Training activity information
Details
Use a slit lamp to visualise patients eyes
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
- What does success look like?
- Identify what is expected of you in relation to this specific activity, considering learning outcomes related to performing and interpreting a range of ophthalmic imaging modalities, employing effective communication, assessing and managing risks in the testing environment, and selecting and operating ophthalmic imaging equipment.
- What does successfully using a slit lamp involve, including patient positioning, manipulating the light beam (width, height, angle, intensity, filters), focusing the microscope, and systematically examining the anterior and posterior structures of the eye?
- Discuss with your training officer to gain clarity on what is expected of you when using a slit lamp.
- What is your prior experience of this activity?
- Think about what you already know about the principles of slit lamp biomicroscopy, operating the controls, and examining basic anterior segment structures (e.g., eyelids, conjunctiva, cornea, anterior chamber) and potentially posterior structures with appropriate lenses.
- Consider possible challenges you might face, such as positioning elderly or anxious patients, managing glare, difficulty focusing through media opacities, achieving parallax for depth perception, or identifying subtle pathology, and think about how you might handle them.
- Recognise the scope of your own practice for this activity, i.e., know when you will need to seek advice or help, and from whom, regarding difficult patients, complex anterior segment pathology, or using advanced techniques (e.g., gonioscopy, pachymetry attachments).
- Acknowledge how you feel about using a slit lamp to visualise a patient’s eyes
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in mastering slit lamp manipulation techniques, systematically examining the entire eye, recognising the appearance of various ocular structures and common pathologies, and documenting findings accurately – drawing upon previous experiences.
- Identify specific insights you hope to gain regarding the relationship between lighting techniques and visualising specific structures, the importance of a systematic approach, or how slit lamp findings integrate with other clinical information.
- What additional considerations do you need to make?
- Consult actions identified following previous experience with ophthalmic examination or using microscopes, if any.
- Identify important information you need to consider before embarking on the activity, such as the reason for the examination, specific structures or pathology to look for based on the referral, potential need for dilation or topical anaesthetics, and patient comfort during the examination.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate while using a slit lamp to visualise a patient’s eyes?
- Are you encountering situations such as involuntary patient movement making it extremely difficult to achieve a stable view, or unexpected pathology (e.g., significant anterior chamber flare/cells) identified, requiring immediate change in illumination and filter technique?
- How is this experience comparing with previous experiences of similar activities, like using other visualisation equipment?
- How are you reacting to the unexpected development?
- Identify how this is impacting your actions while using the slit lamp. Are you responding to the situation appropriately? Are you adapting or changing your approach? Is it affecting your ability to undertake the activity independently?
- In the moment, what steps are you taking, such as immediately adjusting patient positioning to improve compliance, or rapidly changing your illumination technique to better visualise the unexpected finding?
- How are you feeling in that moment? Is the unexpected difficulty in manipulating the controls affecting your confidence in performing a systematic and comprehensive examination?
- What is the conclusion or outcome?
- Identify how are you working within your scope of practice when using a slit lamp to visualise patient eyes (e.g., are you ensuring patient safety and comfort is prioritised while adapting the technique)?
- Identify what are you learning as a result of the unexpected development e.g., gaining key insight into mastering oblique illumination?
On action
- What happened?
- Begin by summarising the key points of the experience of using the slit lamp to visualise the patient’s eyes.
- Consider specific events, actions, or interactions that felt important during the examination, such as mastering illumination techniques, achieving parallax for depth perception, or identifying specific anterior/posterior structures.
- Include any ‘reflect-in-action’ moments, where you had to adapt to the situation as it unfolded, for instance, instantly adjusting the light beam for better focus through media opacity or switching lenses to view the fundus. How did you feel during this experience?
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding slit lamp use and visualisation.
- What strengths did you demonstrate (e.g., technical control of the instrument, systematic examination)?
- What skills and/or knowledge gaps were evident (e.g., difficulty mastering advanced illumination techniques or unfamiliarity with specific posterior segment findings)?
- Compare this experience against previous slit lamp activities. Were any previously identified actions for development achieved? Has your practice in systematic slit lamp examination improved?
- Identify any challenges you experienced during the examination (e.g., patient positioning, difficulty maintaining a clear view, identifying subtle pathology) and how you reacted to these. Did this affect your ability to deal with the situation? Were you able to overcome the challenges?
- Identify anything significant about the activity, such as needing to seek advice or clarification on a finding or escalating due to complex anterior segment pathology.
- Acknowledge any changes in your own feelings now you are looking back on the experience.
- What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received with regards to your use of a slit lamp.
- What will you do differently next time you use the slit lamp? Has anything changed in terms of what you would do if you were faced with a similar situation again?
- Do you need to practise any aspect of the activity further? E.g., Practising indirect illumination or refining documentation of anterior chamber findings.
Beyond action
- Have you revisited the experiences?
- Have you reviewed the actions identified in your previous reflections for using a slit lamp to visualise patients’ eyes?
- What specific actions did you previously identify you would need to take to improve your practice, such as refining your slit lamp technique for visualising different anterior and posterior eye structures?
- Have you completed these previously identified actions? If so, how did completing them impact your subsequent performance of this activity? Are you ready to demonstrate this new learning confidently and consistently when using a slit lamp?
- Engage in professional storytelling about difficulties encountered when using the slit lamp to visualise posterior structures (e.g., vitreous, optic nerve head) or identifying subtle anterior segment pathology with peers, near peers, or colleagues. Has discussing these experiences changed your perspective or approach?
- How have these experiences impacted upon current practice?
- Consider how the accumulated learning from performing or reflecting on using a slit lamp will support you in preparing for relevant observed ‘in-person’ assessments for the module, such as DOPS or in clinical experiences where slit lamp procedures are observed. This relates to demonstrating your ability to use a slit lamp to visualise eyes.
- How has your practice related to using a slit lamp developed and evolved over time? This includes recognising when something related to this activity is beyond your scope of practice, such as when findings are complex or require further investigation beyond basic visualisation.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Perform and interpret a range of ophthalmic imaging modalities. |
| # 4 |
Outcome
Employ effective communication with a range of individuals including the patient and the multidisciplinary team. |
| # 7 |
Outcome
Assess and manage risks in the testing environment. |
| # 8 |
Outcome
Select and operate ophthalmic imaging equipment. |