Trainees are expected to achieve Level 1 at the latest by the end of OST2 by acquiring the basic science knowledge essential for the practice of ophthalmology (assessed by the Part 1 FRCOphth) examination, and the necessary clinical skills and knowledge (as specified in the EPA Level 1). Trainees will also show evidence of expected development of generic professional skills. A Level 1 trainee will work with indirect supervision in the general ophthalmology setting.
Assessments supporting the Level 1 Learning Outcomes focus on acquiring the knowledge base required to be a safe and effective ophthalmologist. An ophthalmologist working at Level 1 will be able to independently perform a patient assessment and basic investigation. They will be able to identify, describe and interpret clinical findings. They will be able to arrive at differential diagnoses, using their basic clinical science knowledge. They will be able to suggest management plans for low complexity patients. They will work effectively with the multiprofessional team. Full details of the descriptors supporting each Learning Outcome can be found in the RCOphth curriculum microsite.
- EPA Level 1 – one for every six months until final one signed off by Named Clinical Supervisor (NCS) as ‘Competent’ in Patient Management Domain Level 1. The requirements for the Level 1 EPA are summarised in Table A.
- This Guide also contains examples of completed EPAs – note that these are Word documents and will look different in the ePortfolio.
- Generic Skills Assessment Tool (GSAT) Level 1 – one for every six months until final one signed off by Educational Supervisor (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 1 GSAT are summarised in Table B.
- Educational Supervisor Report (ESR) – one for every six months and final one confirming a review of the ePortfolio indicating that Level 1 competencies have been achieved in all seven Domains
- Pass Part 1 FRCOphth examination
- Logbook
- Professional Development Plan (PDP)
- Multi-source Feedback (MSF) – one for every calendar year
- Cataract Complications Audit
- Form R, SOAR declaration or equivalent
- Satisfactory outcome in ARCP
Please also see Level 1 training requirements in the section on ARCP and the Learning Outcomes on the curriculum microsite.
| Table A Curriculum requirements as listed in Level 1 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 | Can be achieved either in Outpatients or Theatre | Other mandatory requirements |
| CRS1 Consultation skills | OSATS Microsurgical skills | Removal of sutures* | Longitudinal, periodic observation by consultant assessor in the outpatient and/or on call setting, where possible |
| CRS2 Assess vision | OSATS Cataract Surgery | Longitudinal observation by consultant assessor in the theatre and simulation setting | |
| CRS3 Assess visual fields | OSATS Lid surgery | Review of record keeping and letters | |
| CRS5 External eye examination | Operating microscope* | CbDs | |
| CRS6 Assess pupils | Multi-Assessor Report | ||
| CRS7 Assess ocular motility | |||
| CRS8 Assess intra-ocular pressure | |||
| CRS9 Slit lamp | |||
| CRS10a Fundus assessment – direct ophthalmoscope | |||
| CRS10b Fundus examination using slit lamp condensing lenses e.g. 90D/78D or equivalent | |||
| CRS10c Fundus assessment – diagnostic contact lens | |||
| CRSGon Gonioscopy | |||
| Corneal scrape* | |||
| Use an exophthalmometer* | |||
| Assess lacrimal function* | |||
| Punctal plug insertion* | |||
| Interpretation of automated visual fields* | |||
| Table B Examples of evidence that can be used in the GSAT Level 1 | |
|---|---|
| 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 | |
| Provide appropriate lifestyle advice. | Promote immunisation |
| Avoidance of allergens | |
| Diet and Nutrition | |
| Advice on sources of information | |
| Smoking cessation | |
| AREDS supplementation in advanced AMD | |
| Adopt local and national guidelines of prevention of infection. | Use/create eye local eye casualty guideline |
| Audits | |
| Infection control protocols | |
| Endophthalmitis prevention | |
| Contact lens guidance | |
| Hand hygiene | |
| PPE guidance for appropriate respiratory diseases | |
| Advise appropriately about the systemic side-effects of drugs. | Systemic side-effects of antimuscarinics, beta blocker eye drops, doxycycline administration |
| Make recommendations for bone protection | |
| Know the principles of screening. | Principles of screening (e-LFH) |
| Examples include hydroxychloroquine; diabetic retinopathy; retinopathy of prematurity; fungaemia in immunocompromised patients. | |
| Part 1 FRCOphth | |
| Use and promote means of eye injury protection. | Blunt and penetrating eye injury and foreign bodies – reiterate the importance of protective glasses to prevent eye injury working with high velocity machinery or patients with corneal susceptibility (Ehlers Danlos, High myopia) |
| Avoidance of fireworks in blast injury cases | |
| High velocity machinery to wear protective goggles | |
| DOPS – removal foreign body | |
| OSATS – lid repairs | |
| Eye protection advice/driving advice for patients on cycloplegia | |
| Domain: Leadership and Team Working | |
| Know about leadership competencies in the nine behavioural dimensions as defined by the NHS Leadership Academy: inspiring shared purpose; leading with care; evaluating information; connecting our service; sharing the vision; engaging the team; holding to account; developing capability; influencing the results. | Go through the https://www.leadershipacademy.nhs.uk/ resources/healthcare-leadership-model/nine-leadership-dimensions/ |
| Certificate of learning | |
| 01_01 Introduction to Leadership and LeAD | |
| https://portal.e-lfh.org.uk/Component/Details/510250 | |
| Attend leadership courses | |
| Rota co-ordinator | |
| Know the principles of leadership and identify areas for own development. | Completion of self-learning |
| https://portal.e-lfh.org.uk/Component/Details/511042 | |
| Domain: Patient Safety and Quality Improvement | |
| Know the principles, recognise the contribution to improved practice, and take part in clinical governance, audit and quality improvement activities. | Clinical governance |
| Quality Improvement | |
| Portfolio | |
| Part 2 FRCOphth | |
| Undertake a QIP project; supervise another team member in a project; demonstrate management of a complaint with report and be involved in the investigation; investigate an incident. | |
| Identify appropriate information from a variety of data sources. | Evidence-based approach |
| Quality Improvement | |
| Sources of Information | |
| Epidemiology/evidence-based medicine | |
| Portfolio | |
| Part 2 FRCOphth | |
| MSF | |
| Research/publication | |
| Domain: Safeguarding and Holistic Care | |
| Understand and promote professional responsibility of safeguarding. | Involvement in safeguarding case |
| Non-accidental Injury – screening | |
| Portfolio | |
| Part 2 FRCOphth | |
| Adult Safeguarding Level 1 | |
| https://portal.e-lfh.org.uk/Component/Details/510406 | |
| Evidence of generic skill courses and essential courses like fire safety, information governance, infection control, etc. | |
| https://www.e-lfh.org.uk/ - contains several links that could be used to support this learning, there are too many to list so the trainee can look and see if any are appropriate to undertake if they have seen a case they may relate to recently. | |
| e.g. safeguarding adults, supporting children and young persons with learning difficulties, dementia etc | |
| Demonstrate familiarity with local safeguarding procedures and contacts. | Use RCOphth NAI proforma |
| Laser safety course | |
| Adult Safeguarding Level 1 | |
| https://portal.e-lfh.org.uk/Component/Details/510406 | |
| Evidence of generic skill courses and essential courses like fire safety, information governance, infection control, etc. | |
| Portfolio | |
| Part 2 FRCOphth | |
| Demonstrate awareness of possibility of non-accidental injury in vulnerable patients. | Adult Safeguarding Level 1 |
| https://portal.e-lfh.org.uk/Component/Details/510406 | |
| Child Safeguarding Level 1 | |
| https://portal.e-lfh.org.uk/Component/Details/510412 | |
| CPD from teaching/meetings | |
| Document safeguarding concerns accurately and refers to senior staff. | Safeguarding |
| M+M meeting | |
| Refer to appropriate safeguarding personnel, ECLO, seniors | |
| Adult Safeguarding Level 1 | |
| https://portal.e-lfh.org.uk/Component/Details/510406 | |
| Child Safeguarding Level 1 | |
| https://portal.e-lfh.org.uk/Component/Details/510412 | |
| MSF | |
| 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 | |
| Reflective piece on breaking bad news on condition and effect on driving | |
| Domain: Education and Training | |
| Ensure patient safety is paramount in all training and learning events. | Use EyeSi simulation and wetlab |
| Courses – simulation training | |
| Record of discussion with supervisor of an adverse outcome | |
| Reflective piece on how patient safety was included in a training or learning event and why important | |
| M&M meeting | |
| Reflective entry from complications log where supervisor was sought to help fix a complication | |
| Actively participate in own induction and training. | Use EyeSi simulation and wetlab |
| Evidence of participation in local departmental induction and training | |
| Evidence of attendance in hospital and departmental post-graduate teaching | |
| MSF | |
| Deliver teaching activities under guidance. | MDT teaching/medical student training |
| Contribution to local teaching session that is supervised | |
| Medical Student teaching | |
| Evidence of oral/poster presentation in regional teaching, national, international meeting | |
| Present at regional trainees research symposium | |
| Deliver patient education. | Evidence of participation in patient education event, support groups meeting, developing patient information leaflets, videos |
| MSF | |
| Domain: Research and Scholarship | |
| Adopt an evidence-based approach to clinical practice. | Personal/departmental audits |
| Evidence of involvement in journal club, local teaching, presentation/research publications | |
| Research Agreement | |
| Critically appraise existing published research. | Evidence of involvement in journal club, local teaching, presentation/research publications |
| Research Agreement | |
| Understand research and deliver oral presentations. | Local PG teaching/journal club |
| Regional teaching | |
| Research publication/oral or poster presentation in local, regional, national and international meetings | |
| Research Agreement | |
You can download a sample completed EPA as follows:
Sample completed EPA Level 1 competent
Sample completed EPA Level 1 indirect
Sample completed EPA Level 1 direct
Remember these are Word documents which will look different in the ePortfolio.