OST Curriculum 2024 aims to prioritise trainee-led evidence to show competence in all the domains that make up a consultant ophthalmologist’s practice. Its key objectives are:
- To describe specific professional capabilities that incorporate the knowledge, skills and attitudes needed to practice ophthalmology at consultant level.
- To set the expected standards of knowledge and performance of professional skills for each stage of training through a series of high-level, overarching Learning Outcomes.
- To define the critical points at which the required standards must be achieved.
The significant differences between the 2010 and 2024 curricula are:
- Trainee focus – Trainees can choose what evidence to present to display competence. OST Curriculum 2024 no longer requires evidencing 180 individual learning outcomes and all numbers of procedures or Workplace-based Assessments (WpBAs) have been removed, as required by the GMC. Any such numbers given in this document are indicative only. It is for the trainer and the trainee to determine if competence has been achieved with the evidence provided. Trainees are expected to carry out a much greater degree of self-assessment, which is embedded within the new assessment tools.
- Flexibility – Curriculum 2024 is designed to be more flexible as it is competency-based, as opposed to time-based. The trainee will be able to move to the higher Level once the requirements of the previous Level have been achieved and evidenced, regardless of where they are in terms of their OST programme.
- Different structure – Curriculum 2024 is structured according to Levels and Domains of practice, with detailed descriptors underpinning high-level, overarching Learning Outcomes. Levels need to be achieved as summarised in Table 1 to be awarded the CCT.
| Table 1 - Domains and Levels | ||||
|---|---|---|---|---|
| DOMAIN | LEVEL 1 | LEVEL 2 | LEVEL 3 | LEVEL 4 |
| Patient Management | x | x | x | 2 out of 12 SIAs |
| Health Promotion | x | x | x | x |
| Leadership and Team Working | x | x | x | x |
| Patient Safety and Quality Improvement | x | x | x | x |
| Safeguarding and Holistic Patient Care | x | x | x | x |
| Education and Training | x | x | x | x |
| Research and Scholarship | x | x | x | x |
- Domains of practice – Curriculum 2024 is divided into the seven Domains of clinical practice above, which are framed around the Generic Professional Capabilities (GPCs). These Domains are areas against which trainees must demonstrate capability through achievement of all Learning Outcomes before being awarded the CCT.
- Levels – Trainees will advance from Level 1 to 4, completing all Learning Outcomes required for each Level before moving to the next. For the Patient Management domain:
- Level 1 is management of low complexity patients.
- Level 2 is management of low complexity patients at appropriate rate.
- Level 3 is management of moderate complexity patients (of the type expected from a consultant not specialising in that area) and surgical treatment of low complexity patients.
- Level 4 is management of uncertainty and complexity of specialty patients as expected of a consultant with a special interest in that area.
- Special Interest Areas – Curriculum 2024 has twelve Special Interest Areas (SIAs) in the Patient Management domain. Trainees must complete all Learning Outcomes at Level 3 in all seven Domains, after which they will choose to specialise in two of the twelve Level 4 SIAs for the last 12 to 18 months of training (indicative times, ranges apply to some SIAs to make rotas manageable).
- Learning Outcomes and descriptors – The syllabi include descriptors designed to guide trainees and trainers in what must be evidenced to demonstrate achievement of the Learning Outcomes. The ePortfolio has links to facilitate navigation to individual Learning Outcomes pages and lists of descriptors. The evidence is reviewed through the ePortfolio by Named Clinical Supervisors (NCSs), Educational Supervisors (ESs) and by a panel at the Annual Review of Competency Progression (ARCP).
- Changes to assessment forms – Entrustable Professional Activity (EPA) tools are used to assess Learning Outcomes in the Patient Management domain, whereas a level-specific Generic Skills Assessment Tool (GSAT) is used to assess Learning Outcomes in the six generic Domains. EPA forms replace clinical supervisor reports and rely on the completion of at least one Multi-Assessor Report (MAR), the number of which is decided by the NCS at the outset. Established WpBA tools have been adapted to focus on the formative narrative, as opposed to a granular assessment of competencies. Many WpBAs are no longer mandatory, thereby significantly reducing the overall number of assessments needed. Supervised Learning Events (SLEs) are designed to help doctors in training develop and improve their clinical and professional practice, and to set targets for future achievements. Repeated SLEs allow trainees to demonstrate skills development over time.
| Table 2 - Assessment forms | |||
|---|---|---|---|
| ASSESSMENT FORM | HOW MANY | WHO SIGNS OFF | OTHER TOOLS TO COMPLETE ASSESSMENT |
| EPA – holistic assessment of competence in Patient Management Domain | Level 1 and 2 – one every six months | NCS | Longitudinal observations |
| Level 3 – at least one every six months, sign-off in all 12 SIAs | MAR(s) | ||
| Level 4 – at least one every six months, sign-off in 2 chosen SIAs | Mandatory WpBAs | ||
| Optional WpBAs | |||
| Logbook and audits | |||
| GSAT – assessment of competence in all other generic, non-clinical Domains | One every six months | Global judgment, ultimate responsibility lies with ES | Evidence per Domain is trainee-driven |
| MAR – clinical assessment from other assessors as not all competences may have been witnessed by NCS | No specified number – NCS to stipulate | Other supervising consultants or clinicians | Direct observation |
| Other qualified professionals (e.g. orthoptists, optometrists, nurse practitioners) | Other indirect evidence or feedback | ||
Trainees may request any colleague to complete a WpBA if the latter has the skills and knowledge necessary to make a competent assessment as appropriate to the procedure under review. In general, trainee assessors should be at least two Levels above the trainee being assessed, e.g. Level 2 WpBAs or MAR should only be signed off by a consultant, suitably experienced specialty and specialist grade (SAS) doctor or a Level 4 trainee. However, the NCS can advise as to who is appropriate to supervise and feedback on WpBAs, and trainees should ensure this is discussed with the NCS prior to getting any forms signed off. They may recommend suitable non-medical health professionals within the team to sign off Clinical Rating Scale (CRS) forms as appropriate. Professional hospital/Trust emails, as opposed to personal addresses, must be used to request completion of WpBAs. College Tutor endorsement to become a registered ePortfolio assessor is not required.
Named Clinical Supervisors (NCS) – a new role – and ESs consider the evidence to make a professional judgement as to whether the trainee has achieved each Learning Outcome and is ready to be signed off at a Level. Supervisors who hold either of these roles are trainers recognised by the GMC. The RCOphth strongly supports the provision of adequate, equivalent time in their job plan for the ES and NCS to carry out their duties. The RCOphth advises a minimum of 0.25 PA per trainee per role (NCS and ES).
Named Clinical Supervisors are trainers responsible for overseeing a specified trainee’s clinical work and providing constructive feedback during a training placement. NCSs have a more formalised role than previously, and greater responsibility in terms of judging the level of entrustment. NSCs should complete EPAs after consultation with other supervisors (Assessors) in the post. There should be one NCS for every six months in Level 1 and 2 and one NCS for every SIA every six months for Level 3 and 4. The NCS should:
- Be familiar with the requirements of the curriculum, particularly those set out in the Patient Management syllabi.
- Oversee clinical training and ensure the trainee is given the opportunity to meet the post’s clinical requirements as set out in the relevant Patient Management syllabus, as appropriate for the trainee’s Level of training.
- Meet the trainee in the first two weeks of their rotation to:
- Agree the number of MARs to be completed with the trainee at the beginning of the post, and any additional MARs agreed to be necessary.
- Agree if any additional WpBAs, over and above what specified in the EPA, are required to be completed in that post.
- Complete the relevant EPA at the end of the post by checking the mandatory WpBAs specified in the EPA, checking any additional WpBAs, reviewing any completed MARs and meeting with the trainee.
- Liaise as appropriate with the ES.
Educational Supervisors are trainers responsible for the overall supervision and management of a specified trainee’s educational progress during a clinical training placement or series of placements. There should be one ES per post. The ES should:
- Understand role by:
- Being familiar with the structure of the training programme.
- Being aware of local and regional policies for trainee support.
- Understanding own role in the ARCP process and the trainee’s revalidation.
- Meet their trainee in the first two weeks of their post to:
- Ensure the trainee understands the curriculum requirements and develops a personal developmental plan that considers individual needs and learning opportunities.
- Ensure that the trainee is aware of and has contacted their NCS.
- Meet the trainee regularly to review progress with their personal learning plan, reviewing the ePortfolio, ensuring it is maintained and encouraging reflection on the curriculum and GMC’s GMP.
- Liaise with the NCS as appropriate, provide honest and constructive feedback from information from the EPA, GSAT and MSF.
- Review completed EPAs and sign off GSATs, although this form is primarily trainee-driven.
- Complete the Educational Supervisor Report (ESR) in preparation for the ARCP, including noting any serious incident or complaint involvement and making a global assessment recommendation to the ARCP panel.
- Have career discussions with the trainee and ensure they have access to specific advice and support.
- Identify trainees in difficulty and provide support as necessary at a local level, in conjunction with the local office of NHSE or Deanery/Training Programme Director (TPD)/ Director of Medical Education/College Tutor, in line with local and regional policies.
- Encourage trainees to undertake the annual GMC National Trainee Survey.