Sir,

We would like to thank Turnball and Lash for their study on ‘Confidence of ophthalmology trainees in the management of posterior capsule rupture and vitreous loss’1 and for drawing attention to the importance of training in the management of complications in cataract surgery.

Their study illustrates that confidence in dealing with the complications of cataract surgery cannot be acquired by simply performing 350 cataract procedures and they express a view that ‘a competency based assessment framework of assessment in cataract surgery, instead of the current numerical goal of 350 is required.’

The Royal College of Ophthalmologists Curriculum for Ophthalmic Surgical Training (http://curriculum.rcophth.ac.uk) in the UK is competency based.

The 350 cases required during training in the UK are not a goal, but a minimum number felt necessary to acquire surgical skills; and the minimum number required to have a meaningful continuous audit of complications.

Developing competence is assessed annually using a specific Objective Assessment of Surgical and Technical Skills (OSATS) assessment and feedback tool (http://curriculum.rcophth.ac.uk/assessments/osats). It is mandated that this tool be used on at least 2 occasions per year with a senior trainer, although more frequently is recommended. The tool includes the recording of the difficulty of the case and it is expected that increasingly complex cases will be undertaken as training progresses; these assessments are reviewed at the Annual Review of Competence Progression (ARCP); satisfactory progress is essential for the trainee to continue to the next year of training.

The Learning Outcome (SS4; http://curriculum.rcophth.ac.uk/learning-outcomes/surgical_skills/ss4), this tool assesses, includes the requirement to ‘be able to manage intra-operative and post-operative complications’.

We agree with the authors that given the low rates of surgical complication,2 this competence may not be developed in the in vivo situation and the curriculum is explicit in the use of simulation to teach and assess such skills.

In short, all trainees should have satisfied this learning outcome and be able to deal with complications before a Certificate of Completion of Training is recommended by their ARCP panel.

Outcomes of cataract surgery are also assessed by separate audit.