abnormal lid swelling (chalazion, benign and malignant tumours)
  • Blepharitis
  • Epiphora
  • Infectious external eye disease including conjunctivitis and keratitis
  • Dry eye
  • Cicatricial conjunctival disease
  • Corneal and conjunctival degenerations
  • Peripheral ulcerative keratitis
  • Corneal dystrophies
  • Allergic and atopic disease
  • Complications of contact lens wear
  • Corneal oedema, opacity, ectasia, corneal transplantation and corneal graft rejection and other complications
  • Episcleritis
  • Conjunctival and anterior uveal tumours
  • Aniridia and other dysgenesis
  • Anterior uveitis
  • Anterior segment injury
  • Lens dislocation
  • Assessment, diagnosis and management of all forms of cataract and the complication of cataract surgery

In this section candidates must be proficient in the use of the slit lamp microscope in examining the anterior segment employing direct and indirect illumination, retro-illumination, specular reflection and scleral scatter as appropriate to best demonstrate signs.

Station 2: Glaucoma, The candidate will be examined on two cases.

Skills to be tested may include (but not be restricted to) the assessment, interpretation, diagnosis and management of:

  • Ocular hypertension and all forms of glaucoma and its management, including the use of hypotensive agents and glaucoma drainage surgery and its complications
  • Ocular hypotension following glaucoma surgery and its management

Station 3: Posterior segment

The candidate will be examined on two cases. Skills to be tested may (but not be restricted to) include the assessment, interpretation, diagnosis and management of:

  • Vitreous disorders
  • Retinal detachment
  • Retinoschisis
  • Degenerative retinal disorders
  • Choroidal disorders
  • Macular disorders
  • Intraocular tumours (primary and secondary)
  • Injury involving the posterior segment
  • Retinal disease and retinopathy
  • Genetic diseases affecting the retina

Candidates must be proficient in the examination of the posterior segment and including the use of the direct ophthalmoscope, indirect ophthalmoscope (indentation to be avoided) and slit lamp lenses.

Station 4: Paediatrics and strabismus, The candidate will be examined on two cases.

Skills to be tested may include (but not be restricted to) the assessment, diagnosis and management of:

  • Concomitant strabismus
  • Amblyopia
  • Incomitant strabismus
  • Nystagmus
  • Ocular motility syndromes (e.g. Duane’s, Brown’s)
  • Ocular myopathies
  • Supranuclear eye movement disorders
  • Neuromuscular disease

Candidates should be proficient in eye movement evaluation and cover test (including alternate cover and prism cover test) and methods of examining orbital disease.

Station 5: Orbit and Oculoplastics, The candidate will be examined on two cases.

  • Orbital disease – orbital swelling, exophthalmos, orbital masses, thyroid eye disease
  • Abnormal lid position (ectropion, entropion, ptosis, trichiasis, lagophthalmos and exposure)
  • Abnormal lid swelling (chalazion, benign and malignant tumours)
  • Blepharitis

Station 6: Refraction, In this section the candidate will be examined on two cases.

  • Refracting a patient
  • Performing refraction on a model eye that has been pre-set

Station 7: General Medicine and Neurology

General Medicine

  • Diabetes
  • Hyertension
  • Tuberculosis
  • Human Immunodeficiency Virus (HIV) and AIDS
  • Anaemia
  • Sicklecell disease
  • Haemotopoetic malignancies
  • Grave’s disease

Neurology

  • Visual pathway disorders including optic nerve disorders
  • Visual field loss secondary to disorders of the visual pathway
  • Cranial nerve disorders
  • Pupil abnormalities
  • Upper motor neurone disorders
  • Lower motor neurone disorders
  • Disorders of the sensory system
  • Disorders of the extrapyramidal system
  • Headache
  • Field testing by confrontation
  • Ocular myopathes
  • Nystagmus
  • Incomitant strabismus
  • Supranuclear disorders of eye movements
  • Neuromuscular disease

Candidates should be proficient in assessment of cranial nerves, pupils, the assessment of visual fields by confrontation, motor function in limbs (tone, power, reflexes including plantar responses), sensory function (light touch, vibration sense, proprioception [pinprick to be avoided]) and coordination/cerebellar function. Candidates may be asked to examine a fundus or optic disc using a direct ophthalmoscope during the medicine and neurology station.

Timetable, Sample Flow Chart for an exam with 6 stations and 6 Candidates.

If there are more than 6 Candidates in the rotation then a few break spots will be introduced as appropriate.

 

Time Station 1 Station 2 Station 3 Station 4 Station 5 Station 6
9:00 – 9:15 Candidate 1 Candidate 2 Candidate 3 Candidate 4 Candidate 5 Candidate 6
9:20 – 9:35 Candidate 6 Candidate 1 Candidate 2 Candidate 3 Candidate 4 Candidate 5
9:40 – 9:55 Candidate 5 Candidate 6 Candidate 1 Candidate 2 Candidate 3 Candidate 4
10:00 – 10:15 Candidate 4 Candidate 5 Candidate 6 Candidate 1 Candidate 2 Candidate 3
10:20 – 10:35 Candidate 3 Candidate 4 Candidate 5 Candidate 6 Candidate 1 Candidate 2
10:40 – 10:55 Candidate 2 Candidate 3 Candidate 4 Candidate 5 Candidate 6 Candidate 1

At each station, the examiner should remind the candidate of the time available and the signals used to indicate the timing.  It is vital that the timing of the station is strictly adhered to.

OSCE – Method of Assessment

The mark sheets: 12 mark sheets in total will be completed for each candidate by the examiners i.e. two examiners per station, 6 stations.  Each aspect of the OSCE station is judged on a 4 point Likert scale as follows:

Poor                                                                Good

 

0                      1                         2                         3

For these stations, examiners are asked to reach a judgment for both of the following elements:

  • Examination
  • Diagnosis and Management

This will generate 2 marks per element per patient.  All marks will count towards the final overall score. For all candidates – whether pass or fail – detailed notes will be made on the reverse of the mark sheet so that constructive feedback can be forwarded to the candidate including the type of cases and questions asked.  This feedback will be given as “positive performance” and “negative performance”.

Both examiners score the candidate independently.

Standard Setting for the OSCE

For each station, the candidate will receive a numerical score.

Important Note: Aggressive or inconsiderate behaviour, physical or verbal, to a patient should be noted on the reverse of the marking sheet and be brought to the attention of the chief examiner.

Overall Result: To pass the FCOECSA examination, candidates are required to pass all components (Structured Viva and OSCE). Candidates must re-sit the entire examination, even if a pass was previously achieved in any section.

Cross Compensation

If a candidate marginally fails the Structured Viva, their total marks for both the Viva and the OSCE will be added together.  If this mark exceeds the combined pass marks for both components, they will be allowed to pass the examination.  It is NOT possible to compensate a poor OSCE with a good viva result. Up to 2% from the passmark, is considered a marginal fail.

Notification of Results

  1. Results are posted by First Class Mail with the Pass List being displayed on the College Website. Results are only released upon approval of the Senior Examiner.  We regret that examination results are not available by telephone or email.

Counselling

The College places great importance on providing guidance to those candidates whose performance failed to meet the standard to pass the examination.  For the practical components of the examination, examiners are asked to provide notes to assist in this process, particularly if there is concern regarding a candidate’s conduct during the examination (e.g. if the clinical method of the candidate was rough or caused patient discomfort).  All candidates will receive details of their performance for formative purposes.  It is intended that this is for personal information and that the candidate should only share this with his/her educational supervisor.

 Appeals: Appeals can be made to the COECSA Examination Board not later than 30 days after the date of results posting.

 

 

How To Apply for the fellowship Exam

 

COECSA invites applications for registration for FCOECSA examination from qualified ophthalmologists across the East Africa region. The examinations are held annually in the month of November. The exact date and venue is communicated to the applicants in good time.

To register, the applicant must fill an application form which is available for Download HERE

 

The completed application form is then submitted to the COECSA Secretariat accompanied by certified copies of the degree and Medical Council/Board certificates (registration as a specialist) and the applicable registration fee.