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ENET – European Network for Education of TraineesAPPLICATION 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 @ Agenda (Lisa Flanagan)

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: 1-hour course (1-3 speakers) 2-hours course (4-6 speakers) 3-hours course (6-8 speakers) 4-hours course (8-10 speakers)

10. Course Format: Formal lecture Commented diaporama Video-based course Case presentations On-line course E-learning

11. EBO Curriculum mapping:

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

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 speakerGeneral instructions for MCQ writing are provided on page 6

MCQ submission forms are provided on pages 7 to 16

Course synopsis (max. 10 lines)

Aim(s) of the course (max. 10 lines)

Achievements (what knowledge will the participant achieve)

Course outline (please specify or add a flyer) Name Topic title Time

(min)1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Conflicts of interests (describe if any)

I have no potential conflict of interest I have the following potential conflict(s) of interest to report:

Research grant Research support Honorarium Consulting fee Other, please describe:

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 the EBO Central Office:

EBO Office, Agenda Communications, Temple House, Temple Road, Blackrock, Co. Dublin, Ireland,E-mail: [email protected]

to wave registration fee for the peer reviewer

Name of Course Director: Date:

Signature of Course Director:

X

Agreement (to be filled in by the Chair of the Education Committee and/or the President of the Society) I hereby certify to have read the application and found it complete and conform the ENET regulation requirements.

Signature of Chair Education Programme:

X

Signature of President of the Society:

X

Application Form to be sent by e-mail to EBO Office, Agenda Communications, Temple House, Temple Road, Blackrock, Co. Dublin, Ireland, E-mail: [email protected]

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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

ENET – European Network for Education of TraineesMCQ 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 Falseb. 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

MCQs provided by the EBO Course Faculty (one MCQ per speaker) MCQ 1Stem: a. True Falseb. True Falsec. True Falsed. True False

e. True FalseAuthor detailsAuthor 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 Immunology Pharmacology Therapeutics

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:

MCQ 2Stem: f. True Falseg. True Falseh. True Falsei. True Falsej. True False

Author detailsAuthor name: Author e-mail address: EBO Curriculum mapping of the MCQ1


Reference book(s)2











MCQ 3

Stem: k. True Falsel. True Falsem. True Falsen. True Falseo. True FalseAuthor detailsAuthor 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 Immunology Pharmacology Therapeutics

Reference book(s)2


MCQ 4Stem: p. True Falseq. True Falser. True Falses. True Falset. True False

Reference book(s)2







MCQ 5Stem: u. True Falsev. True Falsew. True Falsex. True Falsey. True False

Reference book(s)2







MCQ 6Stem: z. True Falseaa. True Falsebb. True Falsecc. True Falsedd. True False

Reference book(s)2







MCQ 7Stem: ee. True Falseff. True Falsegg. True Falsehh. True Falseii. True False

Reference book(s)2







MCQ 8Stem: jj. True Falsekk. True Falsell. True Falsemm. True Falsenn. True False

Reference book(s)2







MCQ 9Stem: oo. True Falsepp. True Falseqq. True Falserr. True Falsess. True False

Reference book(s)2







MCQ 10Stem: tt. True Falseuu. True Falsevv. True Falseww. True Falsexx. True False

Reference book(s)2







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