First Things First
Teerajet Taechameekietichai | | Longer Read
In 2019, the UK’s immensely popular Microsurgical Skills (MSS) course was replaced with Introduction to Ophthalmic Surgery for non-ophthalmology trainees. The three-day MSS training had ranked among the most successful courses provided by the Royal College of Ophthalmologists (RCOphth) and, though held in the UK, it was open to international attendees and easily accessible thanks to its London location. The course provided an excellent foundation for ophthalmology trainees to develop good microsurgical skills. In the last few years, there was a clear trend toward doctors’ attending the course early in their careers.
One of the reasons behind the high demand for the MSS course was that it helped Specialist Training candidates secure a point in the Training and Experience section of their recruitment portfolios – but trainees often forgot the knowledge and skills they gained through the MSS course when they started their posts a year later (1). This is why RCOphth decided to replace MSS with the Introduction to Ophthalmic Surgery and Introduction to Phacoemulsification courses for non-ophthalmology trainees and Special Training candidates, respectively. The former presents an opportunity for non-ophthalmology trainees to learn the fundamental skills of ophthalmic surgery.
Who is the course for?
The course is aimed at Foundation Doctors (who are completing a postgraduate medical training course in the UK), medical students, overseas doctors, and anyone who wishes to pursue a career in ophthalmology. Although it is not compulsory, attendees are awarded an extra point in the recruitment section of their portfolio. In October 2019, when I attended, the majority of participants were current Foundation Program Year 2 Doctors.
I decided to sign up for the RCOphth Introduction to Ophthalmic Surgery course for several reasons. First of all, like many medical students, I found that my medical school did not offer much exposure to ophthalmology and I believed that the course would reinforce my own understanding of surgical procedures for different ophthalmic conditions. I was also genuinely fascinated by the complexity of microsurgery and impressed by the high level of manual dexterity required.
Theory and practice
The course includes a short lecture before moving on to practical skills, which familiarized me with different types of ophthalmic surgery. I had around five hours to practice different practical skills on an eye model.
Before the course, students are given a link to an e-learning resource. This allows those with no surgical experience to learn the basic suture types and surgical instruments. Additionally, it provides multiple videos demonstrating different suturing and knot tying techniques; some on real patients.
The course itself was very well organized and I felt that I had sufficient time to go through each skill before moving on to the next one. We were taught how to correctly handle different surgical instruments, as well as the basics of knot tying and suturing, and we had the opportunity to practice these techniques on foam boards. Even my minimal surgical experience allowed me to take full advantage of the training and, by the end of the first session, I felt I’d developed a good basic suturing skill that would be useful for all kinds of surgical jobs.
Learning Objectives of the RCOphth Introduction to Ophthalmic Surgery Course
- Be able to identify commonly used microsurgical instruments and know the procedures for which they are used.
- Develop an understanding of different suture materials and needles.
- Be able to tie an appropriate knot for oculoplastic, corneal, and strabismus procedures.
- Be able to repair a lid margin laceration.
- Be able to safely place a suture in the sclera and in a rectus muscle.
- Be able to construct a self-sealing corneal incision for phacoemulsification cataract surgery.
- Be able to repair a corneal laceration with a 10/0 nylon suture using an operating microscope.
- Be able to set up and use the EyeSi cataract surgery simulator.
The session continued with a demonstration and practice of scleral and rectus muscle suturing, with an introduction to basic muscle surgery concepts such as muscle resection and recession. Each student got a chance to spend around 15 minutes on the Eyesi Ophthalmic Surgical Simulator, using the first setting of the basic anterior chamber navigation module, and we each got an account that allowed us EyeSi access at the RCOphth. We carried on with an eyelid suturing demonstration and were then introduced to using an operating microscope for corneal incision and suturing. I found using the microscope quite realistic, but suturing under it proved a lot more challenging than I had expected, with my field of view considerably restricted. Nevertheless, I felt that the session was well-supervised and the consultants were willing to help with any challenges I encountered.
Was it worth it?
I think that this course hugely improved my surgical skills and I would definitely recommend it to anyone thinking of pursuing a career in ophthalmology. Additionally, the course gave me insight into what it is like to perform an ophthalmic procedure. The course is definitely worth its (inexpensive) price, but it is in high demand, so for those interested – book early!
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- The Royal College of Ophthalmologists, “Microsurgical Skills Course Changes for 2019” (2019).