How are ophthalmologists in training faring in 2022? Vishal Shah, National Medical Director’s Clinical Fellow, RCOphth and South London representative for the Ophthalmologists in Training Group, and Jordan Marshall, RCOphth Policy Manager, summarise the key findings from the GMC’s wide-ranging 2022 National Training Survey.
The General Medical Council (GMC) conducts an annual survey of trainees and trainers across the UK. This covers a range of issues relating to education and training, wellbeing at work and patient safety. Its purpose is to monitor the quality of postgraduate medical education and training, and it is regularly updated to ensure topical questions are being explored.
Just under 49,000 trainees responded to the 2022 survey – 76% of trainee doctors in the UK. Key findings relevant to ophthalmology are:
- Over four fifths (83%) of ophthalmologists in training rate their teaching as good or very good – higher than the 75% average across all specialties. Similarly 90% of ophthalmology trainees rate their clinical supervision as good or very good, compared to the 87% average
- The progression of ophthalmology trainees is still well behind what was typical before the pandemic. 77% of ophthalmology trainees said they were on course to meet their curriculum competencies/outcomes – lower than the 84% across all specialties. The figure for ophthalmology had never fallen below 93% between 2017-19
- 42% felt they had not been able to compensate for the loss of training opportunities resulting from the pandemic – far higher than the 23% across all specialties. By the end of ST2 training, only 37% had done more than 90 cataracts. This had never fallen below 56% before 2021
- The growing role played by independent sector providers (ISPs) in England appears to be an important factor in fewer training opportunities being available to ophthalmology trainees. Of the three quarters who needed to access training opportunities in ISPs, 86% disagreed that they were easily able to access these – just 6% agreed. This situation has worsened since the 2021 survey. This data reflects similar feedback we have had from our Ophthalmologists in Training Group and Training Committee about lack of training opportunities available in ISPs. RCOphth is working with NHS England and other stakeholders to address these challenges
- Three quarters (74%) of ophthalmologists in training agreed that the use of virtual learning environments was effective in supporting training. RCOphth will shortly be launching a new online learning platform – Inspire – to support the development of ophthalmologists and colleagues in eye care
- 15% of ophthalmology trainees are at high risk of burnout – up from 13% in 2021, although lower than the 19% across all specialties . An important contributor to this is rising workloads – over a third (33%) report heavy workloads, and half (49%) working beyond their rostered hours on a weekly basis
Other notable findings from the survey are highlighted below.
Education and training
- Practical experience was rated as good or very good by 74%, reflecting the “hands on” nature of ophthalmology. The survey does not capture what trainees interpret “practical” to mean but is likely to relate to interventions and procedures such as intravitreal injections, laser and surgery.
- Access to sitting professional exams relevant to the stage of training was reported to be excellent with only 1% disagreeing. This reflects the hard work done by the RCOphth Examinations department in maintaining professional exams over the course of the pandemic and beyond.
- Under half (45%) agreed that there was adequate provision of simulation facilities and exercises. It will be important for training programme directors and simulation leads to consider what can be done to improve access and awareness.
- 90% reported being able to attend deanery teaching most or all of the time. However, when asked whether they had sufficient protected time to do so, this falls to 81%. The discrepancy between attendance and protected time could suggest trainees use non-protected time in to maintain attendance. Training Programme Directors may need to consider what can be done to help trainees making difficult decisions between attending teaching and meeting other commitments.
- Local departmental/informal teaching was rated as good or very good by 79% and 75% had protected time to attend these sessions. Overall more than half (55%) said they’ve never had to leave such teaching to answer a clinical call.
- Reassuringly, 93% agreed their Educational Supervisor (ES) was easily accessible and 89% agreed their ES was providing an appropriate level of contact to suit their training needs.
Wellbeing at work
- Over half (57%) reported less than 6 weeks’ notice of rotas. This is concerning given adequate notice of rotas is a requirement of the Junior Doctor contract, and adequate notice helps with other commitments such as arranging childcare or leave.
- Only 15% disagreed that their organisation had a culture of listening to doctors in training with regard to working practices. This is encouraging but also shows room for improvement. Similarly, 77% said their working environment was fully supportive.
- 87% reported their unit provided a supportive environment for everyone regardless of background, beliefs or identity – similar to the 89% average across all specialties. Efforts to continue to improve this picture need to continue – RCOphth is for example running a reverse mentoring scheme. In its report, GMC Chief Executive Charlie Massey says ‘tackling inequality needs to remain an urgent priority for everyone’. Issues relating to equality, diversity and inclusion in ophthalmology have become more prominent since the publication of a paper in Eye on the experiences of black ophthalmology trainees in the NHS.
- Under two thirds (64%) reported knowing who to contact for matters regarding Occupational Health and Wellbeing. NHS organisations need to do more to ensure clear signposting at induction to increase awareness of available services. This is especially important given the prevalence of occupational-related issues in ophthalmology because of the highly specialised kit in clinic and theatre leading to neck and back issues later in careers.
- At induction, 15% either did not receive any explanation of their roles and responsibilities or were unsure if they did. Inductions by provider organisations should be comprehensive so this figure is somewhat concerning.
- 92% of trainees reported never being in a situation whereby they had to take consent for a procedure for which the risks were not fully understood.
- Worryingly, only 59% of ophthalmologists in training agreed that concerns raised by them would be effectively dealt with by their unit. This could reflect the fact that intense service pressures, especially since the pandemic, are hindering appropriate action being taken.
- 95% reported knowing who is responsible for their out of hours clinical supervision and that person being easy to contact. There is still scope for improvement though, given that 5% found that person difficult to contact and a further 5% did not know what that contact was so relied on an informal contact.
Commenting on the NTS report, co-author Vishal Shah, RCOphth Clinical Fellow said, ‘The national training survey is an invaluable tool to gauge the state of postgraduate training across the UK and it is imperative that all parties involved, from educational supervisors through to training programme directors and clinical leads, take note of the key points raised in this report. As trainees we know all too well the many challenges being faced by the specialty and the NHS as a whole, and the delivery of high-quality ophthalmology training must be safeguarded from them.
Trainees appreciate all the hard work done by their trainers on a daily basis, but it is essential that providers understand the difference between training and service provision, and that both must be able to co-exist in harmony if the specialty is to be future-proofed to meet the ever-increasing demands of tomorrow.’
Sarah Maling, RCOphth Chair of Training commented, ‘ Many thanks to Vishal Shah and Jordan Marshall for undertaking such a comprehensive and insightful review of the 2022 National Training Survey. As ophthalmologists, we can be encouraged about the excellent trainee feedback about opportunities for training and exams, ability to accrue curricular competencies and education and clinical supervision. We must not rest on our laurels.
We must continue to review equality of access to all aspects of training for all of our trainees and to support them when incidents occur and ensure that they know where to turn to if they are struggling at work. Despite good results across the board we must not forget that 1 in 4 trainees failed to respond. It is incumbent on us all to maintain an excellent training and work environment to support our future ophthalmology workforce.’
Through the Ophthalmologists in Training Group, Training Committee and close relationships with education and training bodies across the UK, RCOphth continues to work hard to ensure that the challenges faced by ophthalmologists in training are understood and addressed.