SPECIALTY TRAINING PROGRAMME IN OPHTHALMOLOGY IN WESSEX DEANERY

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1 SPECIALTY TRAINING PROGRME IN OPHTHALMOLOGY IN WESSEX DEANERY This is a 7 year training programme in Ophthalmology at ST1 aimed at doctors who can demonstrate the essential competences to enter this level of training. The programme is designed to support training for a CCT in Ophthalmology. Details of essential competences and qualifications are detailed in the MMC person specification for Ophthalmology at ST1 which is available from It is anticipated that completion of this training programme, subject to satisfactory progression at the ARCP, will lead to a CCT or CESR (CP) in Ophthalmology. The programme is based in hospitals in the Wessex Deanery including: HOSPITAL North Hampshire Hospital The Royal Bournemouth Hospital St Mary s Hospital Queen Alexandra Hospital Salisbury District Hospital Southampton General Hospital Royal Hampshire County Hospital LOCATION Basingstoke Bournemouth Isle of Wight Portsmouth Salisbury Southampton Winchester Wessex Deanery is a relatively small deanery with a defined geographical area which does lead to there being a single unit of application. In the majority of cases successful candidates will be asked to preference their choice of location for either one or two years. Some specialties will require successful candidates to preference both commencing location and specialty. Future placements will be based, as normal, on individual training and educational needs. Please note that applications are to the Wessex Deanery as a whole. This may mean that you may be allocated to any geographic location within the Wessex Deanery depending on training needs. The Wessex Deanery covers a geographical area from Basingstoke in North Hampshire to Dorchester in West Dorset and the Isle of Wight to the South; in addition some programmes rotate to Jersey and Chichester in West Sussex. This is a spread of approximately 65 miles North to South and 76 miles East to West. The Wessex Deanery serves a population of around 2.8 million people. The Wessex Deanery is part of South Central Strategic Health Authority which covers Berkshire, Buckinghamshire, Oxfordshire in the north (under Oxford Deanery) and Hampshire and Isle of Wight. In addition, Wessex Deanery provides training programmes within Dorset and South Wiltshire under a formal agreement with the South West Strategic Health Authority. The Wessex Deanery is responsible for the training of some 2,500 trainees. Rotation Information Trainees work with the Consultants and staff of the Units involved, each of which has a Royal College of Ophthalmologists Tutor responsible for the local programme. The training

2 programme rotation will be based on the following guidelines, but there may be some individual variation from this depending on existing staffing levels. The first half of the Training Programme (Years 1 and 2) Trainees will usually be posted for a year at a time to either a district general hospital or a teaching hospital. The second half of the Training Programme (Years 3-7) The last 2 to 2½ years will normally be spent in either Southampton and/or Portsmouth. At least one of the last 2 to 2½ years will usually be spent at Southampton. The Specialty Training Committee (STC), in conjunction with the Postgraduate Dean, will be responsible for the supervision and structure of the programme. Any variation must be approved by the STC in advance. Requirements for the SpR Grade and Enrolment into Higher Specialist Training The applicant for the post of Specialist Registrar should normally have completed two years as an SHO in Ophthalmology and have passed the MRCOphth or equivalent. On appointment to the grade through the requisite appointments procedure run by the Postgraduate Dean, a Specialist Registrar will be allocated a National Training Number (NTN) guaranteeing a continued place in the training programme, subject to satisfactory progress. The final placement will end six months after the date of completion of training, or six months after notification of completion of training, whichever is the later. In exceptional circumstances the Postgraduate Dean may recommend a new fixed term contract. In addition, once appointed to the post, the trainee must immediately apply for enrolment into Higher Specialist Training (HST). This is done by application to the Higher Specialist Training Committee in Ophthalmology (HSTC) at the Royal College of Ophthalmologists. Flexible Training Arrangements for those applicants wishing to pursue flexible training in HST will be addressed after they have been appointed to a Specialist Trainee post in open competition. Flexible training trainees will be required to complete the content of the training programme and achieve the same level of clinical experience as full-time trainees. The minimum number of weekly sessions should be five; it is normal for six sessions to be worked. The length of training will be proportional to the number of weekly sessions. Study and Training The primary aim of all posts is the training programme developed and there is a region wide syllabus and minimum standards of education agreed by all Trusts within the rotation. The Deanery is committed to developing postgraduate training programmes as laid down by GMC, Colleges and Faculties and by COED - the Postgraduate Deans Network. At local level college/specialty tutors work with the Programme Director and Directors of Medical

3 Education in supervising these programmes. Trainees will be expected to take part in these programmes (including audit) and to attend meetings with their nominated educational supervisor. All posts within the training programme are recognised for postgraduate training by the General Medical Council (GMC) in accordance with their standards for training. Study leave is granted in accordance with Deanery/Trust policy and are subject to the maintenance of the service. All posts have a service element and the following covers the majority of duties. There will be minor variations in different hospitals but the list is aimed at covering the majority of duties: 1. Supervise, monitor and assist the House Officer (F1) in the day-to-day management of in-patients in posts with an attached F1. 2. Liaise between nurses, F1 and F2 Doctors, patients, relatives and senior medical staff. 3. Attend and participate in ward rounds as timetabled 4. Attend outpatient clinics. 5. Take part in rostered emergency work. 6. Dictate discharge summaries. 7. Study for higher examination and maintain continued professional development. 8. Attend weekly educational and multidisciplinary sessions. 9. Undertake audit at various times throughout the rotations. 10. Teach medical students as directed. 11. Co-operate with members of the personnel department when monitoring hours of work and other personnel issues. 12. Attend induction in each hospital or new department 13. Comply with all local policies including dress code, annual and study leave Trust Information Isle of Wight Background The Isle of Wight has a fixed resident population of 150,000. This doubles in the summer period through tourism. There is an elderly population skew giving us a higher incidence of Ophthalmic pathology within the Island population. Staff 3 Consultants: 1 Specialist interest Glaucoma 1 Specialist interest Oculoplastics and Ocular Oncology 1 Specialist interest Medical and Surgical Retina

4 4 middle grades: 1 Associate Specialist, Special interest in Childhood Squints 2 Full time Staff Grades 1 Part time Staff grade Wessex Deanery 2 Full time Orthoptists 11 Full time nursing staff, 5 with specialist ophthalmic training 2 P/T Optometrists Outpatients Well-equipped Outpatient Facilities with further expansion planned for later this year. 15,000 Outpatient episodes per year. Each clinic profile allows for between 10 and 12 booked episodes of mixed old and new patients. One-stop Cataract clinics for new cataract referrals, with medical assessment and biometry within a single visit. The cataract waiting list is 3 months. Retina clinic for Age Related Macular Degeneration and surgical Vitreoretinal (VR) problems. Diabetic clinic for assessment of diabetic retinopathy. A Laser clinic exists for posterior segment laser including Panretinal photocoagulation (PRP), Focal, Grid and Transpupillary thermotherapy (TTT). We have indirect laser facilities and micropulse 810nm diode laser in addition to conventional argon and yag lasers. Currently establishing dedicated primary care clinics. Oculoplastics and Lacrimal clinic. Glaucoma clinic. There are 6 general clinics each week. We have a new digital camera within the department. There is now a dedicated FFA clinic and also a diabetic screening program combining mobile and static photography. The outpatient department also has two Humphrey visual field analysers, A and B scan facilities, autorefraction and focimetry. Theatre We perform in excess of 1200 cataract operations per year, 200 oculoplastics and lacrimal procedures and 150 VR operations. There are currently 6 main theatre lists per week, although this is likely to increase over the coming year with good prospects for acquiring a dedicated eye theatre. We have a modern ceiling mounted microscope with co-axial assistants eyepieces, camera and VCR.

5 There is an Alcon legacy Phaco machine and a new Alcon Accurus Vitrectomy machine. We currently offer a single dedicated VR list, offering all manner of VR procedures apart from 360-degree retinal translocation. Similarly an Oculoplastics list offers the entire spectrum of plastics and lacrimal procedures. On Call There is one general GA list for Squints and glaucoma drainage surgery Three LA high volume cataract lists. We have a separate minor-ops lid list run by the middle-grades. The IOW however is very quiet out of hours. We can be very flexible with regards to trainee on-call commitments to ensure EWD compliance. Accommodation will be available if required for on-call. Excess travel expenses will be covered. Example Timetable Monday Theatre (VR) Admin Tuesday General OPD Theatre (Cataracts) Wednesday Theatre (Plastics) Retina OPD Thursday Research Plastics OPD Friday Laser OPD Teaching I would anticipate an SpR achieving at least 2 cataract procedures per week and potentially more depending on ability and experience. This would also apply to basic VR and oculoplastics procedures (Indirect laser, cryo, intravitreal steroid, entropion, ectropion). The timetable is very flexible and could be tailored to meet the needs of any individual SpR. Teaching / Audit/ Research There will be ample opportunity each week to attend Southampton UH for regional teaching. An early departure on Fridays would be permitted to attend the Friday afternoon teaching. Once a month we have local departmental teaching, which includes Audit, Journal club and case presentation. One hour per week is dedicated to reporting and discussing departmental Fluorescein angiograms.

6 There is a well-developed Postgraduate centre here with a library that currently stocks BJO, Eye, Ophthalmology and Retina Journals. There are multiple terminals with Internet access. The Postgraduate centre has a very active social and academic calendar. In our redevelopment of the department we plan to have a dedicated study area for the middle grade staff with Internet access. There will be many opportunities within the department to become involved in Audit and research. There will also be opportunities to be involved in training of local A and E doctors in addition to departmental ancillary staff. Summary The Isle of Wight Eye Department has undergone a number of very significant changes over the last year following the appointment of two new consultants. We now have the sub-specialist infrastructure required to deliver training at SpR level and we are extremely enthusiastic at the prospect of developing this post subject to approval by the Royal College of Ophthalmologists training committee and our own regional Specialist Training Committee. Portsmouth Hospitals NHS Trust The Eye Unit In 1993 the Eye Department was relocated in refurbished accommodation on B level of the main hospital. The department has a dedicated Day Surgical Unit for Ophthalmology. It incorporates two Eye Procedure Suites for intraocular surgery and a third suite for extra-ocular procedures. The main Eye theatre is located within the main theatre complex on E level and will still be used for general anaesthesia cases. All theatres are equipped with Millenium Phacoemulsification systems. The main theatre has a ceiling-mounted microscope and also has full vitrectomy equipment and closed-circuit television. Inpatients are admitted to the combined Head and Neck Unit There is a modern well-equipped outpatient department with a laser/ photographic suite. The Department has recently appointed a full-time Medical Photographer (digital camera system, digital video editing). There is a Direct Access Clinic during normal working hours and out-of-hours eye casualties are seen in the main Accident and Emergency Department. The Eye Department has a specially designed Orthoptic clinic. The four Orthoptists also hold Community screening clinics. There is a Contact Lens clinic, manned by visiting Optometrists. A Paediatric refraction service is also provided by visiting Optometrists. There is a Low Vision Aids clinic. The role of Ophthalmic Medical Assistant is well developed in Portsmouth. Each Consultant has his/her own full-time OMA who works flexibly and independently with each Consultant. All patients attend preoperative assessment clinics, whether they are day case or inpatient. There is regular attendance by a Consultant Ophthalmologist at the Special Care Baby Unit at St Mary s Hospital, where all low-weight babies are examined and, when necessary, followed in the Eye Department. The Eye Department enjoys close links with the other Departments in the

7 Trust. In particular there is an established link with the Diabetic Department at Queen Alexandra Hospital. Prints from the non-mydriatic fundus camera are reviewed in our Department, following which some patients are referred for more extensive eye examination and for Argon laser treatment. Assessment by Opticians of diabetic eyes has been a recent development and such patients can now be referred directly to the Eye Department when urgent treatment is indicated. There is an in-house Wet Lab facility and separate seminar room with excellent audio-visual facilities. There are weekly departmental teaching sessions (Wednesday afternoon), including a monthly ocular pathology session. The Staff 9 Consultants 3 Staff Grades 2 Hospital Practitioners 10 Clinical Assistant Sessions 4 Specialist Registrars 4 Senior House Officers Example Timetables Specialist Trainee 1 Monday Casualty Clinic Tuesday Study Theatre Wednesday Oculoplastic Clinic Teaching Thursday Clinic VR Clinic Friday Study Theatre Specialist Trainee 2 Monday Theatre Clinic Tuesday Casualty Clinic Wednesday Glaucoma Clinic Teaching Thursday Study Study Friday Minor Ops/Laser Theatre Specialist Trainee 3 Monday Paediatric Theatre Study Tuesday Clinic Study Wednesday Laser Clinic Teaching Thursday Theatre Vit Ret Clinic

8 Friday Clinic Paediatric Clinic Wessex Deanery Specialist Trainee 4 Monday Clinic Study Tuesday Theatre Minor Ops Wednesday Glaucoma Clinic Teaching Thursday Laser Clinic Study Friday Theatre Paediatric Clinic Royal Bournemouth and Christchurch Hospitals NHS Trust The Bournemouth Eye Unit The Bournemouth Eye Unit has 13 beds, 3 paediatric beds and a day care cataract unit. It covers the area of East Dorset and a population of about 482,000 largely concentrated in the coastal urban area stretching from Highcliffe and Christchurch through to Bournemouth and Poole. The other main hospitals are the Royal Bournemouth, a new acute hospital with the Accident and Emergency Department and 680 beds, and Poole Hospital in the west of the district with 784 beds. The Staff 8 Consultants 5 Trainees 1 Associate Specialist 3 Staff Grade Officers - 2 full-time, 1 part-time 2 Clinical Assistants Example Timetable Rota 1 Rota 2 Monday Glaucoma Clinic Research Tuesday Casualty Theatre Wednesday General Clinic Research Thursday Corneal Clinic Theatre /Neuro Opth Friday Laser /Theatre Teaching Southampton Monday Casualty Theatre Tuesday Theatre Research Wednesday General Clinic External Disease Clinic / Minor

9 Ops Thursday Laser General Clinic Friday Orthoptics Research Salisbury Health Care NHS Trust Teaching Southampton Wessex Deanery The Eye Department The Ophthalmic Services are located at Salisbury District Hospital, Odstock. The Regional Plastic Maxillo-facial and Burns Unit is located in the hospital, as is the Duke of Cornwall Spinal Treatment Centre and the Regional Cytogentic Service. The Hospital serves an area of Wiltshire and Hampshire with peripheral clinics in Warminster and Devizes to the north and Shaftesbury to the west. The Eye Department serves a catchment population of about 165,000. The Unit is fully equipped with photography, angiography, ultrasonography, automated field and laser facilities. The Orthoptic Department functions full-time and there are Children s Screening Clinics on a regular basis. Prosthetic, contact lens, refractive and low vision aid clinics are provided regularly. The Staff 3 Consultants 5 Trainees (2 of whom are GP trainees) 2 Full-time Staff Ophthalmologists 1 Oculoplastic Fellow Example Timetable The timetable changes at 6-monthly intervals; an example timetable is given below: Rota 1 Rota 2 Monday Paediatric Clinic General Clinic Tuesday Theatre Theatre Wednesday General Clinic Lunchtime: Clinical Meeting Theatre Thursday OPD Oculoplastics Study Friday Study Regional Training Southampton Monday Paediatric Clinic General Clinic Tuesday Theatre Retinal Clinic/Laser Wednesday General Clinic Lunchtime: Clinical Meeting Study Thursday OPD Oculoplastics Theatre

10 Friday Study Regional Training - Southampton Southampton University Hospitals NHS Trust The Eye Unit Southampton Eye Unit has 24 beds and is located at the General Hospital (944 beds). The Eye Unit was purpose built in 1993 with all Ophthalmic Services, including Ophthalmic Casualty, in the one Unit. The open Moorfields design outpatients is fully equipped with diagnostic and laser facilities. There are twin Ophthalmic theatres (equipped for phaco-emulsification and vitreoretinal surgery) and a minor operations theatre in outpatients all with ceiling mounted microscopes. Video recording is available in theatre and digital angiography in outpatients. A full-time medical photographer works in the Unit. The Unit has its own Ophthalmic Library with a good range of computer software and facilities for literature searches and is backed by the Wessex Medical Library with on-line literature search facility which is on site. A professor has recently been appointed, and along with other new Consultants, the unit has increased its specialism in uveitis and retina. The strength of teaching is also with new Consultants having a dedicated session for postgraduate teaching. The Staff 14 Consultants 6 Senior ST3-7 (variable conversion to ASTOs) 4 junior ST1-2 (2 in Winchester Eye Department at any one time) 1 Associate Specialist 2 Staff Grade Officers (part-time) 7 Clinical Assistants (14 sessions) The Consultants provide peripheral clinics including Lymington, Highcliffe, Romsey, Coldeast and Hythe and are active in research themselves. There are close links with Winchester and SHOs at Southampton rotate through Winchester. There are plans to incorporate Winchester into the Southampton Specialist Trainee rotation. The main teaching session is that of a dedicated half day on Friday with case examinations and discussion, specific presentations and slots for Pathology, Genetics and other subjects. The 4.00 pm lecture is given by an invited, and usually outside, speaker. There is weekly vitreo-retinal teaching (Tuesday evening) and sessions on strabismus and oculoplastics monthly. Audit sessions are held regularly every other month. Specialist Registrars are expected to be fully involved in these sessions and are also asked to undertake undergraduate and postgraduate teaching. Example Timetable The Specialist Trainee timetable detailed below is currently subject to review: Rota 1 Monday Study/Diabetic Clinic OPD External Disease Tuesday OPD General Theatre Retinal Teaching (5.30) Wednesday Glaucoma Clinic/Theatre Study

11 Thursday Theatre Study/Paediatric Clinic Friday OPD General Postgraduate Teaching Rota 2 Monday General Clinic Theatre Tuesday Study OPD Macular Wednesday OPD General Study/Laser Thursday Strab OPD/Study Theatre Friday Research Clinic/Study Postgraduate Teaching Rota 3 Monday Study/SpR Theatre Study/Casualty Tuesday Neonatal Scr/OPD General Casualty/Macular Clinic Retinal Teaching (5.30) Wednesday Plastics Clinic/Study Study/Casualty Thursday OPD General/Theatre Study/Casualty Friday Theatre Postgraduate Teaching Rota 4 Monday OPD General Study Tuesday Theatre Theatre/Casualty Retinal Teaching (5.30) Wednesday Plastics Clinic Theatre/Study Thursday Diabetic Clinic/Study Study/Administration Friday Casualty/Diabetic Clinic Postgraduate Teaching Rota 5 Monday Neuro/Study Study/EED Clinic

12 Tuesday Casualty/Study OPD Vitreo-retinal Retinal Teaching (5.30) Wednesday Theatre Theatre/Study Thursday OPD General Casualty/Paediatric Clinic Friday Theatre/Study Postgraduate Teaching Rota 6 Wessex Deanery Monday Casualty EED Clinic/Study Tuesday Theatre Vitreo retinal Wednesday Study/Plastics Clinic Study Thursday Theatre/Study Theatre Friday OPD General Postgraduate Teaching Rota 7 Monday Theatre Theatre Tuesday Gen/Glaucoma Clinic Vitreo retinal Clinic Wednesday Theatre/Study Casualty/Study Thursday Study/Laser Paediatric Clinic Friday Study Postgraduate Teaching Other Features There are full opportunities for personal research and towards the end of training the Specialist Trainee will be expected to be responsible for the smooth running of the junior timetable and will attend the Directorate Management meetings. The post is principally based at the General Hospital although visits for consultation or occasional clinics will be required. Curriculum The 7 year programme should have specified time allocated to: Supervised attachments and teaching in the following areas: Acute Ophthalmology Medical Retina Medical Ophthalmology including inflammatory disease and Neuro Ophthalmology

13 Management of cataract Corneal and external eye disease Oculoplastics Glaucoma Ocular motility Paediatric Ophthalmology Management of lacrimal disorders Wessex Deanery Supervised surgical experience and appropriate pre- and post-operative management in: Cataract surgery including phakoemulsification Retinal surgery Glaucoma Squint surgery Lacrimal surgery Oculoplastic surgery Laser surgery Corneal surgery Training and experience in: Teaching of postgraduate and undergraduate students Audit Management Exposure to and experience of: Vitreoretinal surgery Ocular pathology Orbital surgery - this will vary according to the training needs of the Specialty Registrar The full curriculum for Specialty Training in Ophthalmology is available from the Royal College of Ophthalmologists website: Main Conditions of Service The posts are whole-time and the appointments are subject to: 1. The Terms and Conditions of Service (TCS) for Hospital Medical and Dental Staff (England and Wales) 2. Satisfactory registration with the General Medical Council 3. Medical Fitness You may be required to undergo a medical examination and chest x- ray. Potential applicants should be aware of the Department of Health and GMC/GDC requirements with regards to HIV/AIDS and Hepatitis viruses. Candidates must be immune to Hepatitis B. You will be required to provide, in advance of appointment, evidence of immunity or have a local blood test (as deemed necessary by the Occupational Health Department) 4. Right to work in the UK 5. Criminal Records Check/POCA check carried out by the Trust Medical HR department. 6. Pre-employment checks carried out by the Trust Medical HR department.

14 Hours The working hours for junior doctors in training are now 48-hours (or 52-hours if working on a derogated rota) averaged over 26 weeks (six months). Doctors in training also have an individual right to opt-out if they choose to do so, but they cannot opt-out of rest break or leave requirements. However, the contracts for doctors in training make clear that overall hours must not exceed 56 hours in a week (New Deal Contract requirements) across all their employments and any locum work they do. Pay You should be paid monthly at the rates set out in the national terms and conditions of service for hospital medical and dental staff and doctors in public health medicine and the community health service (England and Wales), the TCS, as amended from time to time. The payscales are reviewed annually. Current rates of pay may be viewed at ddental.aspx Part-time posts will be paid pro-rata. Pay supplement Depending upon the working pattern and hours of duty you are contracted to undertake by the employer you should be paid a monthly additional pay supplement at the rates set out in paragraph 22 of the TCS. The current payscales may be viewed at xx. The pay supplement is not reckonable for NHS pension purposes. The pay supplement will be determined by the employer and should be made clear in their offer of employment and subject to monitoring. Pension You will be entitled to join or continue as a member of the NHS Pension Scheme, subject to its terms and rules, which may be amended from time to time. Annual leave Your entitlement to annual leave will be five or six weeks per annum depending upon your previous service/incremental point, as set out in paragraphs of the TCS. The TCS may be viewed at Training-JuniorDoctorsTermsAndConditions asp Sick pay Entitlements are outlined in paragraphs of the TCS.

15 Notice You will be required to give your employer and entitled to receive from them notice in accordance with paragraphs of the TCS. Study leave The employer is expected to offer study leave in accordance with paragraphs of the TCS. Local policy and procedure will be explained at your induction. Travel expenses The employer is expected to offer travel expenses in accordance with paragraphs of the TCS for journeys incurred in performing your duties. Local policy and procedure will be explained at induction. Subsistence expenses The employer is expected to offer subsistence expenses in accordance with paragraph 311 of the TCS. Local policy and procedure will be explained at induction. Relocation expenses The employer will have a local policy for relocation expenses based on paragraphs of the TCS and national guidance at Training-JuniorDoctorsTermsAndConditions aspx You are advised to check eligibility and confirm any entitlement with the employer before incurring any expenditure. In addition to local policy there is Deanery guidance which can be viewed on Pre-employment checks All NHS employers are required to undertake pre-employment checks. The employer will confirm their local arrangements expected to be in line with national guidance at Professional registration It will be a requirement of employment that you have professional registration with the GMC for the duration of your employment. Health and safety All employers have a duty to protect their workers from harm. You will be advised by the employer of local policies and procedures intended to protect your health and safety and to comply with these.

16 Disciplinary and grievance procedures The employer will have local policies and procedures for dealing with any disciplinary concerns or grievances you may have. They will advise you how to access these, not later than eight weeks after commencement of employment. Educational supervisor The employer will confirm your supervisor on commencement. General information The Deanery s management of Specialty Training programmes, including issues such as taking time out of programme and dealing with concerns or complaints, is available at and in the national Gold guide to Specialty Training at