FAQs

All trainees are expected to audit their surgical results, especially with reference to cataract surgery and any other Level 4 surgical SIA. A continuous cataract complications audit will be mandatory for every ARCP. The 50 consecutive cataract audit will need to be done within 3 calendar years of being awarded Cataract Surgery Level 4.

All trainees will be expected to continue to maintain their surgical logbook similar to the current process. The only difference is that there will be no mandatory requirements for surgical procedures.

We expect that many trainees will achieve descriptors and, in some cases, entire Learning Outcomes in Level 1 ahead of the indicative time. Some training units may choose to use the first Learning Outcomes of Level 1 Patient Management to assess whether trainees are ready to be first on-call early in their training.

However, it may take a little longer to be signed off as competent at all of the Learning Outcomes necessary to manage a low complexity ophthalmology patient, including demonstrating underlying knowledge of basic and clinical science (evidenced by the FRCOphth Part 1 examination) and initiating management plan. The end of ST2 is simply the latest point at which entrustment in all of the Level 1 Learning Outcomes must be demonstrated to allow continuation on the training pathway. Where any capability is demonstrated earlier, trainees should start working towards achieving entrustment at the Learning Outcomes in the next level.

No, surgical training will continue to be delivered from ST1 onwards, augmented with training in simulated environments.

The curriculum defines the Level of training by which the ophthalmologist must be able to perform the described Learning Outcome independently. Therefore, while it is true the Level 3 Learning Outcomes (including surgical capabilities) do not need to be evidenced as competent at an ‘independent’ level until the end of Level 3 (maximum time allowed is 5 ½ years of full-time equivalent training), the EPA summative assessment tools will ensure that surgical capability is being assessed throughout. They will assess the level of entrustment as ‘observing’, ‘under direct supervision’ or ‘indirect supervision’ at the earlier stages of training, and this will be reviewed in the Educational Supervisor Report (ESR) and by the ARCP panel.

When trainees are working in a SIA and have achieved the Level 3 surgical capabilities, training can immediately proceed to develop the skill for the Level 4 capabilities, which will initially be at the ‘direct supervision’ level.

The Level 1 and Level 2 capabilities are achievable in a general ophthalmology environment: general clinics, urgent eye care and on-call ophthalmology will all be excellent environments to achieve these. TPDs will need to ensure that posts can deliver the curriculum, and this is likely to need a change in programme organisation.

Competence in Level 3 capabilities will require exposure to SIA clinics and theatre lists. There is some overlap between the syllabi in some of the SIAs. Again, TPDs will be reviewing their programmes to ensure the curriculum is delivered. For example, two SIAs may be covered in the same 6-month post.

There is a section dedicated to Level 4 on the Frequently Asked Questions webpage on the RCOphth OST homepage.

The new assessment tools are:

• Entrustable Professional Activity (EPA) – key method of assessing the Patient Management domain and will replace the current Clinical Supervisor Report (CSR). Completing the EPA will be the responsibility of the Named Clinical Supervisor (NCS) and a minimum of one EPA will be required every six months.
• Multi-Assessor Reports (MAR) – will feed into the EPA and will be used for clinical assessments from other clinicians (including Supervising Consultants) and other professionals. There is no minimum or maximum number for this as it will vary depending on the rotation, level and domain area.
• Generic Skills Assessment Tool (GSAT) – key method of assessing all the other (non-Patient Management) curriculum domains. At least one GSAT will be required every six months. This may be completed by the Educational Supervisor or Clinical Supervisor or Supervising Consultant but will be the ultimate responsibility of the ES.

All other assessments will remain the same, although the grading scale will be different in places. Please look at the Assessment tab for a full description of how assessments work and a handy summary.

The EPA will be the responsibility of a single Named Clinical Supervisor (NCS). However, there may be other consultants, clinical staff or other health professionals (e.g. orthoptist) who will also be supervising a trainee or witnessing competencies during a rotation. The MAR is meant for them to be able to give feedback to the NCS to help in completing the EPA.

Please remember that simulation training can be high-fidelity or low-fidelity, each providing differing validity.  Simulation training does not necessarily need to be on an EyeSi and could also include suture boards, plastic eyes or even practice at home with grapes / tomatoes and a pair of rhexis forceps!  As emphasis increases on this valuable learning tool, it will be necessary for departments to invest in simulation materials.

Bookable simulation resources are available at college and commercial venues. The document Simulation in the Curriculum gives advice and resources to aid development of simulation.

You may be required to use these skills when a specialist oculoplastic surgeon is not available.  This may be required as an emergency in a trauma case where you are the on call surgeon and have to proceed yourself.

Whilst record numbers are required in the logbook, they should not be used in the portfolio.

It is important that you understand the technical procedure to obtain biometry measurements as this aids with interpreting the results, and can be essential when nurses are unable to perform biometry for any number of reasons.  We suggest that, where doctors are not routinely involved in biometry, this could be a practical session at a regional Postgraduate teaching session at which all trainees would be able to complete this outcome.  This outcome can be assessed by a technician or nurse who regularly performs biometry as long as they are trained in assessments

The RCOphth defines the curriculum which is the requirement for all trainees to obtain CCT.  How the curriculum is delivered is largely determined by the “Deanery” (HEE) leads.  Therefore if a Deanery requires a specific outcome (e.g. EyeSi training, evidence of leadership), then as long as it is made clear that this a requirement for ARCP and the resources are made available to trainees to allow completion, then trainees will be required to complete this for a successful outcome at ARCP.

It is increasingly common to be asked about refractive surgery by patients, and it is therefore important to have a basic understanding of the techniques, risk and benefits.  The curriculum was re-worded in 2016 to clarify this requirement.  Additionally patients who have had refractive surgery in the private sector may present to the NHS with complications and require urgent or long term management.

A CbD does not require any supervision of the consultation by the assessor, and can be done retrospectively from the medical notes.  This particularly facilitates cases seen on-call being discussed and assessed.