Hannah Whelan
DISCLAIMER: All information is correct as of July 2023 as per the Royal College of Ophthalmology website. The curriculum is subject to change and this article may become out of date.
Curriculum 2024 is the new curriculum for Ophthalmology trainees commencing August 2024, with the new e-Portfolio pilot launching August 2023. This article aims to highlight key changes regarding the new curriculum and how this may impact ophthalmology trainees. All information has been acquired from the Royal College of Ophthalmology website and presentations at the Royal College of Ophthalmology Congress in May 2023.
The prevalence of many common ophthalmology diseases is increasing due to our aging population. These include cataracts, glaucoma, diabetic retinopathy and age-related macular degeneration (ARMD). The new curriculum is designed to aid management of this with three specific elements: introduction of community ophthalmology placements, flexible indicative training resulting in trainees being able to CCT (certificate of completion of training) within five and a half years as opposed to the original seven years on the current curriculum, and finally, with an aim to focus on leadership and quality improvement to equip ophthalmologists to gain skills necessary for service improvement and design (1).
Taking a fellowship year following CCT is a regular occurrence amongst many ophthalmology trainees to enable them to gain sufficient skills in areas of special interest. The new curriculum aims to incorporate fellowship within the training by introducing advanced training in two special interests. The intention is to standardise training, reduce the need for fellowships after CCT and thus reduce overall time required to gain a consultant post (1).
Curriculum 24 is split into seven domains. These are patient management, health promotion, leadership and team working, patient safety and quality improvement, safeguarding and holistic patient care, education and training, research and scholarship (1).
The first domain, patient management, is split into twelve special interest areas (SIAs). These are as follows (1):
- Oculoplastics and Orbit
- Cornea and Ocular Surface Disease
- Cataract Surgery
- Glaucoma
- Uveitis
- Medical Retina
- Vitreoretinal Surgery
- Ocular Motility
- Neuro-ophthalmology
- Paediatric ophthalmology
- Urgent eye care
- Community ophthalmology
In order to progress through the curriculum across the training years, four levels have been introduced as highlighted below:
Level One (1)
Focus on basic science knowledge essential within ophthalmology. This level should be completed by the end of ST2, with most trainees completing it prior to the end of ST1. Part 1 FRCOphth examination should be completed in Level one.
By the end of level one, doctors will be independently developing differential diagnoses and management plans for low complexity general ophthalmology patients. Surgical training will begin in a simulated environment and progress to theatre. 50 cataract surgeries must have been performed.
Level Two (1)
Focus on general ophthalmology with trainees becoming more competent in working independently and efficiently. This level should be completed between the end of ST2 and ST3.
By the end of this level, doctors should be increasing efficiency and competency and see increasing number of patients per session.
Level Three (1)
Rotation through posts to gain skills related to the main SIAs. Trainees will not have cataract specific placements but will be required to perform 100 complete cataract procedures, a continuous cataract complications audit and formative assessments. Part 2 FRCOphth must be completed to move up to level four. Level three may be completed as early as the end of ST4 and before mid way through ST6.
By the end of this level, clinicians will develop skills and knowledge to the level of a general ophthalmologist by attending SIA clinics.
Level Four (1)
This level is designed to be the final 18 months of training and the main aim is to focus on two SIAs in patient management domain, and reach Level four in the other six domains. It is predicted that most trainees will be level four competent in cataract surgery prior to starting level four, which will enable more experience in a second SIA of choice. Level four should be completed by the end of the seventh year of teaching, with some candidates achieving completion of this level within five and a half years. By the end of level four, trainees should have the knowledge and skills of an ophthalmologist specialising in the area of their chosen SIA. They should also have completed 350 cataract surgeries.
Each of the four levels have competencies based on the seven domains which doctors will evidence in their e-portfolio. Progression through the programme will be determined by the Annual Review of Competency Progression (ARCP) process similar to the current training annual reviews (1).
References
(2023). Curriculum for Ophthalmic Specialist Training (OST). Available at:Proposed-OST-Curriculum-CAG-submission-October-2021-May-22-revision.pdf (rcophth.ac.uk) (Accessed: 18 July 2023)