Survey: British ophthalmology trainees mostly confident

June 17, 2019

By the time they finish their training, the majority of British ophthalmologists feel confident in most aspects of their profession, and most do not think the training should be shortened in the future, a new survey shows.

By the time they finish their training, the majority of British ophthalmologists feel confident in most aspects of their profession, and most do not think the training should be shortened in the future, a new survey shows.

At least 70% thought of those responding thought they could manage all aspects of medical ophthalmology listed in the survey. Penetrating keratoplasty was the only surgical procedure that fewer than 50% felt confident in handling.

A minority of trainees thought they got more training than they needed.

Results of the survey, by the Royal College of Ophthalmologists in conjunction with UK ophthalmic trainees and trainers, appear in the journal Eye.

Adopted in 2005, the UK policy Modernising Medical Careers shortened training for ophthalmologists to 7 years, yet they still spend more time studying their profession and learn more procedures than any other ophthalmology trainees in the world, according to William H. Dean of the London School of Hygiene and Tropical Medicine and colleagues, who authored the report.

At the same time, UK medical trainees are currently limited by the European Working Time Directive (EWTD) to a mean of 48 hours worked per week, averaged over 6 months. This may limit the total surgical training time available, and the UK’s planned departure from the European Union opens up the possibility of changing this limit.

The UK Departments of Health have recently adopted the Shape of Training plan to shorten training and make it more flexible while increasing the number of generalists.

The first class to study under the Modernising Medical Careers regimen recently graduated. So Dean and colleagues wanted to know how confident UK ophthalmology trainees felt about the training they have been getting under the Modernising Medical Careers directives.

They sent a web-based questionnaire to all ophthalmology trainees in the UK. Their response rate of 188 out of 780 (24.1%) exceeded the minimum they calculated that they needed to achieve a 95% confidence level. The respondents were evenly divided among the 7 years of training.

Asked if ophthalmologist training should be shorter than 7 years, 34.4% of respondents agreed. And 44.8% thought that training could be shortened and still produce competent consultant ophthalmologist. About a quarter had opted out of the EWTD.

“This opposition to shortening a very long training period reflects the high level of competence in diverse areas of ophthalmology expected from a newly qualified UK consultant,” the authors of the report wrote.

Asked if their contracts reflected the actual number of hours they worked, 54.8% of the survey respondents agreed and 33.5% disagreed.

The number of procedures that British ophthalmology trainees must complete exceeds that of other countries. For example, British trainees must complete 350 full phacoemulsification procedures, while in the United States only 86 are required. Yet, 100% of survey respondents in both countries felt competent in the procedure by the time they had finished their training.

The British ophthalmology trainees expressed confidence in most of their non-clinical skills, including communication with patients and colleagues, small group teaching and presenting at conferences.

But 42% of respondents said they were not confident they could prepare a business case. This was similar to results among trainees in the United States and Canada, and among trainees in other medical specialities in the UK, Williams and colleagues wrote. They suggested that more training in business skills be offered.

Asked about career preferences, the largest percentage, 31.4%, chose oculoplastics, followed by vitreoretinal (25.1%), glaucoma (24.6%), and cornea (24.0%).

Most said they picked these subspecialties because of interest; only 11.7% gave “job opportunity” as a reason. In fact, these preferences do not appear to match the availability of “substantive” posts for consultant ophthalmologists in the UK, Williams and colleagues wrote. Over a 1-year period, they noted that only 7% of advertised positions were for oculoplastics, 5% for vitreoretinal, 21% for glaucoma, and 6% for cornea.

To make less popular subspecialties more appealing, Williams and colleagues suggested engaging trainees through sub-specialty associations and regional recruitment forums, and developing consultant job plans with dual subspecialisations or including subspeciality as a part of a generalist remit.