Level 3 Guide

  1. EPA Level 3 – one for each of the Level 3 SIAs (overall requirement of minimum of one every six months) until final one signed off by NCS as ‘Competent’ in Level 3 Patient Management domain. Level 3 EPA requirements are summarised in Table A.
  2. GSAT Level 3 – one every six months until final one signed off by ES as achieving Level 3 competencies in the six non-clinical domains. Examples of evidence that can be used in the Level 3 GSAT are summarised in Table B.
  3. ESR – one every six months and final one indicating that Level 1 competencies have been achieved in all seven domains
  4. Pass in Part 2 FRCOphth examination
  5. Logbook
  6. PDP
  7. MSF – one per calendar year
  8. Cataract Complications Audit
  9. Form R or SOAR declaration
  10. Satisfactory outcome at ARCP

Table A Curriculum requirements as listed in Level 3 EPA for each SIA
*A formative tool should be used if a resident 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 OutpatientsMandatory requirements in TheatreOther mandatory requirements
OCULOPLASTICS
CRS1 Consultation skills in oculoplastics  OSATS Lid surgery  Longitudinal, periodic observation by consultant assessor in the outpatient and/or on call setting, where possible  
Assessment and detailed interpretation of lacrimal function (syringing / sac wash-out)*  OSATS Lateral canthotomy and cantholysis  Longitudinal observation by consultant assessor in the theatre and simulation setting   
Initial management of sight-threatening orbital emergencies (e.g. orbital cellulitis)*Local anaesthesia*  Review of record keeping and letters  
Tarsorrhaphy*  CbDs 
Eyelid laceration repair*  Multi-assessor report 
Eyelid lesion biopsy* 
CORNEA & OCULAR SURFACE DISEASE
CRS1 Consultation skills in cornea and ocular surface disease  OSATS Microsurgical skills - cornea and ocular surface disease  Ocular surface protection (e.g. Botox, Amniotic membrane, tarsorrhaphy)* - either Outpatients or Theatre
Corneal gluing* Corneal trauma repair (may be as part of larger globe repair)*  
Corneal graft suture removal*  Longitudinal, periodic observation by consultant assessor in the outpatient and/or on call setting, where possible  
Local anaesthesia* Longitudinal observation by consultant assessor in the theatre and simulation setting   
Review of record keeping and letters  
CbDs 
Multi-assessor report 
CATARACT SURGERY
CRS1 Consultation skills in cataract surgery OSATS Cataract Surgery  Logitudinal, periodic observation by consultant assessor in the outpatient and/or on call setting, where possible 
DOPSBi Perform and interpret biometry Local anaesthesia*  Longitudinal observation by consultant assessor in the theatre and simulation setting 
Aqueous / vitreous biopsy*  Review of continuous audit of complications of cataract surgery 
Anterior chamber paracentesis*  Review of logbook 
Periocular and intraocular drug delivery*  Review of record keeping and letters  
CbDs 
Multi-assessor report 
GLAUCOMA
CRS1 Consultation skills in glaucoma  OSATS Cataract Surgery  Longitudinal, periodic observation by consultant assessor in the outpatient and/or on call setting, where possible  
Laser for IOP (including YAG PI and SLT)* OSATS Microsurgical skills – glaucoma surgery  Longitudinal observation by consultant assessor in the theatre and simulation setting   
Acute management of angle closure glaucoma* Local anaesthesia*  Review of record keeping and letters  
CbDs 
Multi-assessor report 
UVEITIS
CRS1 Consultation skills in uveitis  DOPS Periocular and intraocular drug delivery  Aqueous and vitreous sampling* - either Outpatients or TheatreLongitudinal, periodic observation by consultant assessor in the outpatient and/or on call setting, where possible  
Interpretation and use of ICG and FFA* Longitudinal observation by consultant assessor in the theatre and simulation setting   
Interpretation of electrophysiology*  Review of record keeping and letters  
CbDs 
Multi-assessor report 
MEDICAL RETINA
CRS1 Consultation skills in medical retina  OSATS Intravitreal injections  Longitudinal, periodic observation by consultant assessor in the outpatient and/or on call setting, where possible  
Interpretation of FFA, ICG, OCT, AF, electrophysiology *  Sub-tenon’s injection*  Longitudinal observation by consultant assessor in the theatre and simulation setting   
Interpretation of electrophysiology*  Review of record keeping and letters  
Retinal laser treatment* CbDs 
Multi-assessor report 
VITREORETINAL SURGERY
CRS1 Consultation skills in vitreoretinal surgery  OSATS Cataract Surgery  Longitudinal, periodic observation by consultant assessor in the outpatient and/or on call setting, where possible  
Ultrasound of the vitreous cavity, retina and choroid* OSATS Microsurgical skills – vitreoretinal surgery  Longitudinal observation by consultant assessor in the theatre and simulation setting   
Local anaesthesia*  Review of record keeping and letters  
Vitreous biopsy* CbDs 
Multi-assessor report 
OCULAR MOTILITY
CRS1 Consultation skills in ocular motility DOPS Forced duction test  
OSATS Surgical skills – extraocular muscle surgery  Longitudinal, periodic observation by consultant assessor in the outpatient and/or on call setting, where possible
Interpretation of orthoptic exam* Longitudinal observation by consultant assessor in the theatre and simulation setting
Review of record keeping and letters
CbDs
Multi-assessor report
NEURO-OPHTHALMOLOGY
CRS1 Consultation skills in neuro-ophthalmology  Longitudinal, periodic observation by consultant assessor in the outpatient and/or on call setting, where possible  
Longitudinal observation by consultant assessor in the theatre and simulation setting   
Use of neuroimaging*  Review of record keeping and letters  
Liaison with other medical and surgical specialties as needed*  CbDs 
Interpretation of orthoptic assessment* Multi-assessor report 
PAEDIATRIC OPHTHALMOLOGY
CRS1 Consultation skills in paediatric ophthalmology  OSATS Surgical skills – extraocular muscle surgery  Longitudinal, periodic observation by consultant assessor in the outpatient and/or on call setting, where possible  
Indirect ophthalmoscopy with indentation (ROP screening)*  DOPS Assessment of lacrimal function, including probing in childrenLongitudinal observation by consultant assessor in the theatre and simulation setting   
Examination for suspected NAI* Review of record keeping and letters  
Referral for genetic counselling*  CbDs 
Interpretation of the orthoptic examination*  Multi-assessor report 
Refract and provide glasses prescription* 
COMMUNITY OPTHALMOLOGY
Knowledge of community ophthalmology commissioning frameworks, local community ophthalmology provision and referral pathways*  Longitudinal, periodic observation by consultant assessor in the outpatient and community setting where possible (consider handling of referrals, communication with primary care, virtual clinics, teleophthalmology, etc.) 
Knowledge of screening programmes*  Review of record keeping and letters 
Application of improvement methodologies* CbDs 
Multi-assessor report 
URGENT EYE CARE
CRS1 Consultation skills in urgent eye care OSATS Microsurgical skills – urgent eye careVitreous biopsy* - either Outpatients or Theatre
Corneal gluing*Lateral cantholysis*Longitudinal, periodic observation by consultant assessor in the outpatient and/or on call setting, where possible
Longitudinal observation by consultant assessor in the theatre and simulation setting
Review of record keeping and letters
CbDs
Multi-assessor report

Table B Examples of evidence that can be used in the GSAT Level 3
CbDs and reflections can be used to demonstrate evidence.
Learning outcome Suggested examples of evidence and topics on which related CBDs and reflective pieces can be used 
DOMAIN: HEALTH PROMOTION 
Demonstrate leadership in the promotion of eye and general health in the wider community. M+M meetings – present any cases of endophthalmitis 
Reflective piece following involvement with Integrated care system pathways (regional) for eye disease e.g. dry eye disease 
Patient information leaflets for general eye health (e.g. contact lens wear guidance)  
QIP in a community ophthalmology clinic e.g in virtual access clinics 
Promote immunisation. Recommend tetanus in trauma cases 
Recommend flu vaccine and covid vaccine to elderly and immunosuppressed
DOMAIN: LEADERSHIP AND TEAMWORKING 
Demonstrate the authority, capacity and motivation to implement change. Undertake management course 
Certificate of learning  
CLE 04 - Managing Services 
https://portal.e-lfh.org.uk/Component/Details/393939 
https://www.leadershipacademy.nhs.uk/resources/healthcare-leadership-model/ 
Examples of training undertaken covering 9 leadership behaviours:   
Undertake management training course with reflective notes or  
shadow senior manager or  
visit hospital or community service scheme and write reflective notes
Ability to manage and lead teams when on call: MSF/CS/ ESR 
Participation in committees e.g., RCOphth role/ trust working parties/ HEENE roles such a Doctors in Training representative 
Design own projects related to leadership and management with outcomes predetermined to reflect on success. QIPs 
Examples include:  
writing a business case e.g., for a piece of equipment.  
Learning about finance or commissioning within the NHS to share the knowledge with others, introducing a new guideline or piece of equipment   
DOMAIN: PATIENT SAFETY AND QUALITY IMPROVEMENT 
Design and implement quality improvement programmes to improve clinical effectiveness, patient safety and patient experience. Portfolio
Part 2 FRCOphth  
QI project 
Audit 
Analyse and critique published research. Portfolio  
Part 2 FRCOphth 
Journal club attendance  
PG teaching 
DOMAIN: SAFEGUARDING AND HOLISTIC CARE 
Take responsibility for safeguarding of children and vulnerable adults, referring and taking appropriate action. Adult Safeguarding Level 2 - https://portal.e-lfh.org.uk/Component/Details/511209 
Child Safeguarding Level 2 – 
https://portal.e-lfh.org.uk/Component/Details/510418 
CBD re: 
Performing an NAI screening in a child 
Involving/initiating a safeguarding incident 
Portfolio  
Part 2 FRCOphth 
Apply mental capacity legislation in clinical practice. Undertake Mental Capacity Act (MCA) training and demonstrate booking best interests meeting 
Hold best interests meeting with supervision 
Trust Deprivation of Liberty training 
MCA: https://portal.e-lfh.org.uk/Component/Details/598749 
Best interest: https://portal.e-lfh.org.uk/Component/Details/597891 
Apply appropriate equality and diversity legislation in clinical practice. Trust equality and diversity training  
Reflective piece/CBD of case involving issues of equality and diversity
DOMAIN: EDUCATION AND TRAINING 
Create learning opportunities for others. Supervise juniors – logbook 
CSR   
Thank you note for teaching or learning support from junior trainee or other professional 
Feedback from medical students 
Provide objective assessment. Objective feedback on teaching or training received  
Reflective piece 
OSCE examiner for medical school 
Design and contribute to patient educationEvidence of participation in patient education events, patient support group meetings etc 
Design or revise patient information leaflets or videos 
Involvement in other forms of patient education 
DOMAIN: RESEARCH AND SCHOLARSHIP 
Implement service improvement by revision and development of guidelines, treatments and practical procedures using current clinical research and contemporary evidence. Involvement in QI project, audit, evaluation, writing business case 
Developing departmental guidelines
Developing teaching handbook 
Evidence of participation in the NIHR Associate Principal Investigator Scheme
Lead research / teaching sessions and critically appraise oral presentations. Chair local postgrad teaching 
Chair simulation course 
Evidence of presentation in local and regional teaching 
Evidence of feedback given 
Evidence of organising teaching session 
Publications