Fellowships

The successful Fellow will work as part of and contribute to a multi-disciplinary team. During the 12-month Fellowship, they will have the opportunity to complete, under supervision, 100 or more of the common oculoplastic operations, including entropion, ectropion, ptosis, excision/reconstruction for periocular skin and eyelid cancers, and lacrimal drainage system reconstruction. The Fellowship includes outpatient clinic care working under the supervision of Ophthalmologists. In addition, the Fellow will assist the Acute Ophthalmic Service – a clinic that provides follow-up for patients who have been referred from the Eye Emergency department. Participation in this clinic provides fellows with the opportunity to organise and triage their own subspecialty referrals, and to maintain their clinical skills in other ophthalmic subspecialties.

NOTE: Over 50% of the fellowship is spent in the outpatient clinic working under the supervision of the Ophthalmologists.

To provide high quality services to Ophthalmology patients, whilst obtaining advanced graduate training in the area of OPAL. The position has a strong clinical component with a busy operating schedule and clinics with a significant number of new tertiary referrals from a wide source and a steady source of emergency patients.

The position also provides unpaid time for research activities to be undertaken. The Fellow is encouraged to be involved in clinical research, the preparation of papers for publication in peer reviewed journals, and presentation at national and international meetings. The Fellow is also expected to be involved in education and supervision of Registrars.

The OPAL Fellow participates in the Emergency Medicine roster with shifts ranging from 0745 to 2200 and Saturday or Sunday shifts as rostered.

Fellowship Objectives:

1. To learn the assessment and management of disorders of the eyelids, lacrimal system and orbit.
   
2. To enhance registrar and undergraduate medical student teaching and provide surgical supervision for registrars where appropriate.
   
3. To provide administrative support as required in regard to organization of surgical and outpatient lists under the care of Dr Hart.
   
4. To pursue clinical or laboratory research in the Department of Ophthalmology, University of Auckland.
   
5. The post is approximately 70:30 clinical/research.

General description:
This fellowship is offered to prepare suitable candidates for a clinical career in ophthalmology. This includes appropriate clinical and surgical skill acquisition in order to be considered a sub-specialist in the field of oculoplastic and lacrimal surgery. There is good exposure to common orbital disease (thyroid orbitopathy, trauma, orbital neoplasia and inflammation), but there is not a big enough caseload or variety for this to be considered a full Fellowship in orbital disease. Posts are generally 70% clinical and 30% research.

Clinical Duties:
These include seeing, diagnosing and treating referred subspecialty patients in an outpatient setting in the Auckland District Health Board Ophthalmology Service, located at Greenlane Clinical Centre. Typically the outpatient sub-specialty clinic (4 hours) would comprise 13-18 patients staffed by a Consultant Ophthalmologist (Hart), the Fellow, plus or minus a Registrar (resident). Additionally, approximately one third of the clinical time would be spent in the operating room, both assisting, and performing oculoplastic and lacrimal procedures under supervision. A typical week would comprise 3 clinical sessions and 3-5 operating room sessions.

The Fellow will be exposed to a full range of eyelid and lacrimal disease, including eyelid malposition, skin cancer, and congenital and acquired lacrimal drainage disease. There is a significant paediatric caseload including congenital ptosis, congenital nasolacrimal duct obstruction, and eyelid malformations such as blepharophimosis syndrome. Trauma cases that are likely to be seen include orbital blowout fractures, eyelid and canalicular lacerations. Common orbital conditions include thyroid orbitopathy, specific and idiopathic orbital inflammation and some orbital tumours. There is also opportunity to participate in multidisciplinary clinics (thyroid) and surgery (ORL for endonasal procedures).

The candidate will be expected to follow and be responsible for patients on the oculoplastic inpatient service. The Fellow is encouraged to be available at all times (except when on vacation) for consultation to Registrars and emergencies referred by outside Ophthalmologists. The Greenlane Clinical Centre Ophthalmology Department is a tertiary service provider with a catchment population of over 2 million and around 60,000 ophthalmology outpatient attendances per annum.

A variety of oculoplastic surgical procedures will be encountered and the Fellow will learn multiple approaches to treating eyelid malposition, tumour reconstruction, enucleation, evisceration and anophthalmic socket reconstruction, lacrimal surgery and diagnostic orbital biopsy techniques.

Surgery will be allocated in a graded fashion of responsibility. Previous Fellows have been involved in around 300 cases over the year, with half to two-thirds as primary surgeon. It is possible that some sessions could be spent at an affiliated private practice (City Eye Specialists), which allows the Fellow to observe cosmetic surgery in addition to general oculoplastic cases.

Research:
The fellow will be expected to spend around 30% of their time on laboratory and/or clinical research. A basic or clinical science project should be completed within the year, hopefully leading to a publication in a peer-reviewed journal. In addition to this, the fellow should be able to complete at least one other brief journal article such as a case report.

Teaching:
Ophthalmology training in New Zealand usually involves one year as SHO, and five years as a vocational registrar. The last year of registrar training is typically spent in a Fellowship position overseas. The Oculoplastic Fellow is expected to be actively involved in the clinical and surgical training of registrars. This includes involvement in interesting cases in the outpatient service as well as teaching and supervision in the operating room for appropriate elective or acute surgical cases.

The Greenlane Clinical Centre is linked to the University of Auckland for teaching of medical students and fellows will frequently be involved in clinical teaching within the clinic and will also provide occasional lectures/tutorials. Participation in teaching of medical students and therapeutic optometry students is also an expectation of this role.

Presentation of interesting cases at regular teaching sessions and at the monthly Departmental meetings is also expected.

The fellow will co-ordinate the 4-weekly radiology meetings.

Annual Leave:
5 weeks paid annual leave per year plus public holidays.

Conference Leave:
Applications are submitted for approval to the HoD, Department of Ophthalmology. There is no specific funding allocated for attending conferences but several sources are available.

Evaluation:
An evaluation after 2 months of the Fellowship will be held to determine performance. A mid-term evaluation will also be held with the Fellow to evaluate his or her performance and to give feedback regarding progress. Fellows are encouraged to provide feedback and express their comments on how their Fellowship is progressing, including areas they would like to further develop.

Fellowship Duration:
1 year

Salary:
The salary is paid at Research Fellow / Level 1 as per the University of Auckland Academic collective agreement.

Weekly Duties:
The Fellow is expected to be on university or clinical sites at a minimum of Monday to Friday, 8:00AM to 5:30PM regardless of clinical activities. Attendance Saturday mornings 9am-10.30am may be required to review surgical/inpatient cases. There is no official obligation to be involved in the on-call emergency roster, but the Fellow may chose to be available for after hours call for lid, lacrimal and orbital cases. The after hours load is relatively light, but often includes very interesting or instructive cases.

All time not occupied by patient responsibilities must be used to further academic pursuits such as research and teaching. Failure to utilize non-clinical time in an appropriate fashion and unsatisfactory progress may result in curtailment of the Fellowship with one month notice. Except in exceptional circumstances all absences from clinic and operating room duties must be cleared six weeks in advance.

Housing:
Unfortunately no residence accommodation is available to support this post. Rental accommodation is widely available in Auckland. Average weekly rental can vary from $500 to $700 per week depending on the type of accommodation required.

Application Process:
Application is by CV at the above contacts or please email Professor Charles McGhee at h.chinoy@auckland.ac.nz. Please include with your application an up-to-date surgical log. Fellowships normally run from July 1st to June 30th, but flexible start dates are considered. Generally, decisions are made approximately 6-9 months prior to the start date. A personal or phone interview is required. Applications are due no later than October 1st of the year prior to beginning the fellowship in July. For flexible start dates, applicants should enquire as to availability.

Medical Registration:
Non-New Zealand Nationals may apply. However, foreign medical graduates should note that they may not enrol in any programmes involving patient contact, nor practice medicine in New Zealand, unless they are registered by the Medical Council of New Zealand. This body is entirely independent of the universities. Completion of an Australian, North American or UK vocational registrar/residency program usually makes medical registration fairly straightforward.

Those applicants whose medical school was not taught in English and who do not speak English as their native language must have the following minimum International English Language Testing System (IELTS) scores as per the Council requirements:

• Speaking 7.0
  
• Listening 7.0
  
• Writing 7.0
  
• Reading 7.0

From 9 September 2018, applicants can pass the Medical Module of the OET by achieving a minimum score of 350 in each of the four components (reading, writing, listening and speaking) within one result. Please check the website www.mcnz.org.nz for full details

Fellow Responsibilities:

1. Obtain medical registration prior to the start of the programme
   
2. Obtain practice insurance via Medical Protection Society
   
3. Obtain visa and work permit from the NZ Immigration Service
   
4. Obtain health insurance for family members while in New Zealand
   
5. Adhere to the policies of the University of Auckland and Auckland District Health Board
   
6. Report to the University Department of Ophthalmology for administrative issues
   
7. Obtain occupational health clearance prior to arriving in New Zealand
   
8. Report to the consultant oculoplastic ophthalmologists for clinical issues

Salary & On call:
$160,000 - $180,000 AUD pa + on call, overtime and recall rates

Prerequisites:

• Demonstrated ability to work independently
  
• Able to perform independent intraocular surgery
  
• Able to manage penetrating eye injuries/ruptured globes
  
• Able to handle general 2nd on-call responsibilities

Highlights:

• Comprehensive eyelid surgery training (including lower lid blepharoplasty)
  
• Endoscopic DCR
  
• Orbital surgery
  
• Joint lists with ENT Rhinology team
  
• Exposure to private surgical assisting
  
• Opportunity to co-investigate thyroid eye disease research programs at Lions Eye Institute with Dr Jean-Louis DeSousa

Expectations:

• On-call for oculoplastics emergencies/urgent cases
  
• Advanced preparation of surgical lists with clear consultant communication
  
• First to attend surgical lists and meet patients prior to team huddle
  
• Monitoring of SCGH Oculoplastics email after hours

Timetable:

• Minimum 12 theatre sessions per month
  
• 4 outpatient procedure sessions per month
  
• 2–3 consultant clinics per week