Specialty Trainee Rotations

The Gloucestershire Eye Unit has two ST1-2 and 2 ST3-7 trainees. It had the highest trainee approval rating (99%) of any Department in the UK in the 2009 PMETB survey. In addition, Cheltenham General Hospital has been voted the top hospital for the third year in a row (GMC survey 2011).

ST1-2 trainees will spend two years in Cheltenham. There are three six-month firms, which means that one of these firms is repeated in this two year period. These firms will be a mix of general ophthalmology and a subspecialty interest related to the supervising consultants (oculoplastics /glaucoma, paediatrics / anterior segment and medical retina / glaucoma)

After an initial one month induction period when ST1s will shadow another more senior trainee before they commence their ST1 timetable proper. This includes twice weekly theatre sessions with hands on experience in cataract surgery, oculoplastic surgery and strabismus surgery. After two years all ST2s should have completed at least 80 phacoemulsification procedures.

Trainees will have two casualty clinics per week and two general clinics. There is also a weekly teaching clinic, where they are supranummery and can therefore sit in with their supervising consultant in their subspecialty clinic.

There are four firms for ST3-7 trainees including, Retinal, Oculoplastic, Glaucoma and Paediatrics / Ocular motility

Oculoplastics and Adnexal Firm

Consultants

  • Mr Glynn Baker
  • Miss Gill Blake

The oculoplastic and lacrimal service is delivered by Ric Caesar, Glynn Baker and Gill Blake. The service is comprehensive and includes an orbital service. There is overlap with the paediatric service provided by John Ferris, who looks after the paediatric lacrimal and oculoplastic cases. An endonasal DCR service is provided by the ENT team on the Gloucester site and complex combined head and neck surgery for free flaps is provided together with the maxillofacial team.

Trainees will have two oculoplastics lists per week and two specialist clinics.

The clinical experience will provide a thorough grounding in all aspects of general oculoplastics. The whole team are committed to providing the highest standard of teaching and the use of video is encouraged. Please review www.oculoplastics.info to see the video training techniques used.

Attendance and presentation at BOPSS and ESOPRS is encouraged and supported.

Glaucoma Firm

Consultants

  • Professor Andrew McNaught
  • Mr James Nairne

This firms provides a wide range of experience in the medical and surgical management of patients with glaucoma, including:

  • Interpretation of visual fields and HRTs
  • Drainage surgery and the use of antimetaboloites
  • Laser procedures for glaucoma
  • Post-operative drainage bleb management

There are threeglaucoma clinics per week. The two operating lists are under the supervision of Professor McNaught.

Professor McNaught has a number of ongoing research projects, which trainees are encouraged to participate in.

Paediatric Ophthalmology and Strabismus

Consultants

  • Mr John Ferris

This firm provides training in the clinical assessment and surgical management of the following conditions:

  • Paediatric strabismus
  • Adult strabismsus / neuro-ophthalmology / including the use of botulinum toxin
  • Paediatric oculoplastics and lacrimal surgery
  • Paediatric cataracts
  • ROP screening

There are two paediatric clinics per week and two adult strabismus / botox clinics per month.

There are two paediatric theatre lists per month and one adult strabismus list per month.

Simulated staged strabismus surgical training is arranged for all trainee on this firm, be they ST1 or ST7 trainees.

Retinal Firm

Consultants

  • Mrs Barbara Harney: Medical retina
  • Mr Rob Johnson: Vitreoretinal and medical retina. Director Medisoft
  • Mr Nigel Kirkpatrick: Vitreoretinal and medical retina
  • Mr Quresh Mohamed: Medical Retina and Uveitis
  • Dr Peter Scanlon: Diabetic eye disease and medical retina. Director of the Diabetic Retinal Screening Programme in England

Gloucestershire NHS trust has an active, modern and innovative medical retina service. There are 3 medical retina consultants, two vitreoretinal consultants and two associate specialists all with a special interest in medical retina. The department is well equipped with FFA/ICG facilities, six OCT machines (including Stratus, Cirrus and Spectralis machines), a HRA 2 (combined FFA, ICG and OCT, videoangiography, and fundus autofluorescence imaging), lasers including a PASCAL laser.

Gloucestershire has one of the best diabetic eye screening services and is pioneering the use of electronic medical record systems and multidisciplinary clinics in management of AMD and diabetic eye disease.

The firm will provide training and experience focused on medical diseases of the retina and vitreous.

Goals

  • Provide structured clinical training in the diagnosis and management of medical diseases of the retina
  • Training in the use and interpretation of diagnostic tests including optical coherence tomography, fluorescein angiography, ICG angiography, and fundus autofluorescence imaging.
  • Training in medical retinal procedures including, panretinal photocoagulation, focal laser treatment of the macula, laser retinopexy of retinal tears, intravitreal, orbital floor and subtenons injections of drugs and photodynamic therapy.
  • Teach the timing and role of vitreous surgical procedures for surgical retina disorders.
  • Care of patients with significant visual loss, including an understanding of sight certification, low vision and other supportive local services.
  • Demonstrate the importance of a team approach, and communication, in the care of patients with vision loss secondary to retinal disease.
  • Encourage the active participation in national and international retina meetings.
  • Teach the fundamentals of clinical trial research through exposure to ongoing trials, review of past trials, and review of journals
  • Encourage and provide support for scientific research in areas of interest and opportunity to submit posters, presentations and publications to conferences and peer reviewed journals.