At this stage the theme of general ophthalmology continues with doctors in training adopting spiral learning and demonstrating increasing independence and efficiency. They will continue to use skills of reflection and self-awareness to recognise their own achievements and limitations. They will begin supervision of more junior doctors, where this is appropriate. At the end of this stage all doctors in training must have passed the Refraction Certificate examination to progress further. This test of knowledge involves an understanding of theoretical principles of optics, refraction and the related clinical skills, essential for higher practice.
An ophthalmologist working at Level 2 will be able to independently manage low complexity patients at an appropriate work rate employing the most appropriate clinical examination and investigation modalities. They will refine differential diagnoses and management plans by application of their clinical knowledge. They will be aware of public health issues relevant to ophthalmology. Full details of the descriptors supporting each Learning Outcome can be found in the curriculum microsite.
- EPA Level 2 – one for every six months until final one signed off by NCS as ‘Competent’ in Patient Management Domain Level 2. The requirements for the Level 2 EPA are summarised in Table A.
- GSAT Level 2 – one for every six months until final one signed off by ES as achieving the competencies required to complete this Level in the six Generic (non-Patient Management) Domains. Examples of evidence that can be used in the Level 2 GSAT are summarised in Table B.
- Refraction Certificate
- Educational Supervisor Report – one for every six months and final one confirming a review of the ePortfolio indicating that Level 2 competencies have been achieved in all seven Domains
- Pass in Refraction Certificate examination
- Logbook
- Professional Development Plan
- MSF – one for every calendar year
- Cataract Complications Audit
- Form R, SOAR declaration or equivalent
- Satisfactory outcome in ARCP
Please also see Level 2 training requirements in the section on ARCP and the Learning Outcomes on the curriculum microsite.
| Table A Curriculum requirements as listed in Level 2 EPA | ||
|---|---|---|
| *A formative tool should be used if a trainee is not achieving the expected level. These requirements can be demonstrated by DOPS, OSATS, direct observation or observation by another team member. | ||
| Mandatory requirements in Outpatients | Mandatory requirements in Theatre | Other mandatory requirements |
| CRS1 Consultation skills | OSATS Microsurgical skills | Longitudinal, periodic observation by consultant assessor in the outpatient and/or on call setting, where possible |
| CRS10d Fundus assessment – binocular indirect ophthalmoscope | OSATS Cataract Surgery | Longitudinal observation by consultant assessor in the theatre and simulation setting |
| CRSret Cycloplegic refraction | OSATS Lid surgery | Review of record keeping and letters |
| Use a pachymeter* | Lateral canthotomy/cantholysis* | Multi-assessor report |
| Insertion of bandage contact lens* | Interpret biometry* | |
| Remove of corneal foreign body* | ||
| Laser to lens capsule* | ||
| Laser for raised IOP* | ||
| Laser retinopexy* | ||
| Interpret orthoptic assessment* | ||
| Interpret FFA* | ||
| Table B Examples of evidence that can be used in the GSAT Level 2 | |
|---|---|
| CbDs and Reflections can be used to demonstrate evidence under each Learning Outcome. | |
| Learning outcome | Suggested examples of evidence and topics on which related CbDs and reflective pieces can be used |
| Domain: Health Promotion | |
| Be aware and respect the impact of social, economic, cultural and religious factors on health. | Evidence of community ophthalmology attachment |
| Cultural: corneal donations/retrievals and its implications. | |
| Social and economic: deprivation and transport. Evidence of detailing examples of people with limited means of transport and being remote. Booking Taxis. Late presentation of cataract and advanced disease secondary to socioeconomic deprivation. | |
| Religion: drops in Ramadan – educational element. Fasting | |
| Have detailed knowledge of National Screening Programmes especially with reference to Ophthalmic diseases. | Placements in paeds (ROP), Med ret (diabetic screening), or glaucoma |
| Demonstrate understanding of UK visual screening for children. An example could be including familial retinoblastoma cases, or cases who have been referred as a part of hydroxychloroquine screening or diabetic retinopathy screening | |
| Domain: Leadership and Teamworking | |
| Document and evidence leadership behaviours. | Reflective practice |
| Courses – e.g. TTT | |
| Certificate of learning | |
| 01_01 Introduction to Leadership and LeAD | |
| https://portal.e-lfh.org.uk/Component/Details/510250 | |
| Completion for Level 1 also counts towards Level 2 evidence | |
| https://www.leadershipacademy.nhs.uk/resources/healthcare-leadership-model/ | |
| Audit / QIP project/or evidence of research project | |
| Write a reflective piece about own attributes and skills in communication, handling feedback, coping with stress, developing resilience, leadership styles that fit your strengths and stretching oneself to develop further | |
| Practice within a multidisciplinary team to develop leadership projects. | Manage rota |
| Human factors training | |
| Certificate of course | |
| Evidence of practice within a multidisciplinary team | |
| Chairing a meeting | |
| Learning appraisal skills | |
| Training on team building | |
| Undertaking patient improvement activity | |
| Domain: Patient Safety and Quality Improvement | |
| Apply clear and appropriate clinical reasoning to make safe decisions. | Portfolio |
| Part 2 FRCOphth | |
| MSF | |
| Practice in line with latest evidence. | Portfolio |
| Part 2 FRCOphth | |
| MSF | |
| Maintain appropriate audits of practice. | Portfolio |
| Part 2 FRCOphth | |
| Surgical logbook; details of complications; Cataract Complications Audit | |
| MSF | |
| Apply quality improvement methods. | Portfolio |
| Part 2 FRCOphth | |
| QI project, Audit | |
| MSF | |
| Domain: Safeguarding and Holistic Care | |
| Recognise where specialised management techniques may be necessary for those with special needs. | CBDs |
| Refer to ECLO | |
| Consent and capacity training | |
| Adult Safeguarding Level 2 | |
| https://portal.e-lfh.org.uk/Component/Details/510406 | |
| CbD re: patient with special needs attending clinic or theatre | |
| Evidence of knowledge in sight impaired registration, DLVA requirements | |
| CBD or reflection on support needed/referral to ECLO | |
| https://portal.e-lfh.org.uk/Component/Details/506969 | |
| ECLO and wider visual support | |
| https://portal.e-lfh.org.uk/Component/Details/506975 | |
| Case relating to vision/visual field and driving | |
| Case relating to Amaurosis/TIA/Stroke and advice regarding driving | |
| Case relating to CVI registration and ECLO/low visual aid referral | |
| CBD/reflection relating patient with dementia/learning difficulties needing consent | |
| Domain: Education and Training | |
| Plan and provide education and training activities for medical trainees and other professionals. | Evidence of medical student teaching, nurses, optometrist or junior trainee |
| Evidence of developing a teaching session | |
| Contribution to regional teaching session or to medical students or other professionals | |
| Reflect on teaching | |
| Feedback | |
| Give constructive feedback on learning activities. | Feedback form completed at end of teaching session with own constructive feedback |
| MAR from a non-clinical supervisor | |
| Feedback on regional teaching | |
| Domain: Research and Scholarship | |
| Implement an evidence-based approach to shared decision making and enhancing patient outcomes | Involvement in MDT |
| CbD | |
| Undertake a literature review to answer a clinical question | |
| Research Agreement | |
| Demonstrate competencies for commencing clinical research. | GCP course – online/in person |
| Research ethics course | |
| Collect evidence of research skills; evidence of a publication is strong evidence or research project undertaken | |
| Good Clinical Practice training | |
| Carry out lit search on topic | |
| Evidence of discussions with supervisor on research projects e.g a project proposal | |
| Write ethics application | |
| eLearning/courses on research skills e.g GCP training, research skills modules from MSc course, Trust R+D training courses | |
| Research Agreement | |
| Distil research, deliver poster presentations and improve oral presenting. | Journal club |
| Regional teaching | |
| Research publication/oral or poster presentation in local, regional, national and international meetings | |
| Critical appraisal clinical trial presented at regional meeting/journal club | |
| Research Agreement | |