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Are ophthalmologists overtrained?
  1. JAMES ACHESON
  1. North Thames Region, UK
  1. Moorfields Eye Hospital, City Road, London EC1V 2PD, UK james{at}acheson0.demon.co.uk

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To the observer from Mars, the length of ophthalmology specialist training in the UK may appear to be rather long in proportion to the content or to the job to be done as a consultant. Are ophthalmologists overtrained?

Evidence the Martian might cite could include a comparison with training elsewhere in the world. A steady stream of Australian and New Zealand trainees nearing the end of the their own postgraduate training programmes spend a year or so in the UK doing official and unofficial fellowships or registrar locums, thereby fulfilling their accreditation requirements and then return home (“practise makes practice”, as one wit put it). How come, the question goes, these individuals reach accreditation standards at least as high as those in the UK in about 4 years when it takes at least 8 years here? This calculation is made simply by adding the minimum 2 years currently required in basic surgical training at senior house officer (SHO) grade together with 4.5 years as a specialist registrar (SpR), which works out at a minimum of 6.5 years. As many SHOs wait for 3 years before becoming SpRs and most SpRs spend the full 5 years allowed, the modern UK average time is at least 8 years. A similar discrepancy is found between North American practice and here. Elsewhere in Europe the surgical content in training programmes is variable and generalisations are impossible.

Well, of course, there are several reasons why the UK training remains so long. For one thing, higher specialist training places in ophthalmology in the UK tend to be oversubscribed, so extra time in basic surgical training or in research waiting for a place is not unusual. The number of training places nationally is highly regulated in an effort to make a good match between the number of …

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