ENET – European Network for Education of Trainees
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ENET – European Network for Education of Trainees APPLICATION FORM ENET ACCREDITED COURSES ONLY FORMS SUBMITTED IN MS WORD FORMAT WITH SCANNED SIGNATURE PAGE (PDF FORMAT) CAN BE ACCEPTED FOR REVIEW PURPOSES Course Number* Date application received* Date approval ENET responsible* Date approval CME Committee* * To be filled in by European Network for Education of Trainees (ENET) responsible Course Director 1. Name: 2. Address: 3. E-mail: _________________________________________________ Supportive society (in due order with UEMS accreditation) ________________ 4. Society: 5. Course date/hour: 6. Location: 7. UEMS application: introduced: in due order: General information ______________________________________________ 8. Course Title: 9. Course Duration: 10. 11. Course Format: EBO Curriculum mapping: 1-hour course (1-3 speakers) 2-hours course (4-6 speakers) 3-hours course (6-8 speakers) 4-hours course (8-10 speakers) Formal lecture Commented diaporama Video-based course Case presentations On-line course E-learning Optics, Refraction, Contact lenses Paediatric ophthalmology, Strabismus External disease, Corneal disease, Adnexal disease Glaucoma, Cataract, Refractive surgery Retina, Vitreous, Uvea Neuro-ophthalmology Orbital disease, Oculoplastic surgery General medicine relevant to ophthalmology Ophthalmic pathology, Microbiology, Immunology Pharmacology, Therapeutics EBO-ENET-2014-v141201 Page 1/16 Faculty ________________________________________________________ Name E-mail Setting 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Please take into consideration that one type X MCQ is requested per speaker General instructions for MCQ writing are provided on page 6 MCQ submission forms are provided on pages 7 to 16 EBO-ENET-2014-v141201 Page 2/16 Course synopsis (max. 10 lines) ____________________________________ Aim(s) of the course (max. 10 lines) _________________________________ Achievements (what knowledge will the participant achieve) ______________ EBO-ENET-2014-v141201 Page 3/16 Course outline (please specify or add a flyer) __________________________ Name Topic title Time (min) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. EBO-ENET-2014-v141201 Page 4/16 Agreement (to be filled in by the Course Director) ______________________ I hereby agree to distribute the evaluation forms prior to the start of the course to collect the evaluation forms after the course and send these to Mairin Condon: Mairin Condon, Agenda Communications, Temple House, Temple Road, Blackrock, Co. Dublin, Ireland, E-mail: mairin.condon@ebo-online.org to wave registration fee for the peer reviewer Name Date: Signature: X Application Form to be sent by e-mail to ______________________________ Mairin Condon, Agenda Communications, Temple House, Temple Road, Blackrock, Co. Dublin, Ireland, E-mail: mairin.condon@ebo-online.org --------------------------------------------------------------------------------------------Items to be verified by the ENET responsible* _________________________ Application form Supportive society UEMS application Faculty meets the criteria Synopsis Aim(s) Achievements Course outline MCQ-form (in attachment) After approval by the ENET responsible, this application form will be forwarded for approval to the CME Committee * To be filled in by European Network for Education of Trainees (ENET) responsible EBO-ENET-2014-v141201 Page 5/16 ENET – European Network for Education of Trainees MCQ FORM ENET ACCREDITED COURSES ONLY TYPE X MCQ’S ALLOWED (SEE FORMAT OF THE EXAMPLE) (MULTIPLE INDEPENDENT TRUE/FALSE MCQ’S) MCQ format (example) The age of onset of presbyopic symptoms: a. is earlier for a patient with a small amplitude of accommodation True False b. is earlier for a hyperopic patient who wears contactlenses rather than spectacles True False c. is earlier for a myopic patient who wears contactlenses rather than spectacles True False d. is earlier for a myopic than a hyperopic patient who wears spectacles with a full distance correction True False e. is earlier for a short than a tall patient True False General instructions for MCQ writing _________________________________ The multiple-choice questions (MCQs) have to be written in the specified format (stem followed by five multiple independent true/false statements) (see example above) Pay special attention to language (spelling, grammar, etc.) In order to allow for standardisation of the level of difficulty of the comprehensive European Board of Ophthalmology Diploma (EBOD) Examination, try to include one relatively easy statement (statement a), one relatively difficult statement (statement e) and three statements of intermediate level of difficulty (statements b, c and d) Avoid the following expressions: “… always …”, “… never …”, “all of the above”, “none of the above”. Indicate for each MCQ the EBO curriculum mapping1 of the content of the question Indicate for each MCQ to which reference book(s)2 the MCQ is related Indicate for each MCQ the name and contact details of the author Provide one MCQ per speaker included in the programme EBO-ENET-2014-v141201 Page 6/16 MCQs provided by the EBO Course Faculty (one MCQ per speaker) __________ MCQ 1 Stem: a. True False b. True False c. True False d. True False e. True False Author details Author name: Author e-mail address: EBO Curriculum mapping of the MCQ1 Optics Refraction Contact lenses Paediatric ophthalmology Strabismus External disease Corneal disease Adnexal disease Glaucoma Cataract Refractive surgery Retina Vitreous Uvea Neuro-ophthalmology Orbital disease Oculoplastic surgery General medicine relevant to ophthalmology Ophthalmic pathology Microbiology Pharmacology Therapeutics Immunology Reference book(s)2 BCSC-1 – Update on general medicine BCSC-2 – Fundamentals and principles of ophthalmology BCSC-3 – Clinical optics BCSC-4 – Ophthalmic pathology and intraocular tumors BCSC-5 – Neuro-ophthalmology BCSC-6 – Pediatric ophthalmology and strabismus BCSC-7 – Orbit, eyelids and lacrimal system BCSC-8 – External disease and cornea BCSC-9 – Intraocular inflammation and uveitis BCSC-10 – Glaucoma BCSC-11 – Lens and cataract BCSC-12 – Retina and vitreous BCSC-13 – Refractive surgery Kanski J.J. – Clinical ophthalmology: a systematic approach Spalton D.J. – Atlas of clinical ophthalmology The Wills Eye Manual Moorfields manual of ophthalmology Any other references: EBO-ENET-2014-v141201 Page 7/16 MCQ 2 Stem: f. True False g. True False h. True False i. True False j. True False Author details Author name: Author e-mail address: EBO Curriculum mapping of the MCQ 1 Optics Refraction Contact lenses Paediatric ophthalmology Strabismus External disease Corneal disease Adnexal disease Glaucoma Cataract Refractive surgery Retina Vitreous Uvea Neuro-ophthalmology Orbital disease Oculoplastic surgery General medicine relevant to ophthalmology Ophthalmic pathology Microbiology Pharmacology Therapeutics Immunology Reference book(s)2 BCSC-1 – Update on general medicine BCSC-2 – Fundamentals and principles of ophthalmology BCSC-3 – Clinical optics BCSC-4 – Ophthalmic pathology and intraocular tumors BCSC-5 – Neuro-ophthalmology BCSC-6 – Pediatric ophthalmology and strabismus BCSC-7 – Orbit, eyelids and lacrimal system BCSC-8 – External disease and cornea BCSC-9 – Intraocular inflammation and uveitis BCSC-10 – Glaucoma BCSC-11 – Lens and cataract BCSC-12 – Retina and vitreous BCSC-13 – Refractive surgery Kanski J.J. – Clinical ophthalmology: a systematic approach Spalton D.J. – Atlas of clinical ophthalmology The Wills Eye Manual Moorfields manual of ophthalmology Any other references: EBO-ENET-2014-v141201 Page 8/16 MCQ 3 Stem: k. True False l. True False m. True False n. True False o. True False Author details Author name: Author e-mail address: EBO Curriculum mapping of the MCQ 1 Optics Refraction Contact lenses Paediatric ophthalmology Strabismus External disease Corneal disease Adnexal disease Glaucoma Cataract Refractive surgery Retina Vitreous Uvea Neuro-ophthalmology Orbital disease Oculoplastic surgery General medicine relevant to ophthalmology Ophthalmic pathology Microbiology Pharmacology Therapeutics Reference book(s) Immunology 2 BCSC-1 – Update on general medicine BCSC-2 – Fundamentals and principles of ophthalmology BCSC-3 – Clinical optics BCSC-4 – Ophthalmic pathology and intraocular tumors BCSC-5 – Neuro-ophthalmology BCSC-6 – Pediatric ophthalmology and strabismus BCSC-7 – Orbit, eyelids and lacrimal system BCSC-8 – External disease and cornea BCSC-9 – Intraocular inflammation and uveitis BCSC-10 – Glaucoma BCSC-11 – Lens and cataract BCSC-12 – Retina and vitreous BCSC-13 – Refractive surgery Kanski J.J. – Clinical ophthalmology: a systematic approach Spalton D.J. – Atlas of clinical ophthalmology The Wills Eye Manual Moorfields manual of ophthalmology Any other references: EBO-ENET-2014-v141201 Page 9/16 MCQ 4 Stem: p. True False q. True False r. True False s. True False t. True False Author details Author name: Author e-mail address: EBO Curriculum mapping of the MCQ1 Optics Refraction Contact lenses Paediatric ophthalmology Strabismus External disease Corneal disease Adnexal disease Glaucoma Cataract Refractive surgery Retina Vitreous Uvea Neuro-ophthalmology Orbital disease Oculoplastic surgery General medicine relevant to ophthalmology Ophthalmic pathology Microbiology Pharmacology Therapeutics Immunology Reference book(s)2 BCSC-1 – Update on general medicine BCSC-2 – Fundamentals and principles of ophthalmology BCSC-3 – Clinical optics BCSC-4 – Ophthalmic pathology and intraocular tumors BCSC-5 – Neuro-ophthalmology BCSC-6 – Pediatric ophthalmology and strabismus BCSC-7 – Orbit, eyelids and lacrimal system BCSC-8 – External disease and cornea BCSC-9 – Intraocular inflammation and uveitis BCSC-10 – Glaucoma BCSC-11 – Lens and cataract BCSC-12 – Retina and vitreous BCSC-13 – Refractive surgery Kanski J.J. – Clinical ophthalmology: a systematic approach Spalton D.J. – Atlas of clinical ophthalmology The Wills Eye Manual Moorfields manual of ophthalmology Any other references: EBO-ENET-2014-v141201 Page 10/16 MCQ 5 Stem: u. True False v. True False w. True False x. True False y. True False Author details Author name: Author e-mail address: EBO Curriculum mapping of the MCQ1 Optics Refraction Contact lenses Paediatric ophthalmology Strabismus External disease Corneal disease Adnexal disease Glaucoma Cataract Refractive surgery Retina Vitreous Uvea Neuro-ophthalmology Orbital disease Oculoplastic surgery General medicine relevant to ophthalmology Ophthalmic pathology Microbiology Pharmacology Therapeutics Immunology Reference book(s)2 BCSC-1 – Update on general medicine BCSC-2 – Fundamentals and principles of ophthalmology BCSC-3 – Clinical optics BCSC-4 – Ophthalmic pathology and intraocular tumors BCSC-5 – Neuro-ophthalmology BCSC-6 – Pediatric ophthalmology and strabismus BCSC-7 – Orbit, eyelids and lacrimal system BCSC-8 – External disease and cornea BCSC-9 – Intraocular inflammation and uveitis BCSC-10 – Glaucoma BCSC-11 – Lens and cataract BCSC-12 – Retina and vitreous BCSC-13 – Refractive surgery Kanski J.J. – Clinical ophthalmology: a systematic approach Spalton D.J. – Atlas of clinical ophthalmology The Wills Eye Manual Moorfields manual of ophthalmology Any other references: EBO-ENET-2014-v141201 Page 11/16 MCQ 6 Stem: z. True False aa. True False bb. True False cc. True False dd. True False Author details Author name: Author e-mail address: EBO Curriculum mapping of the MCQ1 Optics Refraction Contact lenses Paediatric ophthalmology Strabismus External disease Corneal disease Adnexal disease Glaucoma Cataract Refractive surgery Retina Vitreous Uvea Neuro-ophthalmology Orbital disease Oculoplastic surgery General medicine relevant to ophthalmology Ophthalmic pathology Microbiology Pharmacology Therapeutics Immunology Reference book(s)2 BCSC-1 – Update on general medicine BCSC-2 – Fundamentals and principles of ophthalmology BCSC-3 – Clinical optics BCSC-4 – Ophthalmic pathology and intraocular tumors BCSC-5 – Neuro-ophthalmology BCSC-6 – Pediatric ophthalmology and strabismus BCSC-7 – Orbit, eyelids and lacrimal system BCSC-8 – External disease and cornea BCSC-9 – Intraocular inflammation and uveitis BCSC-10 – Glaucoma BCSC-11 – Lens and cataract BCSC-12 – Retina and vitreous BCSC-13 – Refractive surgery Kanski J.J. – Clinical ophthalmology: a systematic approach Spalton D.J. – Atlas of clinical ophthalmology The Wills Eye Manual Moorfields manual of ophthalmology Any other references: EBO-ENET-2014-v141201 Page 12/16 MCQ 7 Stem: ee. True False ff. True False gg. True False hh. True False ii. True False Author details Author name: Author e-mail address: EBO Curriculum mapping of the MCQ1 Optics Refraction Contact lenses Paediatric ophthalmology Strabismus External disease Corneal disease Adnexal disease Glaucoma Cataract Refractive surgery Retina Vitreous Uvea Neuro-ophthalmology Orbital disease Oculoplastic surgery General medicine relevant to ophthalmology Ophthalmic pathology Microbiology Pharmacology Therapeutics Immunology Reference book(s)2 BCSC-1 – Update on general medicine BCSC-2 – Fundamentals and principles of ophthalmology BCSC-3 – Clinical optics BCSC-4 – Ophthalmic pathology and intraocular tumors BCSC-5 – Neuro-ophthalmology BCSC-6 – Pediatric ophthalmology and strabismus BCSC-7 – Orbit, eyelids and lacrimal system BCSC-8 – External disease and cornea BCSC-9 – Intraocular inflammation and uveitis BCSC-10 – Glaucoma BCSC-11 – Lens and cataract BCSC-12 – Retina and vitreous BCSC-13 – Refractive surgery Kanski J.J. – Clinical ophthalmology: a systematic approach Spalton D.J. – Atlas of clinical ophthalmology The Wills Eye Manual Moorfields manual of ophthalmology Any other references: EBO-ENET-2014-v141201 Page 13/16 MCQ 8 Stem: jj. True False kk. True False ll. True False mm. True False nn. True False Author details Author name: Author e-mail address: EBO Curriculum mapping of the MCQ1 Optics Refraction Contact lenses Paediatric ophthalmology Strabismus External disease Corneal disease Adnexal disease Glaucoma Cataract Refractive surgery Retina Vitreous Uvea Neuro-ophthalmology Orbital disease Oculoplastic surgery General medicine relevant to ophthalmology Ophthalmic pathology Microbiology Pharmacology Therapeutics Immunology Reference book(s)2 BCSC-1 – Update on general medicine BCSC-2 – Fundamentals and principles of ophthalmology BCSC-3 – Clinical optics BCSC-4 – Ophthalmic pathology and intraocular tumors BCSC-5 – Neuro-ophthalmology BCSC-6 – Pediatric ophthalmology and strabismus BCSC-7 – Orbit, eyelids and lacrimal system BCSC-8 – External disease and cornea BCSC-9 – Intraocular inflammation and uveitis BCSC-10 – Glaucoma BCSC-11 – Lens and cataract BCSC-12 – Retina and vitreous BCSC-13 – Refractive surgery Kanski J.J. – Clinical ophthalmology: a systematic approach Spalton D.J. – Atlas of clinical ophthalmology The Wills Eye Manual Moorfields manual of ophthalmology Any other references: EBO-ENET-2014-v141201 Page 14/16 MCQ 9 Stem: oo. True False pp. True False qq. True False rr. True False ss. True False Author details Author name: Author e-mail address: EBO Curriculum mapping of the MCQ1 Optics Refraction Contact lenses Paediatric ophthalmology Strabismus External disease Corneal disease Adnexal disease Glaucoma Cataract Refractive surgery Retina Vitreous Uvea Neuro-ophthalmology Orbital disease Oculoplastic surgery General medicine relevant to ophthalmology Ophthalmic pathology Microbiology Pharmacology Therapeutics Immunology Reference book(s)2 BCSC-1 – Update on general medicine BCSC-2 – Fundamentals and principles of ophthalmology BCSC-3 – Clinical optics BCSC-4 – Ophthalmic pathology and intraocular tumors BCSC-5 – Neuro-ophthalmology BCSC-6 – Pediatric ophthalmology and strabismus BCSC-7 – Orbit, eyelids and lacrimal system BCSC-8 – External disease and cornea BCSC-9 – Intraocular inflammation and uveitis BCSC-10 – Glaucoma BCSC-11 – Lens and cataract BCSC-12 – Retina and vitreous BCSC-13 – Refractive surgery Kanski J.J. – Clinical ophthalmology: a systematic approach Spalton D.J. – Atlas of clinical ophthalmology The Wills Eye Manual Moorfields manual of ophthalmology Any other references: EBO-ENET-2014-v141201 Page 15/16 MCQ 10 Stem: tt. True False uu. True False vv. True False ww. True False xx. True False Author details Author name: Author e-mail address: EBO Curriculum mapping of the MCQ1 Optics Refraction Contact lenses Paediatric ophthalmology Strabismus External disease Corneal disease Adnexal disease Glaucoma Cataract Refractive surgery Retina Vitreous Uvea Neuro-ophthalmology Orbital disease Oculoplastic surgery General medicine relevant to ophthalmology Ophthalmic pathology Microbiology Pharmacology Therapeutics Immunology Reference book(s)2 BCSC-1 – Update on general medicine BCSC-2 – Fundamentals and principles of ophthalmology BCSC-3 – Clinical optics BCSC-4 – Ophthalmic pathology and intraocular tumors BCSC-5 – Neuro-ophthalmology BCSC-6 – Pediatric ophthalmology and strabismus BCSC-7 – Orbit, eyelids and lacrimal system BCSC-8 – External disease and cornea BCSC-9 – Intraocular inflammation and uveitis BCSC-10 – Glaucoma BCSC-11 – Lens and cataract BCSC-12 – Retina and vitreous BCSC-13 – Refractive surgery Kanski J.J. – Clinical ophthalmology: a systematic approach Spalton D.J. – Atlas of clinical ophthalmology The Wills Eye Manual Moorfields manual of ophthalmology Any other references: EBO-ENET-2014-v141201 Page 16/16
