Ocular Oncology Teaching

Trainees

It is the duty of the consultant to teach junior colleagues as much as possible about the care of patients with uveal melanoma and other tumours. The experience that they will gain during their short spell in our centre will create lasting impressions, which will greatly influence the way in which they manage their own patients, years later, once they become consultants.

Trainees learn by examining patients in the clinics and the wards, contributing to patient care, discussing clinical problems and findings with the consultant, and assisting at surgery. They also gain valuable experience by performing certain surgical procedures and laser treatments themselves, with appropriate guidance and supervision and only when it is safe and useful for them to do so. As a rule, the consultant performs much of the surgery himself, because of the specialized and difficult nature of the surgery and because it is so important to 'get things right first time'.

Visitors

Each year, we receive several ophthalmologists from overseas with a special interest in ocular tumours. They come to see how our centre is organized and how we manage our patients. Some come especially because they wish to observe the 'trapdoor operation' (i.e., 'trans-scleral local resection'), because this is performed in such a few centres around the world. Others visit because they can see a wide range of treatments performed within a short time, which is an unusual opportunity, as other centres tend to offer only one or perhaps two kinds of treatment. Occasionally, the visitor is an oncology nurse from another hospital.

Visitors usually stay only for one week, with a few staying for between two and six weeks, and one or two staying for about six months. Most visitors are either distinguished ocular oncologists or trainees working with such persons.

Strict safeguards ensure that no problems arise as a result of a visit by a doctor from another hospital. Each visitor is required to submit a brief curriculum vitae so that we can get official permission from the Medical Director of the Royal Liverpool University Hospital for the visit to take place.

Most visitors come as observers and are not allowed to perform any treatment or surgery. If a visitor wishes to get involved in patient care and to perform surgery, then a contract needs to be drawn up with our hospital. Such a contract is granted only once original professional certificates have been scrutinized by the personnel officer and once the visitor has passed a health check, which may include our own blood tests to exclude hepatitis.

Visits to our centre by overseas specialists bring several benefits. Firstly, they keep us all on our toes, asking probing questions and commenting on our methods. Secondly, they invariably give us valuable feedback on our results and on anything they find surprising or unusual. This is almost always positive criticism, and coming from an expert is most reassuring and encouraging. Thirdly, it is gratifying for us when we meet them at international conferences months or years later and when they tell us what changes they have made to their own centre after their visit to our department. There are one or two difficulties that can arise. For example, their presence can slow down a busy clinic if one is not too careful, although various discreet ways of not letting this happen have been developed, for instance, by computerizing the clinical details or dictating the report while they are examining the patient. So far, it has always been a great pleasure to spend some time with our overseas visitors, exchanging ideas and showing off what a great place Britain is, even if it does sometimes rain solidly during our Sunday afternoon visit to North Wales.

Lectures

Lecturing is an important part of Professor Damato's programme, with him usually giving about one lecture a month, nearly always quite far away from Liverpool and usually overseas. On most occasions, he is invited to give these lectures because ocular oncologists are few and far between and general ophthalmologists are very keen to keep up to date, even if they only see one or two patients with an ocular tumour each year.

The meetings include:

Departmental conferences attended by all the staff of a particular eye unit;
Regional meetings held by ophthalmologists in a particular part of the country;
National annual conferences, attended by hundreds of ophthalmologists from all over that country; and
International congresses, attended by thousands of delegates from all over the world.

Conferences are hard work and tiring in some respects but provide a refreshing break from routine and there is nearly always an important lesson or idea to bring back home.

: The International Conference Centre, Kyoto

During Professor Damato's absence from the centre all oncology work practically stops, with as many new patients as possible being seen the week before his absence. Any unexpected problems arising during his absence from the department are dealt with by his colleagues.

Professor Damato is never away for more than two weeks in succession, to prevent an excessive backlog of work from developing. During his absences, trainees are able to catch up with cataract surgery and other routine operations, under the supervision of other consultants. This also helps to shorten the waiting list for non-oncological surgery. The clinics are also used for general ophthalmic patients. The secretary, nurse and data manager invariably have a backlog of filing and other administrative matters to deal with.