Ophthalmic surgical training following modernising medical careers: regional variation in experience across the UK

Abstract

ObjectivesTo evaluate surgical experience among current doctors appointed into ophthalmology training posts since the introduction of the Modernising Medical Careers programme. Additionally, to identify regional variations in surgical experience and training programme delivery.DesignA cross-sectional survey.SettingThe UK's four largest deaneries (Schools of Ophthalmology).ParticipantsTrainee ophthalmologists, all having completed three or more years of training, who were appointed to the new ophthalmic specialty training programme.Primary and secondary outcome measuresThe mean annual surgical rate for each deanery in phacoemulsification cataract extractions and experience in other common elective and emergency surgical operations. Second, to calculate the mean timetabled clinical activity.ResultsThe responses of 40 doctors were analysed, with a response rate of 83%. Overall, the phacoemulsification rate was 73.52±29.24 operations/year. This was significantly higher in the South Thames Deanery (99.69±26.16, p=0.0005) and significantly lower in the North Western Deanery (48.08±19.72, p=0.0008). The annual mean complex cataract rate was 5.21±4.38. Only 40% were confident in dealing with the most common complication of cataract surgery (vitreous loss). The mean trabeculectomy (surgery for glaucoma) rate was 0.47±1.16 and for squint surgery it was 3.54±2.82 operations/year. Regarding the common ocular trauma surgery, 42.5% had not sutured a corneal laceration and 60% a globe rupture. 50% thought the training programme would adequately prepare them surgically. The timetabled clinical activity was highest in the South Thames Deanery (48.17 h/week) and lowest in the North Western Deanery (40.82 h/week) due to variations in the European Working Time Directive implementation and on-call commitments.ConclusionsSignificant regional variations in surgical training experience exist between UK deaneries, particularly with respect to cataract surgery, and they appear to be correlated to timetabled activity. Experience and confidence levels in managing complex cataract surgery and complications were low and experience with previously commonly performed elective and emergency operations was minimal. Although doctors from all the regions surveyed were very likely to achieve the minimum cataract extractions required for specialist training completion, we have identified shortcomings of the current training programme that need attention.

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“…There is an assertion that the number of cases undertaken by trainees has fallen over time. This has been attributed to (among other reasons) organisational and political changes such as the European Working Time Directive . England reported that trainees undertook around 1000 cases per year in 1990, but by 1999, this figure had dropped to 500 with this downward trend persisting .…”

“…Minimum competencies are specified in the training curriculum that is maintained by the RCoA . However, experience accrued during the course of postgraduate specialty training is thought to vary across geographical regions . In recent years, training in anaesthesia has undergone significant change.…”

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“… 15 Some units have moved towards training and non-training lists. 11 , 22 , 23 This has its own challenges in terms of how patients give consent. In terms of risk factors for cataract surgery (eg, very old age, myopia, advanced hypermetropia, deep brow, pseudoexfoliation, etc) very few patients presented with these features (range of 0.2%–1.5%).…”