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Harmonizing ophthalmic residency surgical training across Europe: A proposed surgical curriculum

Eye volume 37, pages 3256–3262 (2023)Cite this article

Subjects

Abstract

Background

One of the core aims of the European Union of Medical Specialists is to harmonize training across Europe by creating European Training Requirements for all medical specialties including Ophthalmology. The theoretical part is already defined by the EBO, however as ophthalmology also includes surgical skills, we herein propose a surgical minimum curriculum for ophthalmology residents in Europe.

Methods

National and international ophthalmic training curricula which are publicly available in English were reviewed and compared. The final proposal was created from 5 criteria: 1. Disease prevalence; 2. Patient safety; 3. Case-trainee ratio; 4. Skill transfer; and 5. Technical difficulty.

Results

In total 7 different training curricula from across the world were compared. Among the surgical procedures, cataract surgery has the highest median number of procedures required to be completed during residency: 86 procedures (50–350). Followed by oculoplastics: 28 procedures (10–40) and panretinal photocoagulation: 27.5 procedures (10–49) Full procedural competence is proposed in 9 surgical skills, including YAG laser posterior capsulotomy, retinal argon laser, intravitreal injection, corneal foreign body removal, removal of corneal sutures, facial and periocular laceration repair, eyelid laceration repair, minor eyelid procedures, and punctal occlusion. These procedures are deemed essential and feasible for all ophthalmology residents in Europe to perform independently upon completion of their training.

Conclusion

This proposal should be regarded as a recommendation based on comparable surgical curricula in use worldwide to establish standards across European countries and may serve as valuable insight to those responsible for compiling ETRs for ophthalmology, or their national curriculums.

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Fig. 1: Disparities in surgical case numbers of cataract performed during training according to the analysed curricula.

Data availability

All data generated or analysed during this study are included in this published article.

References

  1. European Parliament and the Council of the European Union. EUR-Lex - 32005L0036 - EN - EUR-Lex [Internet]. Official Journal of the European Union. 2005 [cited 2022 Feb 16]. https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=celex%3A32005L0036

  2. European Parliament and the Council of the European Union. Council conclusions on common values and principles in European Union Health Systems. J Eur Union. 2006;146:1–3.

    Google Scholar 

  3. European Parliament and the Council of the European Union. Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare. J Eur Union. 2011;88:45–65.

    Google Scholar 

  4. Union E, Medical OF Charter on training of medical specialists in the european community charter adopted by the Management Council of the UEMS, October 1993 [Internet]. 1993 [cited 2022 Feb 16]. https://www.uems.eu/__data/assets/pdf_file/0011/1415/906.pdf

  5. UEMS. European Standards in Medical Training - UEMS ETRs [Internet]. www.uems.eu. 2022 [cited 2022 Aug 9]. Available from: https://www.uems.eu/areas-of-expertise/postgraduate-training/european-standards-in-medical-training

  6. Mathysen DGP, Aclimandos W, Roelant E, Wouters K, Creuzot-Garcher C, Ringens PJ. et al. History and future of the European Board of Ophthalmology Diploma examination. Acta Ophthalmol [Internet]. 2013;91:589–93. https://pubmed.ncbi.nlm.nih.gov/22551295/.

    Article  PubMed  Google Scholar 

  7. Anaya-Alaminos R, Rassmussen ML, Fung SSM, Potic J, González-Andrades M Comparative Analysis of European Residency Programs: Benchmarking and Harmonizing Ophthalmology Training in Europe. Eye (Lond). 2023;37:725–31.

  8. ICO. Residency - International Council of Ophthalmology [Internet]. [cited 2022 Jul 22]. Available from: https://icoph.org/education/residency/

  9. Irish College of Ophthalmologists RM. Curriculum Specialist Training in Surgical Ophthalmology [Internet]. Pdf. 2021 [cited 2022 Jul 22]. p. 1–58. Available from: https://www.eyedoctors.ie/medium/images/ICO_Specialist_Training_in_Surgical_Ophthalmology_Curriculum-d.pdf

  10. The Royal College of Ophthalmologists. Curriculum for Ophthalmic Specialist Training [Internet]. [cited 2022 Jul 22]. Available from: https://curriculum.rcophth.ac.uk/curriculum/ost/

  11. The Royal College of Physicians and Surgeons of Canada. Objectives of Training in the Specialty of Ophthalmology | © 2015 The Royal College of Physicians and Surgeons of Canada. [Internet]. [cited 2022 Jul 22]. Available from: https://www.royalcollege.ca/rcsite/documents/ibd/ophthalmology-otr-e

  12. Grover AK, Honavar SG, Azad R, Verma L. A national curriculum for ophthalmology residency training. Indian J Ophthalmol. 2018;66:752–83.

    Article  PubMed  PubMed Central  Google Scholar 

  13. PAAO. Requisitos Recomendados por la PAAO para el Programa de Residencia Médica en Oftalmología. 2013.

  14. Accreditation Council for Graduate Medical Education (ACGME). ACGME Program Requirements for Graduate Medical Education in Ophthalmology. 2022.

  15. Hoffman J, Spencer F, Ezra D, Day AC. Changes in UK ophthalmology surgical training: analysis of cumulative surgical experience 2009–2015. BMJ Open. 2017;7:e018526. https://doi.org/10.1136/bmjopen-2017-018526

    Article  PubMed  PubMed Central  Google Scholar 

  16. Cimberle M. Lack of standardization, insufficient surgical training take toll on development of European young ophthalmologists. Halio Ophtalmology [Internet]. 2016 [cited 2022 Aug 7]; Available from: https://www.healio.com/news/ophthalmology/20160815/lack-of-standardization-insufficient-surgical-training-take-toll-on-development-of-european-young-op.

  17. UEMS. Union Européenne des Médecins Spécialistes European union of medical specialists - European Training Requirements for the Specialty of Plastic, Reconstructive and Aesthetic Surgery [Internet]. 2015. Available from: www.uems.eu.

  18. UEMS. Union Européenne des Médecins Spécialistes European union of medical specialists- European Training Requirements for Breast Surgery [Internet]. 2015. Available from: www.uems.eu.

  19. UEMS. European Training Requirements in Obstetrics and Gynaecology UEMS Section Obstetrics and Gynaecology / European Board and College of Obstetrics and Gynaecology Standing Committee on Training and Assessment. 2018.

  20. UEMS. Union Européenne des Médecins Spécialistes European union of medical specialists - Section of surgery, division of transplantation. European training requirements in transplantation surgery. [Internet]. 2018. Available from: www.uems.eu

  21. UEMS. European Training Requirements for Pediatric Surgery European Standards of Postgraduate Medical Specialist Training Preamble. 2020.

  22. UEMS. Union Européenne des Médecins Spécialistes European union of medical specialists Training Requirements in Orthopaedics & Traumatology [Internet]. 2017. Available from: www.uems.net

  23. UEMS. European Training Curriculum for Radiology [Internet]. 2014. Available from: https://www.uems.eu/_data/assets/pdf_file/0018/72270/UEMS-2018.37-European-Training-Requirements-in-Radiology.pdf

  24. UESM. Union Européenne des Médecins Spécialistes European union of medical specialists - Training Requirements for the Competency of Rare and Undiagnosed Diseases [Internet]. 2020. Available from: www.uems.eu

  25. UEMS. Union Européenne des Médecins Spécialistes European union of medical specialists -Training Requirements for the Specialty of Geriatric Medicine [Internet]. 2020. Available from: https://www.who.int/ageing/publications/health-workforce-ageing-populations.pdf.

  26. UEMS. Union Européenne des Médecins Spécialistes European union of medical specialists - European Union of Medical Specialists section and board og vaskular surgery training requrements section and board of vaskular surgery. [Internet]. 2021. Available from: www.uemsvascular.com.

  27. UEMS. European Training Requirements for the Specialty of General Surgery. 2021.

  28. UEMS. Union Européenne des Médecins Spécialistes European union of medical specialists - Training Requirements for the Specialty of Neurological Surgery [Internet]. 2021. Available from: www.uems.eu

  29. UEMS. European Requirements for Training in Neonatology [Internet]. 2021. Available from: www.newborn-health-standards.org

  30. UEMS. Union Européenne des Médecins Spécialistes European union of medical specialists - european Training requrements for Neurology. 2022.

  31. UEMS. Union Européenne des Médecins Spécialistes European union of medical specialists -Training Requirements for the Specialty of Endocrine surgery [Internet]. 2022. Available from: www.uems.eu

  32. Muttuvelu DV, Andersen CU. Cataract surgery education in member countries of the European Board of Ophthalmology. Can J Ophthalmol [Internet]. 2016;51:207–11. https://pubmed.ncbi.nlm.nih.gov/27316271/

    Article  PubMed  Google Scholar 

  33. Bell CM, Hatch WV, Cernat G, Urbach DR. Surgeon volumes and selected patient outcomes in cataract surgery: a population-based analysis. Ophthalmology 2007;114:405–10. https://doi.org/10.1016/j.ophtha.2006.08.036

    Article  PubMed  Google Scholar 

  34. Randleman JB, Wolfe JD, Woodward M, Lynn MJ, Cherwek DH, Srivastava SK. The resident surgeon phacoemulsification learning curve. Arch Ophthalmol. 2007;125:1215–9. https://doi.org/10.1001/archopht.125.9.1215

    Article  PubMed  Google Scholar 

  35. Rutar T, Porco TC, Naseri A. Risk factors for intraoperative complications in resident-performed phacoemulsification surgery. Ophthalmology. 2009;116:431–6. https://doi.org/10.1016/j.ophtha.2008.10.028

    Article  PubMed  Google Scholar 

  36. Puri S, Kiely AE, Wang J, Woodfield AS, Ramanathan S, Sikder S. Comparing resident cataract surgery outcomes under novice versus experienced attending supervision. Clin Ophthalmol. 2015;9:1675–81. https://doi.org/10.2147/OPTH.S85769

    Article  PubMed  PubMed Central  Google Scholar 

  37. Gupta S, Haripriya A, Vardhan SA, Ravilla T, Ravindran RD. Residents’ Learning Curve for Manual Small-Incision Cataract Surgery at Aravind Eye Hospital, India. Ophthalmology. 2018;125:1692–9. https://doi.org/10.1016/j.ophtha.2018.04.033

    Article  PubMed  Google Scholar 

  38. Ho J, Claoué C. Cataract skills: how do we judge competency? J R Soc Med. 2013;106:2–4. https://doi.org/10.1177/0141076813476412

    Article  PubMed  PubMed Central  Google Scholar 

  39. McCannel CA. Simulation Surgical Teaching in Ophthalmology. Ophthalmology. 2015;122:2371–2. https://doi.org/10.1016/j.ophtha.2015.08.036

    Article  PubMed  Google Scholar 

  40. Rasmussen RC, Grauslund J, Vergmann AS. Simulation training in vitreoretinal surgery: A systematic review. BMC Ophthalmol. 2019;19:90. https://doi.org/10.1186/s12886-019-1098-x

    Article  PubMed  PubMed Central  Google Scholar 

  41. Federal Aviation Administration. Pilot Certification and Qualification Requirements for Air Carrier Operations. 2013 [cited 2022 Jul 22]; Available from: https://www.faa.gov/regulations_policies/rulemaking/recently_published/media/2120-aj67.pdf

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Acknowledgements

Marko Hawlina for support and guidance.

Funding

JC: Employee, Roche Products Ltd, UK. SF: Consultant for Santen, US; Research support from Dompè, US. MR: Consultant for Santen Denmark. All other authors have no financial disclosures to declare.

Author information

Authors and Affiliations

  1. Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Department of Ophthalmology, Reina Sofia University Hospital and University of Cordoba, Cordoba, Spain

    Miguel González-Andrades

  2. Department of Ophthalmology, University of California Los Angeles, Los Angeles, USA

    Simon S. M. Fung

  3. Clinic for Eye Diseases, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia

    Jelena Potic

  4. Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland

    Jelena Potic

  5. Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK

    Jaya D. Chidambaram

  6. Department of Ophthalmology, Frimley Park Hospital, Portsmouth Road, Frimley, GU16 7UJ, UK

    Ayesha Karimi

  7. Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland

    Clare Quigley

  8. Department of Ophthalmology, Royal Surrey County Hospital, Guildford, UK

    Radka Pontoppidan-Toms

  9. Moorfields Eye Hospital London, London, UK

    Andrew Scott

  10. Department of Ophthalmology, Rigshospitalet, Copenhagen and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Marie Louise R. Rasmussen

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Contributions

All authors (MG, SF, JP, JC, AK, CQ, RP, AS, MR) have participated in the steering committee formed to assess the issue of heterogeneity of European ophthalmology residency training. The steering committee worked under the European Society of Ophthalmology Young Ophthalmologists (SOE YO) committee lead by MR. All authors (MG, SF, JP, JC, AK, CQ, RP, AS, MR) have taken part in developing and analysing the results. MG, SF, and MR wrote the initial manuscript. All authors have contributed and commented on the final manuscript.

Corresponding author

Correspondence to Marie Louise R. Rasmussen.

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González-Andrades, M., Fung, S.S.M., Potic, J. et al. Harmonizing ophthalmic residency surgical training across Europe: A proposed surgical curriculum. Eye 37, 3256–3262 (2023). https://doi.org/10.1038/s41433-023-02502-2

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