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EDITOR The recent letter by Professor Fielder (1) is welcomed for
drawing attention to the woefully inadequate surgical training currently
experienced by the majority of SHOs in Ophthalmology.
The curricular requirements of the Royal College of Ophthalmologists
(2) specifies that SHOs should attend two theatre sessions per week and
that ‘By the end of the second year under normal circumstances, a minimum
number of 50 supervised intraocular procedures should have been performed.
Thereafter, at least 50 intraocular cases should be undertaken per year.’
A survey carried out by the Ophthalmic Trainees Group (3) last year
demonstrated that of SHOs; 30% were only attending one theatre session per
week; 30% had not performed any surgery in the preceding month; 46% had
not performed phacoemulsification at all; and only 30% of trainees with
more than 2 years experience had performed 40 or more phacoemulsification
procedures.
Cataract surgery has changed dramatically in the past 10 years having
moved from general anaesthesia and in-patient stay to day case and local
anaesthetic. During this time patients have become aware of the
possibility of trainees participating actively in procedures. These
changes combined with an with an increasing service requirement have led
to an increased pressure upon surgical trainers and effectively a
reduction in surgery being performed by SHOs. At the same time training
authorities have moved toward competency based curricular; approved wet
lab training will in the near future become mandatory for SHOs before they
are allowed to perform surgery, all of which takes more time and more
supervision.
From the patients perspective, Action on Cataracts (4) is most
welcome, but for how long? The documents introduction states ‘It is not
about the clinical aspects of cataract surgery’ this is clearly nonsense.
Modern cataract surgery requires not only an appropriate efficient care
pathway, which this document espouses, but also well-trained surgeons to
perform it. Action on Cataracts fails to mention training at all, yet in
the development of high volume service lists the plan is bound to impinge
upon it, increase the problems of training and is a missed opportunity to
properly accommodate both service and training requirements.
Exemplary training requirements with competency based curricular and
compulsory wet lab training remain meaningless if they cannot be followed
through with adequate surgical experience. In order that these new
surgical targets are sustainable in the long term, the adverse impact on
surgical training that ‘Action on Cataracts’ will have needs to be
addressed as a matter of some urgency.
May we suggest a few further ideas to reduce this widening imbalance
between the service commitment and the training need
Protected training lists, as mentioned by Professor Fielder, without
the pressure to operate on maximum numbers are essential.
Increased funding to provide ‘wet lab’ facilities throughout the
country to allow junior trainees to develop their surgical skills in a
safe, non-pressure environment.
Increased monitoring of SHO training to ensure that the situation
improves and is maintained.
Acceptance by the NHS Executive that training is an important issue
that will ultimately impact on the service provision of the future. If
this was acknowledged, then at least a debate could begin and we might
start towards a solution to this very real problem.
3. Training news 2000;issue 5:1-2 (Supplement to College News.
Quarterly Bulletin of the Royal College of Ophthalmologists 2000; spring.)
( http://www.rcophth.ac.uk/news/training00.html)
Action on Cataracts should influence surgical training
EDITOR The recent letter by Professor Fielder (1) is welcomed for
drawing attention to the woefully inadequate surgical training currently
experienced by the majority of SHOs in Ophthalmology.
The curricular requirements of the Royal College of Ophthalmologists
(2) specifies that SHOs should attend two theatre sessions per week and
that ‘By the end of the second year under normal circumstances, a minimum
number of 50 supervised intraocular procedures should have been performed.
Thereafter, at least 50 intraocular cases should be undertaken per year.’
A survey carried out by the Ophthalmic Trainees Group (3) last year
demonstrated that of SHOs; 30% were only attending one theatre session per
week; 30% had not performed any surgery in the preceding month; 46% had
not performed phacoemulsification at all; and only 30% of trainees with
more than 2 years experience had performed 40 or more phacoemulsification
procedures.
Cataract surgery has changed dramatically in the past 10 years having
moved from general anaesthesia and in-patient stay to day case and local
anaesthetic. During this time patients have become aware of the
possibility of trainees participating actively in procedures. These
changes combined with an with an increasing service requirement have led
to an increased pressure upon surgical trainers and effectively a
reduction in surgery being performed by SHOs. At the same time training
authorities have moved toward competency based curricular; approved wet
lab training will in the near future become mandatory for SHOs before they
are allowed to perform surgery, all of which takes more time and more
supervision.
From the patients perspective, Action on Cataracts (4) is most
welcome, but for how long? The documents introduction states ‘It is not
about the clinical aspects of cataract surgery’ this is clearly nonsense.
Modern cataract surgery requires not only an appropriate efficient care
pathway, which this document espouses, but also well-trained surgeons to
perform it. Action on Cataracts fails to mention training at all, yet in
the development of high volume service lists the plan is bound to impinge
upon it, increase the problems of training and is a missed opportunity to
properly accommodate both service and training requirements.
Exemplary training requirements with competency based curricular and
compulsory wet lab training remain meaningless if they cannot be followed
through with adequate surgical experience. In order that these new
surgical targets are sustainable in the long term, the adverse impact on
surgical training that ‘Action on Cataracts’ will have needs to be
addressed as a matter of some urgency.
May we suggest a few further ideas to reduce this widening imbalance
between the service commitment and the training need
Protected training lists, as mentioned by Professor Fielder, without
the pressure to operate on maximum numbers are essential.
Increased funding to provide ‘wet lab’ facilities throughout the
country to allow junior trainees to develop their surgical skills in a
safe, non-pressure environment.
Increased monitoring of SHO training to ensure that the situation
improves and is maintained.
Acceptance by the NHS Executive that training is an important issue
that will ultimately impact on the service provision of the future. If
this was acknowledged, then at least a debate could begin and we might
start towards a solution to this very real problem.
William Newman, Chairman, Ophthalmic Trainees Group
bill_newman@eyeweb.org.uk
James Deane, Deputy Chairman, Ophthalmic Trainees Group
Regional representatives
Fiona Bishop, Northern & Yorkshire
Jeremy Bowyer,North West & Northern Ireland
Tom Butler, Trent
Fiona Irvine, Scotland
Martin Leyland, North Thames
Sarah-Lucie Watson, South Thames
David Maharaj, West Midlands
Catherine Marsh, South & West
Si Rauz, West Midlands
Robin Seemongal-Dass, Overseas
David Teenan, Wales
Ophthalmic Trainees Group, The Royal College of Ophthalmologists, 17
Cornwall Terrace, London, WC1 4QW
References:
1. Fielder AR, Watson MP, Seward HC, Murray PI. Action on Caratacts should
influence surgical training. BMJ 2000;321:639
2. Guide for Basic Specialist Training in Ophthalmology. The Royal
College of Ophthalmologists 2000
(
http://www.rcophth.ac.uk/education/shoguide.html)
3. Training news 2000;issue 5:1-2 (Supplement to College News.
Quarterly Bulletin of the Royal College of Ophthalmologists 2000; spring.)
( http://www.rcophth.ac.uk/news/training00.html)
4. NHS Executive. Action on Cataracts:good practice guidance.
Leeds:NHS Executive 2000
(
http://www.doh.gov.uk/pub/docs/doh/cataract2.pdf)
Competing interests: No competing interests