We know that the new Curriculum 2024 may be daunting for many and we want to ensure that everyone involved in training understands the changes, the core information you need to know and act on, as well as the timeline involved and how it affects you, our ophthalmologists in training and those supervisors and trainers involved in supporting you.
Below is a list of frequently asked questions that have already been raised in relation to the new curriculum. We will add to these as more are raised.
Heads of Schools and TPDs are a valuable source of information. They will receive regular newsletters and updates from the RCOphth and have been sent a generic presentation on Curriculum 2024. The Ophthalmologists in Training Group also provides regular updates about Curriculum 2024 in its newsletters. Heads of School and TPDs represent all regions and are members of the RCOphth Training Committee and are all involved in developmental work to implement the new curriculum.
The new curriculum will be introduced in 2024 and all trainees from ST1-5 will transfer to the new system (these are current full-time ST1s and ST2s in April 2022). Those in ST7 (current full-time ST4s) will need to stay on the current curriculum but there will be flexibility for those in ST6 (current full-time ST3s) to decide with their Educational Supervisor and TPD which curriculum will benefit their training most.
The CESR application is submitted to the GMC, who will require the application to ensure that the new curriculum is evidenced. There will be specific information for CESR applicants from the RCOphth. All candidates are encouraged to register their intention to apply with the RCOphth CESR team ([email protected]) so that they can be sent regular updates.
Recruitment may need to change in 2024 in accordance with the new curriculum.
These two Special Interest Areas (SIAs) will not be mixed together as they have completely separate syllabi.
All trainees are expected to audit their surgical results, especially with reference to cataract surgery and any other Level 4 surgical SIA.
In most circumstances, yes. If you have been signed off by your CS and ES for a SIA on the old curriculum, you are likely to have achieved most competencies at Level 3 of that SIA. Checklists will be available to evidence that and any gaps (which are likely to be very few) can be identified.
All trainees will be expected to continue to maintain their surgical logbook similar to the current process. The only difference is that there will be no mandatory requirements for surgical procedures.
CURRICULUM CONTENT AND STRUCTURE
We expect that many trainees will achieve descriptors and, in some cases, entire Learning Outcomes in Level 1 ahead of the indicative time. Some training units may choose to use the first Learning Outcomes of Level 1 Patient Management to assess whether trainees are ready to be first on-call early in their training.
However, it may take a little longer to be signed off as competent at all of the Learning Outcomes necessary to manage a low complexity ophthalmology patient, including demonstrating underlying knowledge of basic and clinical science (evidenced by the FRCOphth Part 1 examination) and initiating management plan. The end of ST2 is simply the latest point at which entrustment in all of the Level 1 Learning Outcomes must be demonstrated to allow continuation on the training pathway. Where any capability is demonstrated earlier, trainees should start working towards achieving entrustment at the Learning Outcomes in the next level.
No, surgical training will continue to be delivered from ST1 onwards, augmented with training in simulated environments.
The curriculum defines the Level of training by which the ophthalmologist must be able to perform the described Learning Outcome independently. Therefore, while it is true the Level 3 Learning Outcomes (including surgical capabilities) do not need to be evidenced as competent at an ‘independent’ level until the end of Level 3 (Year 5 ½ of training), the ‘Entrustable Professional Activity’ summative assessment tools will ensure that surgical capability is being assessed throughout. They will assess the level of entrustment as ‘observing’, ‘under direct supervision’ or ‘indirect supervision’ at the earlier stages of training, and this will be reviewed in the Educational Supervisor Report (ESR) and by the ARCP panel.
When trainees are working in a SIA and have achieved the Level 3 surgical capabilities, training can immediately proceed to develop the skill for the Level 4 capabilities, which will initially be at the ‘direct supervision’ level.
The Level 1 and Level 2 capabilities are achievable in a general ophthalmology environment: general clinics, urgent eye care and on-call ophthalmology will all be excellent environments to achieve these. TPDs will need to ensure that posts can deliver the curriculum, and this is likely to need a change in programme organisation.
Competence in Level 3 capabilities will require exposure to SIA clinics and theatre lists. There is some overlap between the syllabi in some of the SIAs. Again, TPDs will be reviewing their programmes to ensure the curriculum is delivered. For example, two SIAs may be covered in the same 6-month post.
Level 4
The Level 1 and Level 2 capabilities are achievable in a general ophthalmology environment: general clinics, urgent eye care and on-call ophthalmology will all be excellent environments to achieve these. TPDs will need to ensure that posts can deliver the curriculum, and this is likely to need a change in programme organisation.
Competence in Level 3 capabilities will require exposure to SIA clinics and theatre lists. There is some overlap between the syllabi in some of the SIAs. Again, TPDs will be reviewing their programmes to ensure the curriculum is delivered. For example, two SIAs may be covered in the same 6-month post.
All trainees are required to complete at least two Level 4 SIAs. It is expected that most trainees will achieve or be close to achieving Level 4 in Cataract Surgery by the mid-point of ST6, as well as achieve Level 3 in all other SIAs. They may then proceed to complete their cataract Level 4 (if not already done) and take on another Level 4 in the remaining training time.
However, equally, they could choose to complete two further Level 4s in the remaining time. For example, trainees who have completed Level 4 Cataract and all Level 3 in other SIAs by mid ST6 could use their final 18 months of allowed training to complete Level 4 training in both Urgent Eye Care and Community Ophthalmology.
However, training cannot be extended beyond the 7-year training envelope to undertake additional longer SIAs. Educational Supervisors and TPDs will advise about individual selections.
The professional bodies have advised us that the curriculum content stated for Level 4 is deliverable within the indicative times given. This will ensure that trainees can perform the core special interest procedures independently in the Level 4 areas they have selected.
To note that in some of the SIAs, eg Vitreoretinal Surgery and Cornea and Ocular Surface Disease, the Level 4 curriculum does not cover the full complexity of surgical procedures performed by specialist consultants. In some cases, trainees will still choose to proceed to a post-CCT fellowship in these SIAs to gain these additional skills.
However, it is anticipated that, in many of the SIAs, ophthalmologists with a CCT will be equipped to move straight into a consultant post.
Completion of Level 4 training in all of the generic domains and at least two of the Patient Management domains is a requirement for CCT. If you had only completed one Level 4 Patient Management domain by the end of the 7 years of training, you would be awarded an Outcome 3 (‘inadequate progress’) to extend your training time to allow you to complete your second SIA.
In reality, this situation would have been picked up by you, your trainers and your TPD before you reached the end of ST7. If you are unable to achieve the necessary competence in at least two Level 4 Patient Management domains, you would not be awarded a CCT.
Having successfully completed the training programme, you will hold a CCT which allows you to apply for consultant posts. Your consultant employer will include in their selection procedure a person specification for the post. The RCOphth will advise that Level 4 competence in Cataract Surgery is the minimum standard for a consultant practicing in this area.
Most ophthalmic academic trainees will transition from Level 3 to 4 during their post-doctoral periods eg as NIHR (National Institute of Health and Care) Clinical Lecturers (CLs) or during their personal post-doctoral training fellowships. Completion of training is competency (not time) based, so having time protected for academic training (eg 50% clinical : 50% research) should not affect the CCT date, provided the required clinical competencies are met.
However, ophthalmology is a craft specialty, with trainees required to undertake certain procedures on a number of occasions to become competent to perform the procedure independently, and clinical training may take longer, for example if the recommended minimum two operating lists per week for academic trainees is not provided.
NIHR CL posts are for a maximum of four years or until CCT is reached. The GMC has agreed with NIHR that ‘setting a target CCT date is best determined flexibly, and tailored to the needs of the individual trainee.’ The target date for CCT for NIHR CLs should be determined at the first annual ARCP following the award of a CL and following assessment of the initial progress in post. The same process would be appropriate for those on personal post-doctoral fellowships.
Once this has been set, the CCT date can be extended further through the use of an ARCP Outcome 3. This may prove particularly important once trainees progress to Level 4, if it becomes apparent that competencies may not be met on a timetable of 50% clinical work. The RCOphth endorses the NIHR’s view that ‘if there is a need to extend clinical training this should not be regarded as a failure’, but rather necessary to achieve the outcome of simultaneously completing specialist clinical training and academic training.
Usually, yes. We anticipate that all HEE local offices / Deaneries will be able to provide Level 4 training in the most frequently chosen SIA – ie Cataract, Cornea, Glaucoma, Oculoplastics, Medical Retina, and Vitreoretinal Surgery. Other SIAs may not be available in all Deaneries, and it is possible that trainees may have to move in order to do a SIA in, for example, uveitis. We intend that this should be achievable as Out of Programme Training (OOPT), rather than an Inter-Deanery Transfer (IDT).
We expect that most trainees will want to stay in the Deanery in which they have been based for the preceding six years. However, if Level 4 training in their chosen SIA is not available in their own Deanery, they may choose to look elsewhere. The process for this is still being worked out in consultation with the GMC.
This is unlikely to be a frequent event. The median number of trainees in a Deanery is about 35, which means that approx. five trainees/yr will be entering Level 4 training, with 11 different SIAs to choose from. Our priority is to maintain the quality of training, which means there has to be a limit on the number of Level 4 posts in each SIA in the Deanery, or the experience is diluted. If a trainee cannot obtain a post in their chosen SIA in their own Deanery, they may be able to apply to other deaneries with unfilled posts in that SIA.
Some will be converted to Level 4 training posts. Others will become Level 1-3 posts.
As these are funded by local Trusts / Health boards, they will not be affected by changes to the curriculum. If a unit is able to provide both Level 4 and a post-CCT Fellowship in a particular SIA, the post-CCT fellowship will continue in their current form.
At Level 4 training, two SIAs may be done simultaneously or sequentially. This will very much depend on the logistics of the timetable that can be created for that post. Similarly, any restrictions to the combinations will be guided by the indicative time required and the ability of the unit/region to provide the required timetable for training (for example, it may be extremely difficult to do Level 4 in Oculoplastics and Paediatric Ophthalmology as the indicative time is 18 months and 12 months respectively).
Only two Level 4 SIAs are required for CCT. In practice, it would be difficult to fit three SIAs into 7 years of training though, in theory, it may be possible in rare circumstances. However, if a trainee wants to pursue a third SIA, this could also be done as a post-CCT fellowship.
No, numbers are much less important in Curriculum 2024. The emphasis is on competence. Some trainees will be excellent independent cataract surgeons after 250 phacos. Others may need to do over 400 under supervision before they are fully competent cataract surgeons. However, the majority of trainees will be competent after completing 350 phacos, and this is the indicative number for Level 4 Cataract Surgery (similar to the current curriculum CCT requirement).
Generally, they would get an Outcome 3 at their ARCP, and would be given additional time to achieve the required competencies.
No, Level 4 training is part of run-through specialty training. However, we expect that there will be less demand for post-CCT fellowships from UK trainees, as they will be able to obtain their SIA experience prior to CCT. This means that there will be greater opportunities for non-UK trainees to obtain post-CCT fellowships.
No. Once a trainee has been signed off at Level 4 for Cataract Surgery, there will be no requirement to demonstrate ongoing competence while doing a different SIA at that Level. This is similar to some post-CCT fellowships, which concentrate solely on one SIA with no exposure to cataract surgery.
Yes. The indicative times for Surgical SIAs is 18 months (Cornea, Oculoplastics, Glaucoma, Vitreoretinal Surgery, Ocular Motility). The indicative times for Medical Retina, Neuro-Ophthalmology, Paediatric Ophthalmology, and Uveitis is 12 months; for Community Ophthalmology and Urgent Eye Care the time will both be nine months.
PREPARING FOR AUGUST 2024
Yes. We are developing mapping tools, so the competencies you have demonstrated in the current curriculum do not need to be repeated and you will be able to see as soon as you transfer to the new curriculum where any ‘training gaps’ exist, so your continuing training can be properly planned. You will not be required to repeat things that have already been assessed as competent.
Current ST1-3s (as in April 2022) – who will be ST5-7 when the new curriculum is implemented (August 2024) – should undertake a developmental exercise and complete a Curriculum Transition Checklist (CTC) with their Education Supervisors. The exercise will: (1) provide a benchmark of achievement in preparation for transfer to the new curriculum in August 2024; (2) identify any gaps in training; (3) inform the ESR and ARCP, although not as a formal part of the assessment process. The CTC will outline the evidence required by each Learning Outcome at each Level of training.
We recommend that all current ST1s and ST2s (as in April 2022) complete the Level 1 and Level 2 CTCs (which include all Patient Management domains as well as Generic Skills domains). All current ST3s (as in April 2022) should complete the Level 1 and Level 2 CTCs (which include all Patient Management domains as well as Generic Skills domains) as well as the Level 3 Cataract CTC. We recommend that this exercise be completed by 30 June 2022.
They are available via Implementation Note 1 and were emailed out to all ST1-3 trainees and Educational Supervisors.
Although the checklists are designed for ST1-3 trainees, we would suggest that you do the checklists as you would have a choice of transferring to the new curriculum.
The deadline for completion is 30 June 2022. The checklists are not essential for ARCP, so if you do not complete it in time for your ARCP, you should try and get it done as soon as possible thereafter.
Yes, ST1s can use assessments from the Horus portfolio to evidence competencies in the new curriculum checklist.
The new assessment tools are:
Entrustable Professional Activity (EPA) – key method of assessing the Patient Management domain and will replace the current Clinical Supervisor Report (CSR). Completing the EPA will be the responsibility of the Named Clinical Supervisor and a minimum of one EPA will be required every six months.
Multi-Assessor Reports (MAR) – will feed into the EPA and will be used for clinical assessments from other clinicians (including Supervising Consultants) and other professionals. There is no minimum or maximum number for this as it will vary depending on the rotation, level and domain area.
Generic Skills Assessment Tool (GSAT) – key method of assessing all the other (non-Patient Management) curriculum domains. At least one GSAT will be required every six months. This may be completed by the Educational Supervisor or Clinical Supervisor or Supervising Consultant.
All other assessments will remain the same.
We are hoping that the transfer of evidence from one portfolio to the new one will be as seamless as possible. The automatic transfer of evidence is a fundamental element of the new ePortfolio project.
The EPA will be the responsibility of a single Named Clinical Supervisor. However, there may be other consultants, clinical staff or other health professionals (eg orthoptist) who will also be supervising a trainee or witnessing competencies during a rotation. The MAR is meant for them to be able to give feedback to the Named Clinical Supervisor to help in completing the EPA.
London, Scotland, Northern, Yorkshire & The Humber, Northern Ireland and West Midlands will be piloting the new workplace-based assessment tools from 18 July to 31 October 2022. These are the EPA, the GSAT and the MAR. The outcomes from the pilot, which will be reported to the GMC, will help us improve the new tools where necessary. They will then be fully piloted on the new ePortfolio from August 2023 to August 2024.
I will be out of programme when the new curriculum is introduced in 2024 – will I be required to transfer to the new curriculum when I return to ST6 training two years later?
I see this is good for those able to move more quickly through training – how does it adapt for those moving more slowly or more unevenly through training eg clinical academics who have not yet achieved cataract numbers needed for stage or other scenarios where someone may be eg Level 3 in most areas but Level 2 in others?
How will the transition affect LTFT trainees if they are ST6 in 2024 but not due to finish training until a couple of years later?
If you are an ST6.5 in August 2024 (1.5 years left until CCT) is there an option to be on either curriculum?
I am mid-way through ST5 but shortly returning to training LTFT at 60%. I just want to check whether I will need to change to the new curriculum as my training will take longer when I am LTFT?
How will this affect senior trainees who might go out of programme? For example, a ST4 who might go OOP for a 3-year PhD?
How much flexibility will there be? For example, a current ST4 trainee who is not expected to go onto the new curriculum, who then goes LTFT?
If I am ST4 or 5, can I be enrolled in the new curriculum?
The answer to all these case studies is that if CCT is due to be awarded after August 2026, then you have to transfer to the new curriculum, regardless of whether you are LTFT, OOP or academic.
If the CCT is due to be awarded in or before August 2025, then you have to stay on the old curriculum.
If the CCT is due to be awarded after August 2025 and in/or before August 2026, you will have a choice but, in most circumstances, it may be in your benefit to transfer to the new curriculum. Trainees will be encouraged to transfer, and indeed, this will be in their best interests as it will mean that advanced training in the new curriculum will be funded, as opposed to fellowships, which are not.
However, everyone will have to transfer to the new ePortfolio.
