OST Curriculum 2024 aims to prioritise resident-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 this and earlier curricula are:
- Focus – Resident doctors can choose what evidence to present to display competence. It is no longer required to evidence individual learning outcomes (previously,180) and all numbers of procedures or Workplace-based Assessments (WpBAs) have been removed at the request of the GMC. Any such numbers given in this document are indicative only. It is for the trainer and the resident to determine if competence has been achieved with the evidence provided. Residents are expected to carry out a much greater degree of self-assessment, which is embedded within the summative assessment tools.
- Flexibility – The curriculum has been designed to be more flexible as it is competency-based, as opposed to time-based. However, the constrains of a structured national training programme puts some limitations. An Implementation Note issued in 2025 clarifies key flexibility principles.
- Structure – The curriculum is structured according to Levels and Domains of practice, with detailed descriptors underpinning high-level, overarching Learning Outcomes.
| 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 – The curriculum is divided into seven Domains of clinical practice, which are framed around the Generic Professional Capabilities (GPCs). These Domains are areas against which residents must demonstrate capability through achievement of all Learning Outcomes before being awarded the CCT.
- Levels – Residents 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 (SIAs) – The curriculum has twelve SIAs in the Patient Management domain. Residents 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 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 residents and trainers in what must be evidenced to demonstrate achievement of the Learning Outcomes. The curriculum has a dedicated microsite (embedded within the main RCOphth website) to learn about which Learning Outcomes are required per Level and to view accompanying descriptors. 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 Educational Supervisors and panels taking part in the Annual Review of Competency Progression (ARCP) process.
- Assessment tools – 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 rely on the completion of at least one Multi-Assessor Report (MAR), the number of which is decided by the NCS at the outset. WpBA forms focus on formative narrative, as opposed to a granular assessment of competencies. Supervised Learning Events (SLEs) are designed to help residents to develop and improve their clinical and professional practice, and to set targets for future achievements. Repeated SLEs allow them 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 | ||
Resident doctors 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, resident assessors should be at least two Levels above the resident 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 resident. However, the NCS can advise as to who is appropriate to supervise and feedback on WpBAs, and residents 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 some Clinical Rating Scale (CRS) forms. Professional hospital/Trust emails, as opposed to personal addresses, must be used to request completion of WpBAs through the ePortfolio.
Named Clinical Supervisors (NCSs) are trainers responsible for overseeing clinical work and providing constructive feedback to their residents during a training placement. NSCs should complete EPAs after consultation with other supervisors (Assessors). There should only be one NCS responsible for each EPA and one NCS for every EPA 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 resident is given the opportunity to meet the clinical requirements as set out in the relevant syllabus, as appropriate for the Level of training.
- Meet the resident in the first two weeks of their rotation to:
- Agree the number of MARs to be completed in that post.
- Agree if any additional WpBAs, over and above what specified in the EPA, are required to be completed in that post.
- Meet the resident at the end of the post to complete the relevant EPA by checking the mandatory and additional WpBAs and reviewing any completed MARs.
- Liaise as appropriate with the ES.
Educational Supervisors are trainers responsible for the overall supervision and management of the educational progress during a clinical training placement, or a 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 resident’s revalidation.
- Meet their resident in the first two weeks of their post to:
- Ensure the resident understands the curriculum requirements and develops a personal developmental plan that considers individual needs and learning opportunities.
- Ensure that the resident is aware of and has contacted their NCS.
- Meet the resident 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, using information from EPA(s), MAR(s) and the MSF to provide honest and constructive feedback.
- Sign off GSATs, although the latter is primarily resident-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. The ES must indicate if any Level of training has been completed during the period covered by the ESR.
- Have career discussions with the resident and ensure they have access to specific advice and support.
- Identify residents in difficulty and provide support as necessary, in line with local and regional policies.
- Encourage residents to undertake the annual GMC National Trainee Survey.
NCSs and ESs consider the evidence to make a professional judgement as to whether the resident 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 resident per role (for both NCS and ES).
It is recommended to consult the end-of-rotation checklist for ePortfolio tips.