Clinical Governance and Medicolegal Issues

This is the final article in the series following students who undertook the nine-course University of Ulster's e-learning program. This course was taken as an individual online unit of study or as part of the overall award of a postgraduate diploma in cataract and refractive surgery (theory).

WEEK 1

Stefan Peiger presented his online lecture on outcome analysis and nomograms, which helped explain the importance of quality control within a refractive surgery clinic. Quality control enables clinicians to verify current nomogram settings, make adjustments, reduce enhancement rates, increase patient confidence levels, and discover trends (eg, technical problems) to allow quick reaction in the event of a problem. The lecture also listed methods to record data effectively, such as spreadsheets, databases, and commercially available refractive software. The standard refractive outcomes described were stability, safety, predictability, and efficacy. Astigmatic outcomes, such as surgically induced changes in cylinder, double-angle scatter plots, defocus equivalent, contrast sensitivity, aberrometry, and UCVA and BCVA were described.

A comprehensive lecture on visual performance after refractive surgery, delivered by Catharine Chisholm, discussed modalities and causes of reduced vision after refractive surgery. Ms. Chisholm focused on how to measure vision after surgery and listed the main causes of reduced vision, including an increase in forward light scatter and in aberrations and a mismatch between the pupil and optic zone size. A range of objective quality-of-vision tests were described, along with current clinical results reported in the literature. Discussions were based on regular auditing techniques and how to best assess refractive performance outcomes after refractive surgery.

WEEK 2
Rebecca Petris, of the patient group Laser My Eyes, presented a lecture on assessing patient outcomes and satisfaction. This lecture centered around three areas: patient satisfaction, patient complaints, and differences between patient and surgeon criteria for success. Case examples of postsurgical quality of life in refractive patients were also discussed. Participants learned how to avoid patient dissatisfaction and how excellent surgical results may not be the same as excellent patient results.

Mark Korolkiewicz presented a discussion on clinical governance and medicolegal aspects of refractive surgery. According to his lecture, the majority of patient complaints after refractive surgery are resolved, and the threat of litigation is low. However, there are still certain surgical aspects that increase the risk of litigation, including: high patient expectations, high volume of patients who undergo refractive surgery, negative press with regard to refractive surgery, patients who are able to demonstrate economic compromise, and patients who have the potential for pain and suffering with healthy eyes.

This lecture also covered medical negligence, duty of care, causation, informed consent, limitation, clinical governance, risk management, refractive surgery co-management, recent developments, and the future of refractive surgery.

WEEK 3
Antonio Leccisotti presented a lecture on the quality of information in refractive surgery. The main aim of the lecture was to present examples of poor quality information on the subject of refractive surgery.

Information on refractive surgery is delivered to the public by television, newspapers, magazines, and Web sites. Professionals receive information and updates from conferences, scientific journals, trade journals, Web sites, and industry representatives. The huge economic interests involved in refractive surgery and the increasing amount of published data have caused a degradation of information. The topics covered in the lecture included television advertising, conferences, trade journals, peer-reviewed journals, undeclared conflict of interests, and negligent review. The discussions emanated around trusted information sources, peer-reviewed articles, and trade journals.

CONCLUSION
This series of nine short courses is delivered online without the need to attend classes at the University of Ulster. This e-learning approach not only increases access for a variety of students but also increases flexibility for students and promotes global collaboration in providing specialized teaching. A principal advantage of this course was the use of peer learning. The success of the asynchronous discussion boards in terms of the number of students participating greatly enhanced peer learning and encouraged student-driven discussions.

Course assessment and evaluation using the Kirkpatrick evaluation questionnaire demonstrated an overall positive learning experience by this multidisciplinary cohort of students undertaking the e-learning course. We demonstrated effective peer learning in an online course, whereby distance learning enhanced knowledge construction and transferred it to the practical setting. Students felt that the course enhanced their overall professional practice by provoking a change in methods used, and students reported that they thought this could have a positive effect with regard to improving patient outcomes.

We are currently taking applications for the next postgraduate diploma or MSc course in cataract and refractive surgery (theory). The start date is September 2009.

Antonio Leccisotti, MD, PhD, is a Visiting Professor at the School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland, and Director of the Ophthalmic Department, Casa di Cura Rugani, Siena, Italy. Dr. Leccisotti states that he has no financial interest in the products or companies mentioned. He may be reached at tel: +39 335 8118324; fax: +39 0577 578600; e-mail: leccisotti@libero.it.

Colm McAlinden, BSc (Hons), MCOptom, is an Optometrist currently undertaking a PhD in refractive surgery with the University of Ulster, Northern Ireland. Mr. McAlinden states that he has no financial interest in the products or companies mentioned. He may be reached at e-mail: colm.mcalinden@gmail.com.

Damien McConville, MSc, MBCS, FHEA, is a Learning Technologist at the Institute of Lifelong Learning, University of Ulster. Dr. McConville states that he has no financial interest in the products or companies mentioned. He may be reached at tel: +44 0 2890368537; e-mail: d.mcconville@ulster.ac.uk.

Johnny E. Moore, FRCOphth, PhD, is a Visiting Professor at the School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland, and Department of Ophthalmology, Mater Hospital, Belfast Hospital Trust Northern Ireland, and Director of Leeson Eye Institute, Dublin, Ireland. Dr. Moore states that he has no financial interest in the products or companies mentioned. He may be reached at tel: +353 0 16674778; e-mail: johnnymoorebal@gmail.com.

Tara Moore, PhD, NTF, is a Course Director and Senior Lecturer at the School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland. Dr. Moore states that she has no financial interest in the products or companies mentioned. She may be contacted at tel: +44 0 7793226873; e-mail: t.moore@ulster.ac.uk.

Sunil Shah, FRCOphth, FRCSEd, FBCLA, is a Visiting Professor at the School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland, Visiting Professor at the School of Life & Health Sciences, Aston University, Birmingham, UK, Medical Director, Midland Eye Institute, Solihull, UK, Consultant Ophthalmic Surgeon, Heart of England Foundation Trust, Birmingham, UK, and Consultant Ophthalmic Surgeon, Birmingham & Midland Eye Centre, Birmingham, UK. Dr. Shah states that he has no financial interest in the products or companies mentioned. He may be reached at tel: +44 1217112020; fax: +44 1217114040; e-mail: sunilshah@doctors.net.uk.