Introduction

The recently published Royal College of Ophthalmologists (RCOphth) Workforce Census 2018 has highlighted that there is a severe shortage of ophthalmologists to meet the growing demands for this service. The sub-specialties that are particularly affected are medical retina, glaucoma and paediatrics, with 73% of advertised paediatric ophthalmologist posts unfilled [1].

The North East Deanery paediatric ophthalmology training consists of a six-month paediatric ophthalmology rotation during Ophthalmic Specialty Training (OST) year three to six with no prior exposure to any formal paediatric ophthalmology training.

An 18-item questionnaire-based survey was sent out in 2019 to all ophthalmology trainees in the North East Deanery to explore the dissuading factors from pursuing paediatric ophthalmology. Trainees who expressed no interest towards paediatric ophthalmology were required to numerically rank the reasons for this from 1 (most likely reason) to 7 (least likely reason). The rankings were analysed using the Borda Count System. We also examined trainees’ perspective on early supernumerary exposure in paediatric ophthalmology and how this would affect their interest in paediatric ophthalmology.

Results

We achieved a 100% response rate from 29 ophthalmology trainees in the North East Deanery. 72.4% (21/29) of trainees indicated that they were not interested in paediatric ophthalmology (Fig. 1). The top three reasons for this were difficulty dealing with anxious parents, difficulty performing a paediatric ophthalmology examination and no interest in the subject of paediatric ophthalmology. Other reasons in descending order were lack of teaching, do not like children, no interest in paediatric surgery, and lack of private work (Fig. 2). Free text reasons stated were risk of litigation, difficulty performing paediatric refraction, no interest in Retinopathy of Prematurity screening, and fear in managing premature babies.

Fig. 1
figure 1

Trainees’ attitude towards paediatric ophthalmology as a career, and how this may change with early supernumerary exposure in OST year 2

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Fig. 2
figure 2

The perceived barriers towards choosing paediatric ophthalmology as a subspecialty among ophthalmology trainees in the North East Deanery. Results shown as points from the Borda Count System

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An overwhelming majority of the trainees (27/29) agreed that formal paediatric ophthalmology training should be started early as a supernumerary at OST year 2. 62.1% (18/29) of trainees felt that their interest in paediatric ophthalmology would increase if they had early supernumerary experience at OST year 2; 11 of them belong to the “no interest” group (Fig. 1).

Comments

We believe this is the first survey conducted in the United Kingdom to understand the perceived barriers towards choosing paediatric ophthalmology as a career amongst trainees.

A similar study performed among Indian trainees has also shown the difficulty in performing a paediatric ophthalmology examination as a main barrier for not pursuing paediatric ophthalmology [2]. To reduce the fear towards approaching children and to increase confidence in performing a paediatric ophthalmology examination, trainees can be prepared for this through early supernumerary exposure with well-structured strabismus and paediatric ophthalmology teaching. Supernumerary exposure will remove the time pressure and responsibility in clinics and allow learning at the trainees’ pace.

Interestingly, nine trainees have not had their rotation in paediatric ophthalmology but felt that their interest would increase with early exposure. This is suggestive that they may be still uncertain about their career choice and therefore, with early exposure coupled with adequate support, it might be possible to attract these trainees towards paediatric ophthalmology [3].

Members of the North East Trainee Research in Ophthalmology Network (NETRiON)

Tejaswi Bommireddy, Charlotte Bruce, Mark Cachia, Muhammad R. Cheema, Yanmei Chen, Yunzi Chen, Sinead Connolly, Alan Cunningham, Holly J. Duncan, Michael Grinton, Matthew Hartley, Elizabeth Hill, Jeffry Hogg, Rehab Ismail, Lyudmila Kishikova, Michael McKenna, Ankur Mehta, Jia Y. Ng, Yewande Olaoye, Romeela Rana-Rahman, Salman N. Sadiq, Thomas Salisbury, Chathu D. Silva, Samuel Simpson, Shweta Singh, Emma Spowart, Javid Suleman, Esther T.M. Ting, Maria Vrahimi.