Programme Delivery

The programme should be planned with reference to the GMC document Generic Standards for Training and the RCOphth document Guide for Delivery of OST.

Recommendations are considered under 4 headings:

MODEL OF LEARNING

RECOMMENDED LEARNING EXPERIENCES

FEEDBACK

SUPERVISION

 

Model of Learning

Trainees will pursue the learning outcomes described in the curriculum through a variety of learning methods that will be described in the prospectus for each training programme. It is the responsibility of the Specialty Training Committee (STC) at HEE, NES, the Wales Deanery or NIMDTA (referred to with the generic term ‘Deanery’) to produce the prospectus. Individual STCs may differ in the proportions of time allocated to different learning methods. The curriculum recommends as an approximate guide only, over the seven year training programme:

1. Appropriate off-the-job education

7 x 10 days of study leave = Total 70 days

This can be used in a variety of ways that include:

• Attendance at College courses: e.g. basic and advanced microsurgical skills, training the trainers, annual congress
• Attendance at regional and national sub-specialty meetings: e.g. Regional Ophthalmological Societies, BEAVRS, UKISCRS, RSM
• Examination preparation courses
• Private study

2. Local postgraduate meetings

7 x 40, ½ days = Total 140 days

The content of these sessions will be determined by the deanery STC, Training Programme Director and College Tutors and will be based around the curriculum. Suggested activities include:

• Case presentations
• Research and audit projects
• Lectures and small group teaching
• Clinical skills demonstrations and teaching
• Critical appraisal and evidence based medicine and journal clubs
• Joint specialty meetings e.g. neurology, radiology, pathology, rheumatology

3. Independent self-directed learning

Based on a 43 week year: ½ day x 43 weeks = 21½ days per annum in Years 1&2

1 day x 43 weeks = 43 days per annum in Years 3-7

Total 258 days

Trainees will use this time in a variety of ways depending upon their stage of learning. Suggested activities include:

Preparation for assessment and examinations

• Appraisal, feedback and reflection
• Reading
• Maintenance of personal portfolio
• Audit and research projects
• Achieving personal learning goals beyond the essential, core curriculum

4. The remaining time for work-based experiential learning

Based on a 43 week year: 4 days x 43 weeks = 172 days per annum in Years 1&2

3½ days x 43 weeks = 150½ days per annum in Years 3-7

Total 1096 days

The content of this work-based experiential learning will be decided by the Deanery STC but will include active participation in:

• General ophthalmology clinics
• Specialty ophthalmology clinics e.g. paediatric, diabetic eye disease
• Laser clinics
• Eye emergency/casualty/acute referral clinics
• In-patient and day case clinical care
• Ophthalmic surgery

Some of the learning outcomes will be best achieved in some programmes by active participation in or attendance at (this list is illustrative):

• Optometric practice (hospital or community based)
• Contact lens practice
• Pre-operative assessment clinics
• Low vision aid/visual rehabilitation clinics
• Orthoptic practice
• Clinical reporting sessions e.g. retinal angiography, neuro-radiology, pathology
• Ocular investigation sessions e.g. biometry, ultrasound, visual fields, electrodiagnostics
• Clinics in related specialties e.g. neurology, rheumatology

The details of learning activities will be defined by each Deanery STC for the relevant training programme. It will be appropriate for some parts of the curriculum to be delivered in modular format as this is an established system in many Deaneries e.g. 6 months oculoplastic experience, 6 months paediatric ophthalmology, etc.

There will be appropriate levels of clinical supervision throughout OST with increasing clinical independence as learning outcomes are achieved.

Learning Method	Approximate time (days in 7 years)	Comment
Off-the-job learning	70	Equates to 10 days study leave per year
Postgraduate meetings	140
Independent self- learning	258	43 week year, equates to ½ day/week in Years 1&2 and 1 day per week in Years 3-7
Work-based experiential learning	1096	43 week year, equates to 4 days/week in Years 1&2 and 3½ days per week in Years 3-7
Annual and other leave	256
TOTAL	1820	7 years x 52 weeks x 5 days

Recommended Learning Experiences

Learning from practice

Trainees will spend a large proportion of the 1096 days of work-based experiential learning involved in supervised clinical practice in a hospital environment. Learning will involve observation followed by closely supervised clinical practice until competence is achieved. In keeping with clinical ophthalmic practice this will take place in out-patient departments, wards and operating theatres. Opportunities for informal and formal feedback on performance will occur during and at the end of clinical sessions.

Distributed and concentrated practice

Training Programme Directors and Deanery STCs will decide upon the details of clinical attachments. It is anticipated that training in the early years (years 1-3) will be distributed across sub-specialties with emphasis on concentrated experience later in training. The later years of training should allow concentrated practice during Trainee Selected Components (TSC); this may require experience outside the deanery programme.

Learning with peers

There will be several opportunities for trainees to learn with their peers. Local postgraduate teaching opportunities will allow trainees of varied levels of experience to come together for small group learning. Examination preparation will encourage the formation of self-help groups and learning sets.

Learning in formal situations

There are many opportunities throughout the year for formal teaching in the local postgraduate teaching sessions and at regional, national and international meetings. Many of these are organised by The Royal College of Ophthalmologists.

Personal study

Time will be provided during training for personal study. It may be possible for longer periods of private study to be offered as part of study leave.

Specific teacher inputs

Individual units within a teaching programme will identify, in the prospectus, where specific teacher inputs will be provided. These will vary from programme to programme. Examples are:

• Sub-specialty teaching in a clinical environment from a recognised specialist
• Basic life support teaching from a recognised CPR trainer in a hospital
• Basic and advanced microsurgical skills teaching in the College (or other) “wet-lab” from a faculty member
• Refraction skills taught by an optometrist
• Ocular motility skills taught by an orthoptist

Educational strategies

Many of these are described in previous sections. Specific strategies for work-based experiential learning include:

• Out-patient work-based experiential learning

After initial induction, trainees will spend a period of time observing expert clinical practice in clinics. Specific clinical examination skills will be taught and then trainees will assess patients themselves under direct observation. As experience and clinical competence increase trainees will assess new and review patients and present their findings to their clinical supervisor. Supervision will then be extended to case-based discussion and exceptional observation of clinical assessments. Assessment of progress will involve direct observation, case presentations, and possibly simulations and video assessment. Experiential learning will include the assessment and management of emergency patients and the use of ophthalmic lasers.

• Ward-based experiential learning

Trainees will have the opportunity to be responsible for the care of appropriate in-patients. This will include preparation for anaesthesia and surgery, perioperative care, the initial management of the acutely ill patient and referral to and liaison with clinical colleagues as necessary. Assessment of progress will involve case-based discussion and multi-source feedback.

• Surgical work-based experiential learning

All trainees will begin by acquiring basic microsurgical skills in a wet-lab. Further highly supervised surgical experience will be obtained through the use of simulators (where available) and staged surgery involving selected patients. As competence in specific surgical skills is gained, the level of supervision will decrease and the technical difficulty of the procedures will increase until independent practice is achieved. Assessment of progress will involve direct observation, distant observation (using video camera), simulations, video assessment and personal surgical audit.

N.B.: Training Programme Directors, in association with College Tutors and Educational Supervisors, must ensure that each training unit has an adequate critical mass of surgical cases going through it, so that trainees have sufficient experience to reach the required level of competence at each stage of their training. The case-mix must be such that trainees will have the opportunity to undertake straightforward cases early in their training, but also to undertake complex cases later. They must have the opportunity to deal with operative complications so that by the end of training they can manage complications safely and effectively.

• Off-the-job education

Initial opportunities for learning outside the work place will be prescribed to meet specific learning goals e.g. College basic microsurgical skills courses. In the final years of OST, trainees will be encouraged to use these opportunities to pursue their own learning goals as part of a TSC.

Acting up as a consultant (AUC)

“Acting up” provides doctors in training coming towards the end of their training with the experience of navigating the transition from junior doctor to consultant while maintaining an element of supervision.

Although acting up often fulfils a genuine service requirement, it is not the same as being a locum consultant. Doctors in training acting up will be carrying out a consultant’s tasks but with the understanding that they will have a named supervisor at the hosting hospital and that the designated supervisor will always be available for support, including out of hours or during on-call work. Doctors in training will need to follow the rules laid down by the Deanery within which they work and also follow The Royal College of Ophthalmologists guidelines which can be found on the College website.

 

Feedback

Regular and timely feedback on performance is essential for successful work-based experiential learning. To train as a consultant ophthalmologist, a doctor must develop the ability to seek and respond to feedback on clinical practice from a range of individuals to meet the requirements of Good Medical Practice and re-validation.

Specific details of who should give feedback and the timing in relation to training placements will be the responsibility of Deanery STC and the Training Programme Director. Feedback should include the following important elements:

• An initial appraisal meeting shortly after the start of a training placement to establish learning goals
• An interim appraisal meeting to discuss progress against the learning goals
• An appraisal meeting towards the end of the training placement to agree which learning goals have been achieved
• Structured written feedback from clinical supervisors
• Appropriately structured written feedback from other departmental staff (multi-source feedback) to include nursing staff, orthoptists, managerial, clerical and secretarial staff and medical staff in relevant directorates e.g. radiology, pathology, anaesthesia.
• Feedback from patients obtained from patient surveys etc.
• Feedback from College examinations, if a trainee has been unsuccessful
• The results of such feedback will be discussed with the trainee’s educational supervisor during appraisals. Evidence that feedback has been sought and responded to will form part of the annual ARCP

 

Supervision

All units recognised and accredited to provide OST will need to ensure appropriate standards of clinical governance and meet the relevant Health and Safety standards for clinical areas. This will normally be assured where training is taking place in NHS institutions such as hospital trusts but special accreditation standards may be required if training is provided in alternative organisations such as Independent Sector Treatment Centres or Optometric practices.

Training placements will also need to meet the European Working Time Directive for trainee doctors.

Trainees will work with a level of clinical supervision commensurate with their clinical experience and level of competence. This will be the responsibility of the relevant clinical supervisor after discussion with the trainee’s educational supervisor and the designated clinical governance lead. In keeping with the principles of Good Medical Practice trainees will know that they must limit their clinical practice to within their level of clinical competence and seek help and support without hesitation.