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 ophthalmologists in training, supervisors and trainers.
Heads of School and Training Programme Directors represent all regions and are members of the RCOphth Training Committee. They have been involved in developmental work to implement Curriculum 2024 and are a valuable source of information. They are also members of the Regional Curriculum Network, which includes trainees. The Ophthalmologists in Training Group (OTG) provides regular updates about Curriculum 2024 in its newsletters.
Please email [email protected] if you wish to raise topics not already covered in this section.
Find out about Curriculum 2024
The new curriculum will be introduced in 2024 and all trainees from ST1-5 will transfer to the new system. Those in ST7 will need to stay on the current curriculum, but there will be flexibility for those in ST6 to decide with their Educational Supervisor and TPD which curriculum will benefit their training most. Remember that both old and new curriculum will be on the new ePortfolio.
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. Preliminary guidance has been published on the RCOphth website.
Recruitment has changed to enable the transition to the new curriculum, which is competence-based. There will be NO ST3 intake from 2024 onwards.
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. A continuous cataract complications audit will be mandatory for every ARCP. The 50 consecutive cataract audit will need to be done within 3 calendar years of being awarded Cataract Surgery Level 4.
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. Please see this presentation regarding the transition arrangements and equivalence. Checklists are 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.
Moving to the new ePortfolio
Access to the old ePortfolio has been extended until 31 July 2024. Up until that point, you will be able to complete assessments and are strongly encouraged to download your ePortfolio.
Everyone is moving to the new ePortfolio, including those staying on the old curriculum. You will get an invitation from the ePortfolio provider in mid-July 2024 and you should then follow the instructions to be automatically allocated to the 2010 Curriculum.
You will have to upload some information so that you are able to view your previous progress. See here for more guidance.
Everyone is moving to the new ePortfolio, including those staying on the old curriculum. You will get an invitation from the ePortfolio provider in mid-July 2024 and you should then follow the instructions to be automatically allocated to the 2024 Curriculum.
You will have to upload some information so that you are able to view your previous progress. See here for more guidance.
ARCP 2024
The UEC CTC lists examples of evidence that can be used to demonstrate that you have achieved the required competencies. It is not prescriptive and is simply a guide to ensure there are no gaps in training. The CTC will only be required if somebody wants to demonstrate completion of Level 3 UEC at the time of transition. The CTCs will become redundant after August 2024 when the new curriculum kicks in. After that, the EPA Level 3 UEC will need to be completed.
Although Part 2 FRCOphth is a requirement for advancement to Level 4, trainees transitioning to Level 4 in August 2024 and February 2025 will be exempt from this condition. After February 2024, Part 2 FRCOphth will be required before advancing to Leel 4.
You are entering ST4 and will have automatically entered Level 3 if you have the Refraction Certificate and Outcome 1 in your last ARCP. You are not aiming to demonstrate completion of Level 3 so SIAs that have already been signed off will be considered signed off in Level 3. You do not need to complete any CTC unless you want to demonstrate that you have completed Community Ophthalmology, Cataract Surgery or Urgent Eye Care in which case you complete those.
The Generic domains Level 3 checklist is only to be completed if you want to go straight to Level 4. Otherwise, you can get them signed off in Level 3 using the GSATs after you have moved to the new Curriculum.
Please note that the CTCs are not in themselves assessments, nor are they compulsory. They are simply a way for trainees and trainers to benchmark your current achievements against the new curriculum. However, they will be used to as evidence by your ES when reviewing your Intended Level Form – which is mandatory.
The Community Ophthalmology Level 3 SIA sign off requirement is the transition checklist. It lists all learning outcomes and descriptors. The lists of evidence on that document as well as the guide to Community Ophthalmology on Inspire are not prescribed pieces of evidence or modules that need to be completed – they are simply examples of evidence that can be used to demonstrate that a learning outcome has been met.
It is important to remember that this is not a tick box exercise – the quality of evidence against every learning outcome should be assessed to determine if it demonstrates that the outcome has been achieved. Some of these pieces of evidence will be modules; others will include passing of exams, CbDs and time spent in a community optometrist practice or in a triage service, communication with community optometry, attendance at primary care provider meetings, etc. Sometimes one piece of evidence of good quality may suffice for more than one learning outcome.
If you have been signed off for an SIA on your CSR, you will not have to complete that SIA in Level 3 irrespective of when it was signed off in your training. That means that when you enter Level 3, you will be deemed to have already completed that SIA.
This years ARCP process should clearly indicate the SIAs that have already been signed off on CSRs, and therefore for Level 3, on the ARCP outcome form so that this outcome form is the only piece of evidence required when they get to Level 3.
No, that is all you need to do.
You should have a discussion with your ES (and CS) regarding the competencies of Level 3 glaucoma. If you have been signed off and they feel that you have the competencies, you do not need the surgical numbers as the new curriculum is competency-based and not number-based.
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 (maximum time allowed is 5 ½ years of full-time equivalent training), the EPA 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
Professional bodies (e.g. BEAVRS, BIPOSA, etc.) were consulted about the amount of time likely to be required for trainees to be entrusted to undertake independently the activities described in the Level 4 Learning Outcomes. Those that are more surgically based, and/or where experience of the specialist surgery is likely to have been limited before entering Level 4 training, are longer. These are only indicative times as Curriculum 2024 is competency-based rather than time-based.
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 Level 4 Cataract Surgery (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 Surgery 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 e.g. as NIHR (National Institute of Health and Care) Clinical Lecturers (CLs) or during their personal post-doctoral training fellowships. Completion of training is competence (not time) based, so having time protected for academic training (e.g. 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 have undertaken various mapping exercises with TPDs to ascertain that all Deaneries will be able to offer Level 4 training in virtually all SIAs. 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. 5 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 the trainee is unable to get a Level 4 post in their chosen SIA in their Deanery, they may have to complete Level 4 in a different SIA and then choose to apply for a post-CCT Fellowship in their chosen SIA.
Some will be converted to Level 4 training posts. Others will become Level 1-3 posts. Those remaining on the old curriculum will continue doing TSCs even after August 2024, but these are different from Level 4 posts, even though timetables will have similarities. TSC posts cannot be referred to as Level 4 posts after August 2024.
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 up to 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, it is to be remembered that, 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 may be used as an indicative number for Level 4 Cataract Surgery (similar to the current curriculum CCT requirement) by some Deaneries. However, the syllabus does not require any minimum numbers of any surgical procedure.
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. Deaneries will use the following ranges when planning their Level 4 SIA programmes:
Up to 18 months – Oculoplastics, Cornea and Ocular Surface, Glaucoma, Vitreoretinal Surgery
6-12 months – Urgent Eye Care, Community Ophthalmology
6-12 months – Cataract Surgery (to be integrated longitudinally)
Preparing for August 2024
Yes. The Transition Progression Requirements explains how Outcome 1 and completion of Curriculum Transition Checklists will be used to guide transition to Curriculum 2024. This is 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 (Aug 2023) – complete CTC Level 1 (and preferably Level 2) to assess the competencies that are required to be gained before you can transition to Level 2. You may find that you will be able to transition to Level 2.
Current ST2 (Aug 2023) – if you obtain outcome 1 in ARCP 2024 then you will automatically progress to Level 2. We suggest you complete CTC for Level 2 as you may be able to achieve the competencies of Level 2 by ARCP 2024 and may be able to progress to Level 3 in August 2024.
Current ST3 (Aug 23) – if you obtain outcome 1 in ARCP 2024 then you will automatically progress to Level 3. If you have been signed off by your CS for any SIA on a CSR at any point in your ophthalmic specialist training, you will not need to repeat that SIA in Level 3. You can also complete Level 3 checklists in SIAs (particularly Cataract Surgery, Urgent Eye Care and Community Ophthalmology) and the generic domains to demonstrate that you have achieved Level 3 competencies in that area.
Current ST4 onwards (Aug 23) – You will enter Level 3. If you have been signed off by your CS for any SIA on a CSR at any point in your ophthalmic specialist training, you will not need to repeat that SIA in Level 3. You can also complete Level 3 checklists in SIAs (particularly Cataract Surgery, Urgent Eye Care and Community Ophthalmology) and the generic domains to demonstrate that you have achieved Level 3 competencies in that area.
They are available on this webpage and were emailed out to all ST1-3 trainees and Educational Supervisors in 2022.
A number of CTCs have been developed and published at different times over the past year. To make it easier for trainees and trainers to access them, the complete list is published here. Each link will take you to the relevant CTC.
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 (NCS) 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 but will be the ultimate responsibility of the ES.
All other assessments will remain the same, although the grading scale will be different in places.
London, Scotland, Northern, Yorkshire and The Humber, Northern Ireland and West Midlands took part in piloting the new assessment tools from July to October 2022. These are the EPA, the GSAT and the MAR. The outcomes from the pilot were reported to the GMC and helped us make necessary improvements. The report to the GMC can be found here. The new assessments will be fully piloted on the new ePortfolio from September 2023 to August 2024.
There should be no work required on your part as the current ePortfolio suppliers will be providing our new ePortfolio partners with all your evidence, so the process of moving 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 (NCS). However, there may be other consultants, clinical staff or other health professionals (e.g. 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 NCS to help in completing the EPA.
Sample queries on transfer
The answer 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.
The answer 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.
The answer 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.
The answer 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.
The answer 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.
The answer 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.
The answer 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.
The answer 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.
Case studies
For the ARCP in June 2024, the trainee will still need to ensure that WpBAs are all up to date and the traffic lights are green for ST5 so that an Outcome 1 can be obtained.
For 9 SIAs, the trainee will simply need the CSRs to confirm that she does not need any further training time (as stated at the end of the Clinical Supervisor reports). For Cataract Surgery, Urgent Eye Care and Community Ophthalmology, the trainee will need to have a completed and signed transition checklist for Level 3.
If the trainee has done a rotation in an SIA and was not signed off, the gaps can be identified and it may be possible to gain the competencies during Research/Study/Teaching/Audit/Curriculum (RSTAC) sessions so that the CS and ES can supply an additional letter confirming that the requirements have been met.
If there are large gaps or the rotation has not been completed, the trainee will need to do the rotation in the first six months of ST6 and have an EPA (new assessment for C2024) signed off.
For the other six domains (non-patient management), the trainee can complete the transition checklists and have them signed off before the ARCP in June 2024.
The progression of one level to another can only be confirmed by the ARCP Panel.
The short answer is yes. She should discuss her Level 4 choices with ES and TPD as one year on LTFT may be a short time to complete some of the Level 4s.
The forms that are currently on the website are draft only until final GMC approval. The forms were amended after the Assessment Pilot feedback and will be tested in the ePortfolio Pilot Programme during 2024, but even these should be regarded as draft, as they will not have been approved by the GMC. They therefore cannot be used as official evidence before August 2024 but can be used as evidence to complete the Curriculum Transition Schedule (and Community Ophthalmology and Urgent Eye Care CTCs) to satisfy the ES and TPD that all competencies have been met. This would be similar to any other evidence that may be generated and used (reflections, evidence of attendance, evidence of online modules, CBDs, etc). This trainee will need to complete the old paperwork to get outcome 1 in their ARCP in June 2024. If she keeps track of the new curriculum as she goes through their SIAs, she will be able to ensure that all competencies are completed. No assessments are required before August 2024; simply completing the Level 3 Curriculum Transition Schedule will be enough to identify any gaps. If they have been signed off for a particular SIA in the CSR, that will be equivalent to completing Level 3 in that SIA. The deficits and gaps will need to be covered by utilising their RSTAC sessions wisely. The ES and TPD can help if more time is needed.
This trainee will be unable to apply to any other Deanery for the Level 4 VR training (implications on service, on-call rota, etc.) This is not dissimilar to the current situation where an applicant may not get a competitive TSC or Fellowship that they want. A discussion should take place with the trainee about other SIA options for specialisation. If trainee wants to do only VR, then he should do Level 4 Cataract Surgery and one more Level 4 which he can achieve in the shortest possible time (for example, Urgent Eye Care or Community Ophthalmology). He can then apply for a VR post-CCT Fellowship. There is no obligation on the Deanery to create another Level 4 post. If a Deanery offers a Level 4 post in a particular SIA, the trainee cannot ask for an IDT on those grounds.
This will be a very difficult situation for the trainee. Depending on the reason for OOP, the option of delaying that project (academic or otherwise) until after CCT should be discussed. This would allow her to remain in the old curriculum, complete CCT and then take the time out before a Fellowship or Consultant job. If the above is not an option, the trainee can still try to come back to Level 4 in August 2026; however, she will be aiming to complete this Level 4 Cornea in 12 months. It is to be remembered that the time of 18 months is only indicative. However, she is taking the risk that if she does not complete her competencies, she will get an outcome 3 to extend her training. Risk can be mitigated by completing Level 4 Cataract Surgery.
It is highly probable that most trainees would have done Level 4 Cataract Surgery by the time they are finishing the rest of the Level 3 competencies. That would allow them to do Level 4 in Paediatric Ophthalmology and Ocular Motility if this can be facilitated. This is no different to current arrangements where it is very unlikely that a single Fellowship will offer Paediatric Ophthalmology, Ocular Motility and Cataract Surgery. The additional advantage will be that all of this can be completed within the CCT envelope.
The second possibility is that the trainee does not complete Level 4 Cataract Surgery by 5.5 or 6 years of training and has then to do Cataract Surgery and one other (Paediatric Ophthalmology or Ocular Motility) in the last 1-1.5 yrs. In that scenario, the trainee may take up a post-CCT Fellowship to get the additional training in either or both of these SIAs. This will not reduce their total training time but is very likely to allow them to be trained at a higher level than currently.
The final situation is where a trainee may not want to do Cataract Surgery at all and just does Level 4 in Paediatric Ophthalmology and Ocular Motility. This should be achievable in Level 4 within the CCT with the big advantage of not wasting the trainee’s and trainers’ time doing cataract theatres in the last 1-1.5 yrs.
The above are also applicable to any other combinations of Level 4 that trainees may wishes to do.
It might be possible to complete Level 4 Cataract Surgery first, or it could be that Paediatric Ophthalmology and Ocular Motility can be timetabled for the same 18-month period.
The issue of a post-CCT Fellowship vs. Level 4 is relevant to the Deanery or region as a whole and not specific units. The idea is that there should not be a situation in any rotation where a Fellowship in a particular SIA is available but, at the same time, a Level 4 post is not. This is to prevent Deaneries continuing to offer post-CCT fellowships in preference to providing Level 4 training. In the case where Trusts in a region appoint to a fellowship locally and refuse to provide Level 4 training, the HoS should discuss this with the DME who may consider withdrawal of fellowships. This may not be enforceable (certainly not from the RCOphth) but the DME should consider that the trainees of the region are being deprived of training in preference to other doctors. This would only be required if the Deanery could not provide that Level 4 SIA anywhere in the Deanery which is unlikely to be the case.
