Skills Training with Simulation 

 

For many years now Yorkshire has been ahead of the game in ophthalmic simulation. We are lucky to have enthusiastic trainers whose surgical expertise and passion for education have led to the implementation of regular opportunities for training and deliberate practice in both technical and non-technical skills.

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Our region has recently seen two senior OSTs go out-of-programme (OOP) to undertake Leadership fellowships in Simulation and Education in recent years, as part of the HEYH Future Leaders Programme. Based at The Hull Institute of Learning and Simulation (HILS) these Fellows have developed and led the delivery of training in: Ophthalmic examination skills for ST1s, ophthalmic laser procedures, complex cataract surgery (including wet-lab anterior vitrectomy simulation), Thiel cadaveric courses in Oculoplastics and Strabismus, and technology-enhanced training in non-technical skills and human factors for operating teams to manage adverse intraoperative scenarios.

Additionally in April 2019 Yorkshire hosted the first RCOphth Simulation Study Day For Trainers, where we were able to showcase to Simulation Leads from multiple UK units the breadth of ophthalmic simulation that we have achieved in our region.

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Simulation facilities in Yorkshire include:

  • Stephen Foster Room, Hull:  This new state-of-the-art Ophthalmology wet-lab, house within HILS at Hull, was officially opened in May 2019, as an upgrade from its cosier predecessor in the Eye Hospital. It boasts purpose built workstations with fully functional operating microscopes, phacoemulsification machines, full sets of real surgical instruments and height adjustable tables and chairs to encourage good operating posture. All our microscopes have camera attachments, enabling individual and networked group video viewing and recording, for easy supervision of trainees. The wet-lab hosts several courses a year, covering basic microsurgical skills and phacoemulsification, as well as courses in complex cataract surgery utilising high fidelity simulations to teach advanced skills such as management of vitreous loss, small pupils and zonular instability.
  • VRmagic EyeSi simulators: EyeSi has become a popular virtual reality training device for cataract and VR surgery. Simulators are located in Leeds, Sheffield, York and Doncaster. See below for booking process at each site. 
  • PixEyes Retinal Laser Simulator: This is located in the Hull Eye Hospital, and is one of the few remaining models in Europe! You are likely to encounter it during the Hull Laser Training courses. 
  • Bradford skills lab: This lab is available to trainees for self-directed practice of microsurgical skills, and also hosts summer courses in corneal gluing and glaucoma surgery.
  • Cadaveric Simulation (Hull & Leeds): We run cadaveric courses 2-3 times a year in Strabismus surgery and Oculoplastic surgery. These are entirely practical (supported by e-learning completed in advance) and hosted at the Anatomy departments of the University of Leeds and the University of Hull. Cadavers are embalmed using the Thiel "soft-fix" preservation method developed by Walter Thiel in the 1990s that leaves tissues with a more realistic feel and appearance whilst maintaining resilience to surgical handling during training. The Strabismus course has an excellent track record, running for 11 years now, and the Oculoplastics course was launched in 2018, now running annually.

 

 

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Further information on simulation requirements and study days

It is a requirement for trainees to complete a minimum of 10 hours of simulation each training year. Please take advice from your local TPDs about what would be required at your stage of training.

Most courses are “blended” with complimentary e-Learning via e-LfH.org.uk. All our courses are supported voluntarily by enthusiastic senior staff. 

There are multiple simulation study days available through the calendar year - See Study Days section for upcoming courses. Note: Some are compulsory for certain OST stages.

  • An induction course for ST1s at HILS (Hull) 
  • Beginner (ST1) and advanced (ST3+) cataract wet-lab study days at HILS
  • Laser course at Hull (ST1 & 2)
  • Cadaveric strabismus and oculoplastics courses at Hull & Leeds University anatomy departments (ST2-3)
  • Ocular Trauma course at HILS
  • RCOphth Practical Ultrasound course at HILS
  • In-situ simulation for human factors training with operating teams at Hull Eye Hospital (for trainees on rotation in Hull)
What simulation is available in Hull?

The new wet lab is located in the Hull Institute of Learning and Simulation (HILS) on the second floor of the Eye Hospital building. It is a 5 minute walk from the train station; in fact you can see the Eye Hospital as your train pulls in!

N.B. It is not directly accessible from the Eye Department without staff-only internal access cards, so please enter through the left hand entrance of the building and take the stairs or lift to the second floor. 

The wet lab and HILS offer regular courses in ophthalmic surgery:

  • Introductory skills for ST1s - A 2-day course that takes place in the first couple of weeks of the ST1 year, engaging trainees in learning basic slit lamp examination skills, applanation tonometry, foreign body removal, corneal scrape, fundoscopy - both slit lamp and indirect ophthalmoscopy using indentable training eyes and a video-linked indirect ophthalmoscope to permit supervision. There is supporting e-learning from e-Learning for Healthcare
    • N.B. YAG laser training now takes place on the same day as this course, to ensure ST1s are skilled prior to being required to perform YAG laser procedures in clinic. We use part-task simulation and real laser machines in clinic to teach safe capsulotomy and iridotomy techniques. 
  • Basic phacoemulsification wet-lab (ST1s) - This is a course in early September for ST1s, covering basic cataract surgery techniques and practical understanding and use of real microscopes and phacoemulsification machines. We also try to cover basic microsurgical skills including suturing on simulation eyes. There is associated e-Learning for this course.  Trainees can thereafter make arrangements for individual self-directed learning in the wet-lab. 
  • Advanced cataract surgery course (ST3+) - This course covers the management of complex cataract cases. We use novel simulations to teach the management of vitreous loss (anterior vitrectomy), small pupils, zonular instability, intumescent lenses and sulcus IOL insertion.
  • Ocular trauma courses - Including lid/adnexal and globe trauma
  • Laser course - This is a mandatory blended course supported by e-Learning for ST2 and 3 attendees, taught in groups of two. We use a combination of live laser with simulated targets (including bespoke materials) to teach retinopexy, pan-retinal photocoagulation and focal macular laser, as well an opportunity to practice on the only surviving PixEyes computer laser simulator in the UK.
  • RCOphth Practical Ultrasound Course - An annual course using novel ultrasound phantoms and patient volunteers to cover basic principles of ultrasound as well as ocular ultrasound techniques.

We use simulated eyes from Phillips Studio, Kitaro, SimulEYE and PhakIs including cataract basic and advanced, vitreoretinal, strabismus and suturing models.

On the horizon: Vitrectomy, corneal surgery and glaucoma surgery courses coming soon.  

Access to the wet lab for local and regional trainees is by arrangement and must be initially supervised.  Local trainees can arrange unsupervised practice thereafter. 

Contact Mr James Innes for wetlab enquiries

For laser training course enquiries contact Mr Madhu (individual sessions can be arranged in special circumstances e.g. returning to training after absence, specific PDP goals)

What simulation is available at Leeds?

Access to the EyeSi simulators is generally restricted to those on the Yorkshire and Humber Ophthalmology Training Programme and unsupervised use should only be after attending the Compulsory Cataract Simulator and Biometry Study Days.

Location: LIMIT / LISTA.  COVID 19 RELOCATION TO ASHLEY WING SJUH - Clinical Practice Centre, 2nd floor, Room 10a

Extra social distancing measures for COVID-19 - The simulator is accessible M-F 9am-4pm in 3 x 2 hour slots per day. Trainees will be responsible for cleaning the simulator and workstation before and after use. Cleaning instructions and cleaning kit are available. 

COVID-19 LIMIT contact person - Lesley Wood 

Contacts:

Vernon Long

Consultant Ophthalmologist & TPD North
 

Booking:
www.medicaleducationleeds.com  for online bookings once trainee has had an introduction to the EyeSi.

LIMIT Contact: leedsth-tr.LIMIT@nhs.net 

What simulation is available in Sheffield?

The ophthalmology simulator suite is located on R floor of the Royal Hallamshire hospital. Access is granted by reception staff on R floor within office hours.  A log book of use is also kept in the simulator room. 

If further details are required, please contact Miss Zanna Currie

The suite includes:

EyeSi simulator - cataract and VR modules

Operating microscope

Kitaro kit

Skills board and surgical instruments

 

What simulation is available in Doncaster?

There is an EyeSi simulator available for use by those working in the Doncaster eye department.

Access to the EyeSi simulators is generally restricted to those on the Yorkshire and Humber Ophthalmology Training Programme and unsupervised use should only be after attending the Compulsory Cataract Simulator and Biometry Study Days.

Liaise with Mr Nick Mawer (Doncaster ES) for further details.

What simulation is available in York?

There is an EyeSi simulator available in York.

Access to the EyeSi simulators is generally restricted to those on the Yorkshire and Humber Ophthalmology Training Programme and  unsupervised use should only be after attending the Compulsory Cataract Simulator and Biometry Study Days.

Location: Level 4 (below PGMEC), York Teaching Hospital NHSFT, Wigginton Road, York, YO31 8HE

Contacts:

Polly Dickerson, Consultant Ophthalmologist

Booking:
Mrs Victoria Newlove
Telephone: 01904 725938

 

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