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RCOphth Supports Ophthalmologists in Training in the UK

18 July 2016

The College fully recognises that the recent dispute over the junior doctors contract has not been solely about terms and conditions, but is a reflection on a number of long standing concerns about the direction of medical training in the UK.

It highlights that many of our trainees feel unsupported and undervalued in their roles as doctors in training. The advances in delivery of care to patients, the move to a more consultant led service and service pressures due to the lack of capacity to meet the demand, mean that many ophthalmologists in training have less opportunity to deliver continuity of care.

There are fewer opportunities to share in the whole patient journey and to understand what and how the impact of outcomes has had on patients. They also spend less time “apprenticed” to individual trainers so may feel somewhat cut adrift from a cohesive team with less recognition for their contributions.

It is imperative that we do all that we can to reverse this trend.  In order to do so, the College is working to promote supportive learning environments for all ophthalmologists in training through curriculum development and training recommendations.

  • Reconnecting ophthalmologists in training with the patient journey is vital
    – The curriculum will embed the necessity for those in ST1 and 2 to be able to see patients before surgery, and post-operatively, as well as learning the skills of how to perform surgery. This enhances the essential understanding about patient selection, technical details of the procedure itself, the physical status of the eye in the early post-operative period and the outcome for patients (including the more subtle benefits and difficulties)
    – The importance of developing an understanding of long term care of chronic eye disease eg glaucoma and what this means for the patient, the clinical team and society
  • Less emphasis on ‘box ticking’ assessments to demonstrate competencies is important. While essential to demonstrate individual skills, this has reduced the significance of overall performance. Instead, a clearer understanding of the broader role of the doctor, encompassing the Generic Professional Capabilities will be given more emphasis. This will help to deal effectively with the complexity, uncertainty and the challenges of contemporary medical practice in order to become a competent and confident consultant colleague
  • A flexible approach to research, leadership and education within the working week should be encouraged to broaden these general skills. Out of programme (OOP) activities should be encouraged and accommodated where appropriate to broaden experience and professionalism
  • Where possible, rotas and timetables should be formulated so that ophthalmologists in training are more connected to a lead clinical supervisor with whom they can develop a close working/ training relationship. This will enable them to feel a valued and respected member of the team, receive more effective feedback and develop professional skills faster. This will be challenging to achieve where spaces on rotations can affect service delivery, but training opportunities need to be prioritised and optimised. Training under multiple clinical supervisors may not have any real benefits for trainer, ophthalmologist in training or patients under their care
  • Knowledge of future placements and rotations well in advance permits better professional and personal planning and should be encouraged in all regions
  • An area where many ophthalmologists in training do not feel adequately supported is in the delivery of acute/emergency services and this needs to be stressed to maximise this area of training potential

It is recognised that a doctors own health, wellbeing and engagement is intimately linked with their ability to provide safe, effective patient care, and the College aims to do all it can to improve the non-contractual aspects of ophthalmologists working and training to this end.

“Looking after yourself so that you can take good care of others” is acknowledged as being relevant to all doctors throughout their medical careers. Developing resilience is a key tool for maintaining wellbeing and dealing with the daily challenges. Resilience training has been delivered through the College to Heads of Schools in order to equip trainers with the skills to cascade programs locally for the benefit of the entire team.

The College provides resources for supporting for ophthalmologists in training which can be found here www.rcophth.ac.uk/training/resources-and-support-for-trainees/

Professor Carrie MacEwen                                                     Miss Fiona Spencer
President                                                                               Chair, Training Committee