There has been a general broadening of all UK health related Global activities since the Crisp Report (2007) promoted the utilisation of UK health experience to assist developing countries. The main drive of this Report was to promote collaborative partnerships between providers of care in the UK with those in the developing world. Another thread was to create methods of improving the delivery of health education and training, driven by local need. The UK Government supported this Report, and its strategic document Health Is Global (2008) committed to an increase in governmental funding for international health development and to encourage liaison with overseas departments and organisations at a local level.
One of the objectives of The Royal College of Ophthalmologists’ Royal Charter is to ‘further instruction and training in Ophthalmology, both in the United Kingdom and Overseas’. The College has been actively involved in international work over the past 25 years and it is timely to consolidate these activities. We set out below our approach to international affairs in its principal roles of education, training and examinations; setting standards for professional practice and promoting research.
The key International strategies of the College
- Improving education and training to raise standards in Ophthalmology worldwide by sharing knowledge and expertise
- Strengthening support for international members and fellows and increasing support to members as they undertake international work, working in partnership with other UK and international agencies
- Developing governance and coordination around international work to ensure College processes are both in place and adequate.
This is the main thrust of College International policy which supports making sustainable improvements to ophthalmic health care. This can be achieved in a number of ways – sharing knowledge and expertise to improve standards and to find methods to share the experience gained.
College examinations are an excellent mechanism to promote learning through assessment. The expansion of College examinations overseas is being requested and sought by a number of interested parties as our assessment system is increasingly recognised as being able to define clear standards.
- Currently part 1 written examinations are held in UK; Dubai; India; Cairo; Kuala Lumpur – all under British Council supervision
- There are further requests from Indonesia; Singapore and Western Africa regarding the refraction certificate and part 2 written papers which are being pursued.
Expertise in teaching and training is used to improve sustainable standards in ophthalmic care. Currently this is the basis of the VISION 2020 link between the College and the College of Ophthalmology of Eastern, Central and Southern Africa (COECSA) – (the expanded successor of EACO). Under the leadership of Nick Astbury, this link has strengthened considerably because the Links Team at ICEH successfully applied for a multi-country partnership project grant for £416,000 from the Tropical Health and Education Trust (THET). This provides funding for members of the RCOphth to share knowledge and skills with the local African ophthalmologists who will then be able use them to adapt to local need from:
- Training the Trainers courses
- Examiners’ Training programmes
- Continued Professional Development – sharing basis of systems and mechanisms to provide points
- Curriculum and syllabus development to encourage the setup of best practice in local training and assessment methods
- Assisting, in practical terms, in organisation of examination papers and clinical assessments
- Microsurgical skills courses
- Leadership courses
- Sharing guidelines
This type of activity is highly successful and provides a sound model on which College support can be provided. Affiliate membership for partners in these schemes has been beneficial in helping to strengthen the role of the College and should be encouraged.
There has been a MoU signed with the Research Institute of Ophthalmology (RIO) in Egypt which should have a similar remit.
- Further co-ordination with organisations that are able to fully fund our input, such as the International Council of Ophthalmology (ICO) – liaison regarding Training the Trainers and examinations should be positively viewed and explored on the ability to deliver. Consideration should be given to the delivery of these courses either in the UK or in overseas centres.
- The College should consider the development of an International fund to recruit faculty to deliver courses based on income from courses delivered in the wealthier countries, such as the existing course in Abu Dhabi – surgical skills training. The aim of this would be to provide expenses for delivery of similar course and support to less affluent areas. This would require careful administration and review regarding eligible countries. Appropriate MoUs should be drawn up as required.
Dual sponsorship scheme / Medical training Initiative (MTI)
More information can be found out about the Dual sponsorship scheme. It is run by the College in association with the Academy, the GMC and Deaneries and is designed to provide an opportunity for international medical graduates to undertake targeted training in ophthalmology in the UK for a limited period of time. The scheme encourages access to College Congress and participation in International meetings:
- An International symposium is a regular feature at Congress. This helps to maintain the profile of International ophthalmology and should continue with speakers from overseas research or clinical projects being encouraged.
- Members of COECSA and other countries will be funded to attend Congress as part of the Annual Congress Sponsorship Scheme.
- Invitations to International meetings to share College initiatives and experiences of training and education should be accepted and encouraged, as occurred at the WOC and OSEA (now COECSA) meetings recently.
- Poster and oral presentations about all aspects of International work – research, clinical experience, audits and outcomes – should be encouraged to promote discussion and participation.
Being cognisant of European legislation and assessment methods and their relevance to our training, assessment, working practice and recruitment in the UK. The European sub-committee has representatives on the European Board of Ophthalmology (EBO) and the European Society of Ophthalmology (SOE) who have been unfunded to date. Support for travel and subsistence has now been approved by the College as the represented body providing that prior agreement has been reached and that a brief report is provided to the Executive Committee via the International Committee.
Supporting relevant collaborative research. The College should support and, where indicated, fund International research in the same manner as it does UK based research. In addition the College has a considerable wealth of expertise in research and could provide the support of appropriate individuals where required for overseas research projects.
2) Strengthening support for international members and fellows and increasing support to members as they undertake international work
Approximately 25% of our 3,000 active members are resident overseas. They require advice and support from the College regarding an increasing number of issues. This should be drawn from expertise within the College from the relevant committees with specific understanding of issues that affect International members such as
- Advice and guidance regarding revalidation and retention of a licence to practise in UK.
- CPD access and organisation. Mechanisms should be facilitated by which overseas courses and meetings can draw up their own accreditation processes
- Returning to work in the UK – policies and barriers
Improving information and networking:
- Developing a database of International activities of our members. This provides the College with essential information regarding the plethora of work being undertaken by ophthalmologists overseas, any outstanding needs and details of interested parties who have the desire and skills to contribute.
- Constructing a network of international members to work more closely with the College regarding local issues and to promote relevant College policies, exams, courses etc. should be considered. This would both engage overseas members and increase the College’s global reach and broaden international relations
- Ensuring the broadest possible access to e learning opportunities and on line EYE
Increasing support to members as they undertake international work. The College has recently endorsed the volunteering statement drawn up by the Academy of Medical Royal Colleges’ International Forum (AoMRC IF) to support health professionals who wish to volunteer to improve health in developing countries. This involves 6 main themes
- Encouraging a consistent approach to granting time out of training or employment
- Formally recognising volunteering for professional development
- Improving collaboration and communication regarding volunteering
- Monitoring, evaluating and researching volunteering activities
- Providing information, training and support for volunteers
- Recognising the additional costs and loss of employment entitlements that come with volunteering
- Advising on the status of indemnity
Some progress has already been made to support these aims and further awareness is important.
Working in partnership with other UK and international agencies to share evidence and ideas; to assist in joint ventures and funding applications and to inform policy-makers. There are several organisations involved in International medical/ophthalmic work (eg Academy of Medical Colleges International Forum (AoMRC IF); Tropical Health and Education Trust (THET); Department for International Development (DfID); WHO; European Board of Ophthalmology) EBO, SOE, World Sight Foundation (WSF); Vision 2020 links programme UK; International Council of Ophthalmology (ICO) etc)
3) Developing governance and coordination around International activities to ensure that College processes are both in place and adequate.
Any developments or initiatives must be feasible and affordable. A fair and robust approach must be in place.
The International Committee will act as co-ordinator for International affairs and as the point of contact for international members. This committee reports directly to Council and the Chair is a co-opted member of council. It will:
- Co-ordinate information and support for International members through the appropriate committees and sub committees
- Develop a database of members’ and fellows’ International activities and use this to assist in co-ordination of overseas work when requested.
- Act as the centre for the College links programme
- Keep information up-to-date on an expanded International college web page
- Work with relevant standing committees to ensure that adequate capacity and funding exist for overseas projects and activities
- Act as a liaison point for Government and non-Governmental bodies
- Work with parties to develop collaborative business cases and grant applications for external funding
- Offer support to refugee ophthalmologists
- Engage expert members and other groups as required
The decision making and operational responsibilities will fall to the relevant committees – Examinations, Professional Standards, Education, Training, Finance, Scientific – and their sub committees eg. revalidation. A communication system between the International Committee and the other committees based on minutes from each meeting should suffice with direct contact and working when required. Invitation to attend specific meetings may be necessary under certain circumstances. Specific requests will commonly come directly to standing committees and the International committee should similarly be informed. Decisions regarding what to accept and what to decline need to be carefully engineered when many parties are involved and mechanisms for coordination will need to be developed with all interested departments within the College.