The COVID-19 pandemic has caused unprecedented disruption to ophthalmic specialist training in the United Kingdom (UK). The need to increase ward and critical care capacity and limit COVID-19 transmission has led to the suspension of elective surgery for an estimated 12 weeks [1], a significant reduction in outpatient activity and the postponement of The Royal College of Ophthalmologists postgraduate examinations [2]. Many ophthalmic trainees have been redeployed to other specialties to help cope with the extra workload posed by COVID-19. Ophthalmic congresses worldwide have been cancelled, resulting in a loss of face-to-face teaching opportunities.

We surveyed ophthalmic trainees across the UK, via a self-administered anonymous online survey, to assess their views on the impact of COVID-19 on training. Responses were collected over a 1-week period (14/05/2020–21/05/20). Questions focused on redeployment, aspects of training likely to be affected and what could be done to improve training. Trainees were also asked about their opinion on alternative teaching methods (e.g., webinars) and whether their mental health was affected. A free text option for additional comments was also included.

A total of 111 trainees completed the survey (Fig. 1a, b). Forty-three trainees (39%) were redeployed to specialties outside of ophthalmology, with 33 (77%) concerned about the impact of redeployment on training (Fig. 1c). Ninety-six trainees (86%) were concerned about the impact COVID-19 would have on training (Fig. 1c). The most common concern was cataract surgery (n = 89, 80%; Fig. 2a). A sub-analysis by level of seniority revealed differing priorities for junior and senior trainees (Fig. 2b). Trainees’ opinions on webinars were positive although a significant proportion of trainees felt their mental health had been negatively impacted by COVID-19 (Fig. 2c). Suggestions on how training could be improved during COVID-19 included more simulation and wet lab opportunities along with intensive cataract surgery training when possible.

Fig. 1: Demographics of surveyed ophthalmic trainees.
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a Which deanery do you work in? b What grade of doctor are you? c Were you redeployed? (If yes, are you concerned about the impact redeployment will have on your training?). Are you concerned about the impact the COVID-19 pandemic will have on your training?

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Fig. 2: Impact of COVID-19 on training (WpBA, Workplace-Based Assessment; BSTs, basic surgical trainees, ST1-3; HSTs, higher surgical trainees, ST4+; TSC, trainee selected component).
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a What aspect of your training are concerned about? (Select all the apply). b What aspect of your training are you concerned about the most? (select ONE only). c What are your thoughts on using webinars as a way of delivering teaching/learning? Would you like webinars continue once the pandemic is over? In what way has COVID-19ʼs impact on ophthalmic training affected your mental health?

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Our survey highlights the many concerns faced by UK ophthalmic trainees. It is perhaps unsurprising that cataract surgery is their biggest concern, especially for those in earlier stages of training. Trainees are expected to have completed a minimum of 350 phacoemulsification cataract procedures by the end of training and to have experienced “a full range of clinical situations” and be “competent in managing complications” [3]. Senior trainees were more likely to be concerned about the postponement of examinations and achieving all workplace-based assessments, possibly related to limited time remaining in training. They were also less likely to be concerned about the effect of COVID-19 on their training compared to junior colleagues.

COVID-19 has forced a change in how medical education is delivered with a surge in online teaching and webinars, as a way of supporting academic continuity during the pandemic. Our cohort of trainees expressed positive support for this new method of distance learning, with a desire for continuation once the pandemic is over.

Like the wider profession, there is much uncertainty over how things will prevail. Ongoing contingency plans will need to be in place to minimise the impact of COVID-19 and address the multifaceted nature of training.