For nearly a decade, cataract outsourcing by hospitals has been noted to have an adverse effect on cataract training.1 Outsourcing companies often have stringent exclusion criteria that exclude the cataracts with significant comorbidities or technical difficulties. These more complex cataracts are then left to be carried out in NHS hospitals and often end up on training lists. Sparrow et al2 found that case mix is a major determinant of the probability of an intraoperative complication. Posterior capsule rupture (PCR) being the benchmark intraoperative complication. A senior house officer (ST1–2) was found to have an odds ratio of 3.53 (2.93–4.26) of having a PCR compared with a consultant (1.00).2 A recent audit at the Royal Gwent Hospital where outsourcing took place, found that 90 out of 134 (67%) cataracts on training lists were deemed not suitable by a consultant for an ST1–3 to operate on. Only 27% (36/134) of the cataracts on training lists were operated on by the trainees (ST1–5). The majority of which 61% (22/36) were carried out by ST4–5. A retrospective audit of the same time period prior to outsourcing occurring found that 14 more cataracts were performed by trainees the year before who actually had one ST5 less. Heads of deanery and Programme Directors should be aware of which hospitals in their deanery are undertaking outsourcing of cataracts and appropriate adjustments undertaken. That may involve placing more senior trainees in those hospitals that may benefit them by doing more challenging cases. A recent article in College News chronicled the experience of Severn Deanery trainees attending Emerson’s Green treatment centre.3 They reported a positive experience doing more cataracts than their NHS colleges (8.7 vs 2.8).3 However, the treatment centre also has an exclusion criteria of trainees in years ST2 and below. Therefore, the trainees most affected by outsourcing in the area seem to be the most junior (ST1–2). The College should be aware of the impact which outsourcing is having across the UK and guidelines be given to all Deaneries on potential adaptations that can be made to minimise the effect of outsourcing on cataract training.
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Burke T, McVeigh K, Anthony T . Phacoemulsification training in an independent sector treatment centre (ISTC): The severn deanery experience. Royal College of Ophthalmologists College News, Quarterly Bulletin. Autumn 2015; p 19.
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Wijetilleka, S., Yeo, C., Roberts, A. et al. The impact of outsourcing on cataract training in the UK. Eye 31, 827 (2017). https://doi.org/10.1038/eye.2017.35
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DOI: https://doi.org/10.1038/eye.2017.35