The ARCP is a formal Statutory Education Body (SEB) process overseen on their behalf by a TPD. It is used each year to review trainee progression against standards set down in the curriculum for their training programme. These standards are set down in the Matrix of Progression (Appendix 1) which has been developed to assist trainees, ES and ARCP Panels. It is incumbent on the trainee to provide portfolio evidence to the ARCP panel to demonstrate that all curriculum requirements have been met. ARCP panels expect the following evidence to be included in portfolios:
- Educational and clinical supervision – documentation of meetings and outcomes
- Regular participation in the mandated programme of assessment (EPAs, GSATs, MARs, WpBAs, MSF)
- Surgical logbook
- Audits as required
- Examination outcomes
- Professional Development Plan (PDP)
- Reflective entries
- Record of training and teaching events
- Teaching resources
- Clinical governance/quality improvement activities
- Presentations/research/publications
- Evidence of Continual Professional Development (CPD)
The ES should utilise much of this evidence when completing the ESR as this will be used to inform the ARCP panel. The decision regarding the appropriate Level of training should be reached unanimously before the ARCP and recorded in the ESR. There will be no right to appeal at any point. The ARCP panel makes the final summative decision determining whether the trainee has progressed at the appropriate rate and is able to move to the next OST year, or advance to the next Level of training if at a critical point, before being awarded the CCT at the end of the programme.
A trainee may not have yet demonstrated to the ARCP panel that they are ready to move to the next Level; however, they must show that they are making appropriate progress towards it as laid out in the Matrix of Progression.
At each ARCP, it will be expected that the trainee will have uploaded the relevant evidence to their portfolio for the Level they are working towards (see table 2 and 3), even if their NCS or ES cannot yet sign them off at that Level.
A surgical logbook allows competence that has been measured using various assessment tools to be placed in the context of experience. Although not a formal assessment, trainees are mandated to use the Eye Logbook platform to keep a log of all operative procedures in which they have been involved, including the level of supervision (A-Assisting, PS-Performed supervised, P-Performed independently, SJ-Supervising a junior). The logbook demonstrates the breadth of experience, particularly essential for the assessment of Level 4 Learning Outcomes. During Level 4, in particular, the supervision of more junior trainees must be documented and it is important to demonstrate maintenance of skills as well as new procedures undertaken in Level 4 SIAs.
Training ophthalmologists are expected to keep and present a continuous complications audit of their cataract surgery. This allows reflection and developmental planning with their supervisors. Benchmarking against peer norms enables outliers to be highlighted and early appropriate action to be taken in the interest of patient safety.
As doctors approach the end of training, they are required to present audits of outcomes of their surgical procedures. By the end of training, they need to undertake a prospective audit of 50 consecutive cataract cases where the surgery is performed within three calendar years of achieving Level 4 Cataract Surgery. Post-operative refractive data must be provided on at least 10% of cases.
Accepted national or international standards are used as benchmarks and this information is an important consideration for an ARCP panel in deciding that a doctor has reached the standard of competency required for CCT.
During this stage (usually spanning the OST1-2 years), trainee ophthalmologists develop clinical and procedural skills which are essential for both acute care and general ophthalmology. They also develop values and behaviours in all other curriculum Domains, including reflective practice and communication, and acquire the basic science knowledge essential for the practice of ophthalmology, which is assessed by the Part 1 FRCOphth examination.
Assessments supporting the Level 1 Learning Outcomes focus on acquiring the knowledge base required to be a safe and effective ophthalmologist. Trainees have a maximum of two years to be signed off in all Level 1 competences, although it is expected that many will achieve competence by the end of OST1.
The Level 1 Guide lists which evidence is required to demonstrate meeting all Level 1 Learning Outcomes. In addition, trainees must:
- Have a satisfactory ARCP Outcome
- Pass the Part 1 FRCOphth examination
- Provide a surgical logbook with details of A/PS/P
- Ensure that one MSF is completed for each 12-month training period
- Maintain a cataract complications audit
- Complete Form R, SOAR declaration or equivalent for each 12-month training period (or a SOAR declaration if training in Scotland)
The theme of general ophthalmology continues at this stage with trainee ophthalmologists adopting spiral learning and demonstrating increasing independence and efficiency. They continue to use skills of reflection and self-awareness to recognise their own achievements and limitations. They begin supervision of more junior doctors where appropriate.
At the end of this stage the Refraction Certificate examination must have been passed 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.
All Level 2 competences must have been signed off by the end of OST3.
The Level 2 Guide lists which evidence is required to demonstrate meeting all Level 2 Learning Outcomes. In addition, trainees must:
- Have a satisfactory ARCP Outcome
- Pass the Refraction Certificate examination
- Provide a surgical logbook with details of A/PS/P
- Ensure that one MSF is completed for each 12-month training period
- Maintain a cataract complications audit
- Complete Form R, SOAR declaration or equivalent for each 12-month training period (or a SOAR declaration if training in Scotland)
During this stage (usually spanning the OST3 to mid-way OST6 years), training ophthalmologists rotate through posts to receive mandatory training in the specific clinical skills related to the twelve SIAs. Trainees develop transferable surgical skills as they move between these specialty posts and continue to consolidate their cataract surgical skills. Progression in cataract surgery is demonstrated by the completion of more complex procedures, a continuous cataract complications audit and formative assessments. Other surgical and procedural skills are also assessed formatively. Clinical knowledge is assessed by the final Part 2 FRCOphth examination.
- Level 3 will generally range between 2.5 to 3.5 years.
- Trainees have a maximum of 5 ½ years to be signed off in all Level 3 competences.
- Cataract Surgery, Urgent Eye Care and Community Ophthalmology SIAs will not need dedicated postings because competencies are acquired simultaneously.
The Level 3 Guide lists which evidence is required to demonstrate meeting all Level 3 Learning Outcomes. In addition, trainees must:
- Have a satisfactory ARCP Outcome
- Pass the Part 2 FRCOphth examination (both Written and Oral components)
- Provide a surgical logbook with details of A/PS/P
- Ensure that one MSF is completed for each 12-month training period
- Maintain a cataract complications audit
- Complete Form R, SOAR declaration or equivalent for each 12-month training period (or a SOAR declaration if training in Scotland)
During the final stage of the programme (which may vary in duration), training ophthalmologists develop Level 4 skills of at least two SIAs within the Patient Management domain.
Trainees planning to work in localities where it is necessary to provide a more generalist ophthalmology service could continue to develop their skills in Urgent Eye Care and/or Community Ophthalmology along with their cataract expertise.
- A minimum of two Level 4 SIAs are needed to be recommended for CCT.
- Level 4 training cannot start until Level 3 in all 12 SIAs and all six generic, non-clinical Domains is completed, except for Level 4 Cataract Surgery (see below).
- Level 4 entry criteria for Cornea and Ocular Surface Disease, Glaucoma and Vitreoretinal Surgery SIAs is to have been signed off in Level 4 Cataract Surgery in addition to the above. This may well be achieved by the time Level 3 is completed in all other SIAs. In exceptional circumstances, this condition may be waived in consultation with the Chair of the Training Committee and the Chair of the Curriculum Sub-committee.
The Level 4 Guide lists which evidence is required to demonstrate meeting Level 4 Learning Outcomes. Trainees must:
- Provide two EPA Level 4 Managing an Operating List for each surgically-based SIA (Oculoplastics, Cornea and Ocular Surface Disease, Cataract Surgery, Glaucoma, Vitreoretinal Surgery, Ocular Motility and Paediatric Ophthalmology)
- Provide a surgical logbook indicating the expected breadth of surgical experience and indicating supervision of juniors (up to Level 3) in the chosen SIA (Oculoplastics, Cornea and Ocular Surface Disease, Cataract Surgery, Glaucoma, Vitreoretinal Surgery, Ocular Motility and Paediatric Ophthalmology) and supervision of juniors (up to Level 4) in Cataract Surgery (only for Cornea and Ocular Surface Disease, Glaucoma and Vitreoretinal Surgery)
- Complete a cataract complications audit where Level 4 Cataract Surgery training is undertaken
- Complete an audit of surgical outcomes for each surgically-based SIA undertaken (Oculoplastics, Cornea, Cataract, Glaucoma, Vitreoretinal Surgery, Ocular Motility and Paediatric Ophthalmology)
In addition:
- Have a satisfactory ARCP Outcome
- Ensure that one MSF is completed for each 12-month training period
- Complete Form R, SOAR declaration or equivalent for each 12-month training period (or a SOAR declaration if training in Scotland)