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ASOPRS Program Requirements for Fellowship Education
In Oculofacial Plastic Surgery
Effective: May 6, 2011
Introduction
A.
Definition and Scope of the Subspecialty
The goal of fellowship training in Oculofacial Plastic Surgery is to complement
the basic knowledge gained in the ophthalmology residency program and to
provide greater exposure to the diagnosis, management, and surgical correction
of ophthalmic plastic and reconstructive disorders.
B.
Duration of Education
The length of the educational program is 24 months of full time education,
including appropriate short periods for vacation, special assignments, or
exceptional individual circumstances approved by the program director. Because
Oculofacial Plastic Surgery education requires an intensive continuum of training,
it should not be interrupted by frequent and/or prolonged periods of absence.
Before entry into the program each fellow must be notified in writing of the
required length of the Oculofacial Plastic Surgery educational program.
II
Educational Program
A.
The curriculum must contain the following educational components:
1.
Overall educational goals for the program, which the program
must distribute to fellows and faculty annually;
2.
Competency-based goals and objectives for each assignment
at each educational level, which the program must distribute
to fellows and faculty annually, in either written or electronic
form. These should be reviewed by the fellow at the start of
each rotation;
3.
Regularly scheduled didactic sessions;
2.
Delineation of fellow responsibilities for patient care,
progressive responsibility for patient management, and
supervision of fellows over the continuum of the program;
and,
3.
ASOPRS Competencies
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The program must integrate the following ASOPRS
competencies into the curriculum:
a)
Patient Care
Fellows must be able to provide patient care that is
compassionate, appropriate, and effective for the
treatment of health problems and the promotion of
health. Fellows:
(1)
must directly evaluate, and provide diagnosis and
treatment plans in the care of a minimum of 1,200
patients per year during the course of training. These
patients must have Oculofacial Plastic Surgery related
problems. The fellow must be able to demonstrate
that the history and examination were accurate and
appropriate, the use of laboratory and imaging tests
was directed by the history and physical examination,
and that the differential diagnosis and management
were appropriate;
(2)
should teach Oculofacial Plastic Surgery to
ophthalmology residents;
(3)
should have experience in the following specific
areas:
(a)
anatomy and physiology of the orbit, eyelids,
lacrimal system, nose, sinuses, and head and
neck as it relates to the orbits and adnexa;
(b)
orbit;
(i)
common orbital problems of children,
including: congenital anomalies,
cellulitis, benign and malignant tumors,
and orbital inflammations.
(ii)
Common orbital disorders of adults
including orbital cellulitis, thyroid
orbitopathy, idiopathic orbital
inflammation, vasculitis, congenital
tumors, vascular tumors, neural tumors,
lacrimal gland tumors, fibro-osseus
tumors, histiocytic diseases, lymphoid
tumors, metastatic tumors, blunt and
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penetrating trauma, orbital and facial
fractures, anophthalmic socket problems
and skull base disease
(c)
eyelid including congenital syndromes,
inflammation, trauma, ectropion, entropion,
trichiasis, blepharoptosis, eyelid retraction,
dermatochalasis, blepharochalasis, eyelid
tumors, blepharospasm, facial nerve palsy,
eyebrow, midface and lower face function and
aesthetics, and histology and pathology of the
facial skin including medical and surgical
management of these conditions;
(d)
lacrimal system including congenital tearing,
acquired tearing and trauma;
(e)
ocular surface pathology including cicatricial
processes affecting the bulbar and palpebral
conjunctiva, management of corneal and
conjunctival exposure, and relationship of the
lids, mid-face and brow to ocular exposure;
(f)
regional anatomy including graft donor sites
frequently used such as cranial bone, ear,
nose, temporal area, mouth and neck,
abdomen, buttocks, legs, supraclavicular area
and arm.
(g)
fundamentals of ocular and orbital anatomy,
chemistry, physiology, microbiology,
immunology, and wound healing;
(h)
experience in neuroradiology for radiologic
interpretation of images (CT, MRI, MRA,
arteriography, ultrasound)
(i)
Ocular Pathology to interpret ocular and
periocular pathology and dermatopathology
(j)
documented ten hours of pathology slide
review with clinical correlation;
(k)
diagnostic and therapeutic procedures with
comprehensive examination of the eyelids and
periorbital region should be documented;
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(l)
examination of the lacrimal system, nasal
exam with speculum and endoscope;
(m)
eyebrow and face examination assessing the
eyebrow position for brow ptosis, paralysis,
and determining its relation to upper eyelid
dermatochalasis, assessing facial paralysis
and evaluation of the effects of mid-face
cicatricial, paralytic and involutional changes
on lower eyelid position. Also assess the face
in terms of harmonious aesthetic units and
evaluation of the inter-relationships of each;
(n)
examination and measurement of orbital
structures and functions;
(o)
understanding and interpreting imaging
techniques;
(p)
the principles of plain films, CT, MRI, and
ultrasound imaging relating to the head and
neck with particular emphasis on the orbit;
(q)
the type of scan/imaging to order, given the
clinical setting and be able to read the film or
scan; and,
(q)
skills in the use of information technology for
study of reference material, including electronic
searching and retrieval of relevant articles,
monographs, and abstracts.
(4)
are expected to maintain a surgical log including
Surgeon (primary surgeon) and Assistant (assisting
and/or observing surgeon) cases;
(5)
must have a minimum number of 300 cases plus 150
minor office procedures (biopsies and
incision/curettage);
(6)
must have a sufficient number and distribution of
complex cases for Surgeon (fellow as the primary
surgeon) and Assistant (fellow as the first assistant),
as determined by the Review Committee, for the
achievement of adequate operative skill and surgical
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judgment;
(7)
will have the following required procedures:
(a)
Enucleation, evisceration, exenteration,
secondary implants of the orbit
(b)
Orbitotomy for exploration, biopsy, and tumor
removal using anterior, lateral, medial and
superior approaches and orbital reconstruction
(c)
Fracture repair of bones involving the
periorbital region and orbit
(d)
Eyelid retraction repair
(e)
Blepharoptosis repair
(f)
Ectropion and Entropion Repair
(g)
Blepharoplasty (upper and lower eyelids,
functional and aesthetic)
(h)
Eyelid reconstruction (following congenital
defects, trauma or tumor excision)
(i)
Repair of trichiasis (cryoablation, lid split and
excision, mucous membrane graft)
(j)
Conjunctivoplasty
(k)
Trauma and laceration repairs
(l)
Tissue transfer, grafts and flaps
(m)
Dacryocystorhinostomy and other lacrimal
procedures
(n)
Excision of tumors involving the periorbital and
adjacent regions-benign and malignant
(o)
Facial flaps including temporal, midface, lower
face/neck for functional and aesthetic
conditions related to the management of
periorbital processes. Rhytidectomy including
the periobital and adjacent areas
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b)
(p)
Management of upper face and brow
conditions including brow ptosis Repair
(q)
Turbinectomy and nasal surgery as related to
the management of lacrimal and periorbital
processes
(r)
Nasal endoscopy as related to the
management of lacrimal and periorbital
processes.
(s)
Sinus surgery and endoscopy as related to
periorbital and lacrimal processes
(t)
Use of neuromodulators (botulinum toxin),
dermal fillers, other technologies (eg. laser)
and chemical/pharmaceutical agents for the
management of contour and skin quality
abnormalities (functional and aesthetic)
(8)
should actively participate in the preoperative and
postoperative management of surgical cases in which
they are part of the surgical team;
(9)
must learn the fundamentals of cosmetic surgery and
its complications with emphasis on brows and midface as well as alloplastic inserts; and,
(10)
must learn the team approach to orbital and
periorbital trauma.
Medical Knowledge
Fellows must demonstrate knowledge of established
and evolving biomedical, clinical, epidemiological and
social-behavioral sciences, as well as the application of
this knowledge to patient care. Fellows:
(1)
will be required to prepare and present teaching
conferences and participate in the teaching of fellows,
residents and/or medical students. The fellow must
participate in a minimum of 80 hours of didactic
instruction, including seminars, lectures, approved
basic science courses, and hands on skilled courses
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of which at least 40 hours will be intramural. These
should include the following:
(2)
(a)
attendance at grand rounds: The fellow is to
actively participate in case presentation
conferences and discussions of patients with
Oculofacial Plastic Surgery;
(b)
mandatory attendance at regularly scheduled
case presentation conferences: The fellow
must prepare and present a minimum of two
case presentations per year;
(c)
attendance at lectures on Oculofacial Plastic
Surgery topics given by the faculty during the
fellowship teaching program; These must
include at least six lecture hours per year. The
fellow is required to prepare and present a
minimum of two didactic lectures per year on
the diagnosis/treatment of entities afflicting the
eyelids, tear system, orbit, or face. These talks
will be presented to faculty, other fellows, and
residents;
(d)
attendance and preparation of case
presentation for at least one Oculofacial Plastic
Surgery visiting professor conference per two
years; and,
(e)
attendance and participation in at least two
courses devoted to Oculofacial Plastic Surgery,
tumor resection, lacrimal disease, or cosmetic
surgery.
must participate in one orbital dissection during their
24 month program.
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