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									            MMC
Ophthalmic Trainees Perspective



                                  Amit Patel
                       SpR – Ophthalmology
                     OTG Representative RCO
                     Views
•   Medical Students
•   SHOs
•   SpRs
•   Ophthalmic Trainees Representatives
•   Websites
    – Success in MRCOphth
    – Doctors.net forum
• SAS
• Consultants
                  Training
• Undergraduate
• Postgraduate
              Undergraduate
• Change in
  – Entry requirements
  – Length of training
  – Curriculum content
               Undergraduate
• Entry requirements
• Chemistry
  –   Maths, Biology, Physics
  –   Arts – ‘trendy’
  –   1 science (5 schools)
  –   AAB - ABB
             Undergraduate
• Length of training
  – 5 years (6 if pre-med)
  – Fast Track Medical Schools - 4 years (13
    schools)
  – 3 years (2 Private med schools)
             Undergraduate
• Curriculum
  – Traditional   Anatomy                              Medicine
                  Biochemistry                         Surgery
                  Physiology                           Psychiatry
                                 Pre-
                  Psychology                Clinical   Paediatrics
                                 clinical
                  Sociology                            Obs / Gynae
                  Statistics                           ENT
                                                       Ophthalmology
                                                       Dermatology
                                                       Etc

  – New           PBL
                Undergraduate
• Ophthalmology
  – Questionnaire Survey
  – 26 of 30 (87%) schools responded
  – Questions related to:
     •   Time allocated to ophthalmology
     •   Content of Curriculum
     •   Teaching methods
     •   Assessment
                   Undergraduate
• Results:
   – Time allocated – 1-2 weeks (<1.5%)
      • Optional in 3 schools
   – Curriculum:
      •   Cataract & Fundoscopy – universal
      •   No DR (2 schools)
      •   No VF (4 schools)
      •   No ARMD (5 schools)
      •   No DR or Glaucoma (2 schools)
      •   No Hypertensive r’pathy (11 schools)
              Undergraduate
• Results:
  – Teaching methods:
     • Small group – universal
     • +Lectures (21 schools)
     • PBL, Self-directed, Computer-aided (5 schools)
  – Assessment:
     • MCQ’s, OSCE (13 schools)
     • Clinical exam (10 schools)
                  Undergraduate
• Issues:
   – Standardised curriculum
   – ‘Training the Trainers’ (46.5% SpR’s, 39.6%
     Consultants – satisfied with their teaching abilities.)
   – Local curriculum
      •   Anatomy – ‘FB in the pupil’
      •   Visual acuity – ‘24/6’
      •   Pupils – ‘somewhat sluggish’
      •   Blepharitis etc
                  Training
• Undergraduate
• Postgraduate
                     The Change


Med school   HO          SHO            SpR                   Cons

5-6 yrs      1 yr        2(3.5) yrs     4.5(5.5) yrs        [8-9 yrs]



Med school   F1 F2       Run Through Grade    Cons          Specialist


? 3-4 yrs    2 yrs           7 yrs            [7 yrs]   ?
 Optional     4 Months
                         Concerns
•   What happens when my contract ends?
•   Non-training grade?
•   Rush into the old system?                           ?!!
•   Await OST because they will want experienced SHOs
•   What happens if I take time out for research?
•   Previous experience doesn’t count!
•   What transferable skills will I have?
•   How will on calls change?
•   More paperwork??
•   Supernumery F2! – impact on clinics?
•   Sub consultant grade?
•   F2 taken by
•   ………
                Concerns
•   Jobs (now & future)
•   Exams
•   Training
•   Service commitments
UK MMC Career Framework Proposal
Continuing Professional Development



                                          Senior Medical Appointments


                                            Specialist and GP Registers
                            CCT                                              Article 14/11
                           route                                             route
  Specialty training in               Postgraduate Medical Training       Continuing Professional Development
  Specialty/GP training
  “schools”




                                                                                  Career
  Specialist and GP training programmes
          (Run-through training)
                                                                                   posts

                                                        Fixed term
                                                         specialist
                                                          training



 Foundation training in
 foundation schools

                             F2
                             F1
Undergraduate medical training
in medical school
                                                                             Arrows indicate competitive
            Medical school – 4-6 years                                            entry
                              Jobs


Med school   HO         SHO           SpR            Cons

5-6 yrs      1yr       2(3.5)yrs      4.5(5.5) yrs



              >300:1    300          100             46


                       400    160
                               Jobs

                                                 CCT
Med school   F1 F2        Run Through Grade               Cons


                                                       Article
                                                       14
       Fixed Term Specialist      Career Posts
       Training
                                      Jobs

                                                             CCT
Med school      F1 F2            Run Through Grade                    Cons


                                                                   Article
                                                                   14
        Fixed Term Specialist                Career Posts
        Training
  Current SHOs ?400                             ? New Lost tribe
  Duration, end of contract?
  Training structure ?special competencies
  -ve impact on future job applications
                                Jobs

                                                       CCT
Med school   F1 F2         Run Through Grade                    Cons


                                                             Article
                                                             14
       Fixed Term Specialist            Career Posts
       Training

                    ? Competencies
                    Preference to F2/ FTST
                               Jobs

                                                 CCT
Med school   F1 F2        Run Through Grade               Cons


                                                       Article
                                                       14
       Fixed Term Specialist      Career Posts
       Training
                               Jobs

                                                        CCT
Med school   F1 F2        Run Through Grade                      Cons


                                                              Article
                                                              14
       Fixed Term Specialist      Career Posts
       Training
                                  Skills Gap
                                  ? Drop out from RTG
                                  ? Support available
                                  Change specialty
                               Jobs

                                                 CCT
Med school   F1 F2        Run Through Grade                    Cons


                                                         Article
                                                         14
       Fixed Term Specialist      Career Posts    No of Jobs
       Training
                                                  Job Security
                                                  (ISTC impact)
                                                  ? Specialist training
                                                  after
                               Jobs

                                                 CCT
Med school   F1 F2        Run Through Grade               Cons


                                                       Article
                                                       14
       Fixed Term Specialist      Career Posts
       Training

                    Overseas
                    candidates           Research
                Concerns
•   Jobs (now & future)
•   Exams
•   Training
•   Service commitments
                     Exams
• Change from 4 to 3
• New format from October 2006
• Concerns re:
  – Changeover
  – Planning
  – Attaining jobs
Routes to obtain Fellowship of the Royal
College of Ophthalmologists                                                                   New candidate
Part 1 MRCOphth
The last sitting is October 2006 for
this examination. You will need to
have passed to continue with this                                                                                       FAILED - If you have not passed
                                                                                            Part 1 FRCOphth
format.                                       FAILED - If you have not passed                                           this examination by the end of year
                                                                                          Starting in October 2006      2 in OST.
                                              this examination in the last sitting in
                                              October 2006 you will automatically
PASSED Part 1 MRCOphth                        start the new examination structure.


                                                                                                                        FAILED - If you have not passed
Part 2 MRCOphth                                                                                                         this examination by end of year 3 in
                                                                                          Refraction Certificate        OST.
                                                FAILED - If you have not passed           Starting February 2007
The last sitting is November 2008 for this      this examination in the last sitting in
examination. You will need to have passed       November 2008 you will
this examination to continue with this          automatically start the new
format.                                         examination structure.

                                                                                          PASSED - Part 1 FRCOphth
                                                                                          and PR Certificate
PASSED Part 2 MRCOphth


Part 3 MRCOphth                                 FAILED - If you have not passed
                                                this examination in the last sitting in
The last sitting is September 2008 for this     September 2008 you will
examination. You will need to have passed       automatically start the new
                                                                                               Part 2 FRCOphth
this examination to continue with this          examination structure at the Part 2
                                                                                                                         FAILED - If you have not passed
format.                                         FRCOphth.
                                                                                               Starting Autumn 2008      this examination by the end of year
                                                                                                                         7 in OST.


PASSED Part 3 MRCOphth
- MEMBERSHIP

                                                                                             PASSED - Part 2 FRCOphth
Fellowship Assessment -
FELLOWSHIP

                                                                                                     FELLOWSHIP
                  Exams
• Adequate overlap?
• Will pass rates change with job demand?
• No pressure to move from one system to
  another
• Fellowship assessment as long as required
• Changes likely – check college website
  – http://www.rcophth.ac.uk/exams/
                          Exams
• ………..similar to the current Part 3 MRCOphth exam but this
  examination will be assessed at a much higher level. Candidates
  are expected to demonstrate a depth of knowledge and
  understanding expected of an independent specialist
  (consultant).

• ……assessed in skills such as the use of removing/tying sutures,
  nasolacrimal duct syringing, setting up instruments such as
  phaco machines, visual field analysers etc. …..
                Concerns
•   Jobs (now & future)
•   Exams
•   Training
•   Service commitments
                  Training
•   Apprenticeship  Course
•   ‘Emergency safe’ practitioners
•   Tick boxes (both sides)
•   EWTD & New Deal ‘squeeze’

• Modernising medical careers: an open letter to
  Royal College Presidents. Osborne J JRSM 2006
  99: 56-57
        Training

 Run Through Grade


Part 2 FRCOphth after Year 4

 Part 3 MRCOphth


SHO             SpR

2 yrs             4.5 yrs
                Concerns
•   Jobs (now & future)
•   Exams
•   Training
•   Service commitments
                        Service
• SpR/SAS/Cons
• Collapse of the on call rota?
• F2 Supernumery – Impact on:
  – clinics
     • Fewer seen
     • Slower clinics
  – SHOs/OST, SpRs
                     The Change


Med school   HO          SHO            SpR                   Cons

5-6 yrs      1 yr        2(3.5) yrs     4.5(5.5) yrs        [8-9 yrs]



Med school   F1 F2       Run Through Grade    Cons          Specialist


? 3-4 yrs    2 yrs           7 yrs            [7 yrs]   ?
 Optional     4 Months
      ? The Future Consultant




Fast-Track   Foundation   Run Through
Med School   Years        Grade
Thank You

								
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