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Edinburgh
1. Rekonstruksi,
OkuloplastikdanOnkologi( Tahap
Magang 1)
Topik / pengalamanesensial
To have become familiar with the following:
Residen memberi tanda apabila sudah menguasai
1 Kelainan posisi Pemeriksaanuntukectropion, entropion, ptosis, trikiasis,
. palpebra lagoftalmos, dan
2 Edema palpebral Termasukchalazion, Hordeolum, kistaretensi, pailoma,
. abnormal dankarsinomasel basal.
Termasukbagaimanamembedakananaralakrimasiberlebihandengane
3
Mata berair pifora, blefaristis,;mengenalidanmemeriksaobstruksi ductus
.
nasolakrimalis.
Termasukdysthyroid eye disease,
4
Pembengkaan Orbita membedakanantaralesidesakruang yang intra konaldan extra konal,
.
selulitisorbita, danmengenalicompressive optic neuropathy
5 Kerjasamadenganbagi
Denganspesialisbedahsyaraf, THT danahliprotesaorbita
. an lain
Keterampilan praktis
Telah melakukan ( di bawah supervisi) tindakan berikut ini::
Pembimbing menanda tangani bila sodah dlakukan
1. Karsinomasebaseadankarsinomaselskuamosapadakelopakmata
2. Malposisikelopakmatasikatrikal
3. Penangnanan ptosis and blefarospasme
4. Repair kanalikulus
5. Dakriosistorhinostomi
6. Tumor orbita dan tumor lakrimal beserta penanganannya.
7. Inflamasiorbitadanlakrimal, besertappenangnanannya
8. Kelainan sinus paranasal
9. Penggunaan X foto, CT Scan dan MRI
10. Enukleasi, Eviserasidan fitting protesa
11. Eksenterasi
Catatan: Bisa ditambahkan topik/pengalaman/keterampilanygrelevan lain yang didapatkan
Portfolio of Ophthalmic Specialist Training and Surgical Logbook The Royal College of Surgeons of
Edinburgh
I. Rekonstruksi, Okuloplastikdan Onkologi
Tahap Magang 2
Tempat rotasi RSUP M Djamil padang Mulai 1102206 Sampai 10022016
Supervisor/Pembimbing: dr Hendriati, SpM (K) Td tangan Tanggal
Kompetensi yang dbutuhkan
Terampil dalam melakukan pemeriksaan dan penanganan kelainankelainan palpebra dan
adneksa antara lain :
Pembimbing tanda tangan apabila residen sudah menguasai :
(i) Oculoplastic management of lid disease, including
entropion, ectropion, trichiasis, distichiasis,
dermatochalasis, lagophthalmos and small tumours, in
particular using the techniques of biopsy,
blepharoplasty, lateral canthal sling and lateral,
tarsorrhaphy, epiblefaron, epicanthus inversus,
blefaroptosis, baggy eyelid, lagoftalmos (parese N
VII).
iii) Primary repair of lid lacerations, including canalicular
repair.
iv) Assessment of cases of orbital and facial trauma, including
recognition of fractures.
v) Management of epiphora and dacryocystitis, including
dacryocystorhinostomy.
vi) Enucleation, evisceration, orbital implantation and socket
care.
vii) Recognition of compressive optic neuropathy in dysthyroid
disease and management of the milder dysthyroid problems
including lid retraction.
viii) Appropriate use and interpretation of relevant special
investigations, including CT, MRI and ultrasound scans.
ix) Liaison with associated services (ENT, faciomaxillary,
endocrinology, dermatology, neurology, neurosurgery
and plastic surgery)
Essential clinical experience which must be documented in this Logbook
Pemeriksaan kelopak mata (termasuk FPV, MRD, LA, LF) dan apparatus lakrimalis 20
To have attended at least 20 oculoplastic and/or orbit or lacrimal clinics
To have undertaken a minimum of 40 surgical cases (20)
To have audited the outcome of at least 10 of these cases (5)
To have managed 3 patients with thyroid eye disease (2)
To have actively participated in, or assisted, at 3 cases of levator ptosis surgery (1)
Penatalaksanaan rupture bola matadanadneksa (5)
Portfolio of Ophthalmic Specialist Training and Surgical Logbook The Royal College of Surgeons of Edinburgh
Oculoplastic and / or adnexal clinics attended (minimum of 20 required)
Insert clinic dates, and have each initialled by your Trainer or a single signature below
Management of patients with thyroid eye disease (minimum of 3 required)....(2)
Insert patient case no. or initials and DOB, and have each initialled by your Trainer or a single
signature below
Desirable clinical experience
Note: Any exposure to these areas should be documented in any written format that you like,
but ensure that these pages are inserted in the appropriate section of this Portfolio of
Ophthalmic Specialist Training.
Portfolio of Ophthalmic Specialist Training and Surgical Logbook The Royal College of Surgeons of Edinburgh
Oculoplastic and adnexal surgery performed during Specialist Training
please insert numbers of procedures in each category P PS SJ A O
Oculoplastic Tarsorrhaphy
Ectropion
lower lid entropion
upper lid entropion
ptosis – levator resection /advancement/frontal sling
Blepharoplasty
Enucleation +/ orbital implant/DFG
Evisceration +/ orbital implant/DFG
mucous membrane grafting
socket reconstruction
epilasi-electroepilasi
Lacrimal punctal surgery, punctal plug insertion
External dacryocystorhinostomy
canalicular surgery
Probing
Orbit removal of orbital space occupying lesion
orbital decompression
insertion of secondary orbital implant
Trauma lid or facial lacerations
penetrating ocular trauma
blowout fracture
Other
Trainer’s signature ............................................................................... .Date ...................................
PortfolioPendidikan Dokter Spesialis Mata Kolegium Oftalmologi Indonesia
Trauma and emergency ophthalmology
Competencies
Trainees to tick individual items and sign when
Experience of and familiarity with: familiar
1. Eye protection and prevention
of injury
2. Superficial ocular trauma Assessment and treatment of foreign bodies,
abrasions and minor lid lacerations
3. Severe blunt ocular injury Management of hyphaema, recognition and initial
management of more severe ocular injury
4. Severe orbital injury Recognition and initial management of blowout
fracture, optic nerve trauma and compression
5. Lateral canthotomy and inferior cantholysis for retrobulbar haemorrhage
6. Penetrating ocular injury Recognition and initial care of corneal and scleral
wounds; recognition of aqueous leakage and
tissue prolapse
7. Retained intraocular foreign Anticipation from history; confirmation by Xray
Body and CT scan
8. Chemical/alkali burns of the conjunctiva and cornea
9. Sudden painless loss of vision Recognition and initial management of arterial
and venous occlusions, acute ischaemic optic
neuropathy, optic neuritis; urgency of treatment
10. Severe intraocular infection Recognition and initial investigation of
Endophthalmitis
11. Drug penetration into the eye and vitreous
12. Use of intravitreal antibiotics, including dosage and potential complications
13. Acute angle closure glaucoma Recognition and emergency treatment to reduce
intraocular pressure
14. Liaison with other departments Radiological department, microbiologists, ENT
and maxillofacial surgeons
Practical skills
To have undertaken (under supervision until proficient) the following
Trainer to sign when proficient
1. Removal of superficial foreign bodies
2. Corneal epithelial debridement
3. Repair of minor conjunctival/eyelid lacerations
4. YAG iridotomy
5. Repair of penetrating ocular injury
6. Repair of canalicular lacerations
Keterangan:
6 Ketaatanpadatugas yang
diberikan(Ktg)
7 Ketaatanmelaksanakan pedoman
penggunaan obat dan alat/
modalitas
8 Komunikasi:
Komunikasi efektif:
9 Terhadap penderita (Ktp)
10 Terhadap Staf pendidik &
Kolega (Kts)
11 Terhadapparamedisdan non
paramedic (Ktpp)
12 Kerjasama Tim :
13 Hubungan yang baik antara
dokter, perawat dan karyawan
kesehatan, dan Pasien dan
keluarga pasien (Kth)
14 Bisa bekerjasama dalam
bentuk tim secara harmonis
untuk pelayanan optimal (Kto)
15
, SpM (K)
Perilakuprofesionalnegative
N Perilaku Tidakpe Pern Lebih Seri
o rnah ah dari 1 ng
X
100 60
80 40
1 Tidakhadiratauterlambatpadakegiatanpendidikanwajib
( Laporanpagi, kuliah, dll) tanpaalassan yang jelas
2
Tidaktepatwaktudalammengumpulkanpekerjaanataut
ugasakademik
3 Tidakmenjawab/meresponpermintaanbagiandalamwa
ktu yang tepat
4 Kurangperhatandalammelaksanakantugasklinik
5 Melakukaninteraksitdakprofesionaldenganssesamares
iden, mahasiswa, dosen, pegawai, ataupasien.
( sepertketdakpekaanbudayaterhadappasienmaupun
sesamaapekerja, ketdakjujuran, atauintegritas yang
diragukan
6 Tidakmampumenjawabsuratmenyuratataumelengkapi
rekammedikdalamwaktu yang ditentukan (24-36 jam).
7 Keterlambatandalammenyusundaftardokterpelayanan
emergensisetapbulannya
8 Menyalahgunakankebijakancut,
kebijakanijintdakmasuk, dan/atau seminar yang
dibiayaibagian.
9 Ketdakmampuandalammelengkapirekammedisdalam
waktu yang ditentukan
1 Penampilandiri yang kurangpantas.
0
PerilakuProfesionalPositf
N Perilaku Tidakpe Pern Lebih Seri
o rnah ah dari 1 ng
70 X
80 90 100
1
Menerimasuratpujianataupenghargaansukareladaripasie
ndanataukeluarganya yang memujikompetensi,
kepedulian, maupunempat sang residen
2 Menampungpendaftar PPDS
padasetapmusimpendaftaranresidenbaru
4 Menjadipanitaatauberpartsipasidalam acara
pelayanankesehatanmasyarakat
5 Memberikanedukasikesehatanmasyarakat
6. Membantusecarasukarelapadakejadiantdakterdugabaik
bencanaalammaupunpenyakit
1. Malakoff GL, et al. Accountng for Proffesionalism: an Innovatve point system to
assess resident professionalm.Journal of Community Hospital Internal Medicine
Perspective,2014,2:23313. http://dx.doi.org/10.3402/jchimp.v4.23313
Nama Penilai:
4 Melakukankesalahandalamtndakanprosedur 50 60 70 100
/pembedahan yang menimbulkankebutaanpasien
5 Melakukankelalaiandalammendeteksikeadaanaler 50 70 70 100
gipasiensehinggamenimbulkanreaksialergi
8 Melakukankesalahandalamtndakanprosedur 50 60 80 100
/pembedahan
yangberpotensimenimbulkankebutaanpasien
(tetapikebutaantdakterjadi)
9 Melakukankelalaiandalammendeteksikeadaanaler 50 60 80 100
gipasien yang
berpotensimenimbulkanreaksialergi
10 Tidakmemberikanpenjelasankepadapasiendankel 50 60 80 100
uargamengenaiindikasi, tujuan, hasil yang
diinginkan,
sertakemungkinanefeksampingsuatutndakanmed
is yang akandiberikan .
Jumlah
Nilai = Jumlah/10=
Penilai
( )
Tanggal Pemeriksaan:
Anamnesis:
Diagnosis:
Penanganan:
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