Frequently asked questions

We have created a FAQ section on the ‘What do I need to know?’ webpage that relates solely to moving to the new ePortfolio. This is being continually updated. Please check here first before contacting [email protected] .

The CESR application is submitted to the GMC, which will require the application to ensure that the new curriculum is evidenced. There is specific information for CESR applicants on the RCOphth website. All candidates are encouraged to register their intention to apply with the RCOphth CESR team ([email protected]).

CESR candidates wishing to apply to the new curriculum will be able to download Word versions of the new curriculum forms from the curriculum microsite

London, Scotland, Northern, Yorkshire and The Humber, Northern Ireland and West Midlands took part in piloting the new assessment tools from July to October 2022. These are the EPA, the GSAT and the MAR. The outcomes from the pilot were reported to the GMC and helped us make necessary improvements. The report to the GMC can be found here.

You should go to the OST Curriculum 2024 microsite  which is a complete repository of all learning outcomes and assessments. It also contains core documentation such as the Curriculum Handbook and Matrix of Progression.

The RCOphth has developed the Matrix of Progression which describes the key progression requirements for each year of training, taking into account the requirements for advancement between levels. The Matrix has been disseminated to all deaneries as essential guidance for ARCP panels. The ARCP process itself is exactly the same as before.

Yes. The Transition Progression Requirements explains how Outcome 1 and completion of Curriculum Transition Checklists have been used to guide transition to Curriculum 2024. This is so the competencies you demonstrated in the current curriculum do not need to be repeated and you will be able to see as soon as you transfer to the new curriculum where any ‘training gaps’ exist, so your continuing training can be properly planned. You will not be required to repeat things that have already been assessed as competent.

The UEC CTC  lists examples of evidence that can be used to demonstrate that you have achieved the required competencies. It is not prescriptive and is simply a guide to ensure there are no gaps in training. The CTC will only be required if somebody wants to demonstrate completion of Level 3 UEC  at the time of transition.  The CTCs will become redundant after August 2024 when the new curriculum kicks in. After that, the EPA Level 3 UEC will need to be completed.

Although Part 2 FRCOphth is a requirement for advancement to Level 4, trainees transitioning to Level 4 in August 2024 and February 2025 will be exempt from this condition. After February 2024, Part 2 FRCOphth will be required before advancing to Level 4.

You are entering ST4 and will have automatically entered Level 3 if you have the Refraction Certificate and Outcome 1 in your last ARCP. You are not aiming to demonstrate completion of Level 3 so SIAs that have already been signed off will be considered signed off in Level 3. You do not need to complete any CTC unless you want to demonstrate that you have completed Community Ophthalmology, Cataract Surgery or Urgent Eye Care in which case you complete those.

The Generic domains Level 3 checklist is only to be completed if you want to go straight to Level 4. Otherwise, you can get them signed off in Level 3 using the GSATs after you have moved to the new Curriculum.

Please note that the CTCs are not in themselves assessments, nor are they compulsory. They are simply a way for trainees and trainers to benchmark your current achievements against the new curriculum. However, they will be used to as evidence by your ES when reviewing your Intended Level Form – which is mandatory.

The Community Ophthalmology Level 3 SIA sign off requirement is the transition checklist. It lists all learning outcomes and descriptors. The lists of evidence on that document as well as the guide to Community Ophthalmology on Inspire are not prescribed pieces of evidence or modules that need to be completed – they are simply examples of evidence that can be used to demonstrate that a learning outcome has been met.

It is important to remember that this is not a tick box exercise – the quality of evidence against every learning outcome should be assessed to determine if it demonstrates that the outcome has been achieved. Some of these pieces of evidence will be modules; others will include passing of exams, CbDs and time spent in a community optometrist practice or in a triage service, communication with community optometry, attendance at primary care provider meetings, etc. Sometimes one piece of evidence of good quality may suffice for more than one learning outcome.

If you have been signed off for an SIA on your CSR, you will not have to complete that SIA in Level 3 irrespective of when it was signed off in your training. That means that when you enter Level 3, you will be deemed to have already completed that SIA.

This years ARCP process should clearly indicate the SIAs that have already been signed off on CSRs, and therefore for Level 3, on the ARCP outcome form so that this outcome form is the only piece of evidence required when they get to Level 3.

No, that is all you need to do.

You should have a discussion with your ES (and CS) regarding the competencies of Level 3 Glaucoma. If you have been signed off and they feel that you have the competencies, you do not need the surgical numbers as the new curriculum is competency-based and not number-based.

Professional bodies (e.g. BEAVRS, BIPOSA, etc.) were consulted about the amount of time likely to be required for trainees to be entrusted to undertake independently the activities described in the Level 4 Learning Outcomes. Those that are more surgically based, and/or where experience of the specialist surgery is likely to have been limited before entering Level 4 training, are longer. These are only indicative times as Curriculum 2024 is competency-based rather than time-based.

All trainees are required to complete at least two Level 4 SIAs.  It is expected that most trainees will achieve or be close to achieving Level 4 in Cataract Surgery by the mid-point of ST6, as well as achieve Level 3 in all other SIAs. They may then proceed to complete their Level 4 Cataract Surgery (if not already done) and take on another Level 4 in the remaining training time. However, equally, they could choose to complete two further Level 4s in the remaining time. For example, trainees who have completed Level 4 Cataract Surgery and all Level 3 in other SIAs by mid-ST6 could use their final 18 months of allowed training to complete Level 4 training in both Urgent Eye Care and Community Ophthalmology. However, training cannot be extended beyond the 7-year training envelope to undertake additional, longer SIAs. Educational Supervisors and TPDs will advise about individual selections.

The professional bodies have advised us that the curriculum content stated for Level 4 is deliverable within the indicative times given. This will ensure that trainees can perform the core special interest procedures independently in the Level 4 areas they have selected.

To note that in some of the SIAs, eg Vitreoretinal Surgery and Cornea and Ocular Surface Disease, the Level 4 curriculum does not cover the full complexity of surgical procedures performed by specialist consultants. In some cases, trainees will still choose to proceed to a post-CCT fellowship in these SIAs to gain these additional skills.

However, it is anticipated that, in many of the SIAs, ophthalmologists with a CCT will be equipped to move straight into a consultant post.

Completion of Level 4 training in all of the generic domains and at least two of the Patient Management domains is a requirement for CCT.  If you had only completed one Level 4 Patient Management domain by the end of the 7 years of training, you would be awarded an Outcome 3 (‘inadequate progress’) to extend your training time to allow you to complete your second SIA.  In reality, this situation would have been picked up by you, your trainers and your TPD before you reached the end of ST7. If you are unable to achieve the necessary competence in at least two Level 4 Patient Management domains, you would not be awarded a CCT.

Having successfully completed the training programme, you will hold a CCT which allows you to apply for consultant posts. Your consultant employer will include in their selection procedure a person specification for the post. The RCOphth will advise that Level 4 competence in Cataract Surgery is the minimum standard for a consultant practicing in this area.

Most ophthalmic academic trainees will transition from Level 3 to 4 during their post-doctoral periods e.g. as NIHR (National Institute of Health and Care) Clinical Lecturers (CLs) or during their personal post-doctoral training fellowships. Completion of training is competence (not time) based, so having time protected for academic training (e.g. 50% clinical:50% research) should not affect the CCT date, provided the required clinical competencies are met.

However, ophthalmology is a craft specialty, with trainees required to undertake certain procedures on a number of occasions to become competent to perform the procedure independently, and clinical training may take longer, for example if the recommended minimum two operating lists per week for academic trainees is not provided.

NIHR CL posts are for a maximum of four years or until CCT is reached. The GMC has agreed with NIHR that ‘setting a target CCT date is best determined flexibly, and tailored to the needs of the individual trainee.’  The target date for CCT for NIHR CLs should be determined at the first annual ARCP following the award of a CL and following assessment of the initial progress in post.  The same process would be appropriate for those on personal post-doctoral fellowships.

Once this has been set, the CCT date can be extended further through the use of an ARCP Outcome 3. This may prove particularly important once trainees progress to Level 4, if it becomes apparent that competencies may not be met on a timetable of 50% clinical work. The RCOphth endorses the NIHR’s view that ‘if there is a need to extend clinical training this should not be regarded as a failure’, but rather necessary to achieve the outcome of simultaneously completing specialist clinical training and academic training.

Usually, yes. We have undertaken various mapping exercises with TPDs to ascertain that all Deaneries will be able to offer Level 4 training in virtually all SIAs. We intend that this should be achievable as Out of Programme Training (OOPT), rather than an Inter-Deanery Transfer (IDT).

We expect that most trainees will want to stay in the Deanery in which they have been based for the preceding six years. However, if Level 4 training in their chosen SIA is not available in their own Deanery, they may choose to look elsewhere.

This is unlikely to be a frequent event. The median number of trainees in a Deanery is about 35, which means that approx. 5 trainees/yr will be entering Level 4 training, with 11 different SIAs to choose from. Our priority is to maintain the quality of training, which means there has to be a limit on the number of Level 4 posts in each SIA in the Deanery, or the experience is diluted. If the trainee is unable to get a Level 4 post in their chosen SIA in their Deanery, they may have to complete Level 4 in a different SIA and then choose to apply for a post-CCT Fellowship in their chosen SIA.

Some will be converted to Level 4 training posts. Others will become Level 1-3 posts.  Those remaining on the old curriculum will continue doing TSCs even after August 2024, but these are different from Level 4 posts, even though timetables will have similarities. TSC posts cannot be referred to as Level 4 posts after August 2024.

As these are funded by local Trusts / Health boards, they will not be affected by changes to the curriculum. If a unit is able to provide both Level 4 and a post-CCT Fellowship in a particular SIA, the post-CCT fellowship will continue in their current form.

At Level 4 training, two SIAs may be done simultaneously or sequentially. This will very much depend on the logistics of the timetable that can be created for that post. Similarly, any restrictions to the combinations will be guided by the indicative time required and the ability of the unit/region to provide the required timetable for training (for example, it may be extremely difficult to do Level 4 in Oculoplastics and Paediatric Ophthalmology as the indicative time is up to 18 months and 12 months respectively).

Only two Level 4 SIAs are required for CCT. In practice, it would be difficult to fit three SIAs into 7 years of training though, in theory, it may be possible in rare circumstances. However, it is to be remembered that, if a trainee wants to pursue a third SIA, this could also be done as a post-CCT fellowship.

No, numbers are much less important in Curriculum 2024. The emphasis is on competence. Some trainees will be excellent independent cataract surgeons after 250 phacos. Others may need to do over 400 under supervision before they are fully competent cataract surgeons. However, the majority of trainees will be competent after completing 350 phacos, and this may be used as an indicative number for Level 4 Cataract Surgery (similar to the current curriculum CCT requirement) by some Deaneries. However, the syllabus does not require any minimum numbers of any surgical procedure.

Generally, they would get an Outcome 3 at their ARCP, and would be given additional time to achieve the required competencies.

No, Level 4 training is part of run-through specialty training. However, we expect that there will be less demand for post-CCT fellowships from UK trainees, as they will be able to obtain their SIA experience prior to CCT. This means that there will be greater opportunities for non-UK trainees to obtain post-CCT fellowships.

No. Once a trainee has been signed off at Level 4 for Cataract Surgery, there will be no requirement to demonstrate ongoing competence while doing a different SIA at that Level. This is similar to some post-CCT fellowships, which concentrate solely on one SIA with no exposure to cataract surgery.

Deaneries will use the following ranges when planning their Level 4 SIA programmes:

• Up to 18 months – Oculoplastics, Cornea and Ocular Surface, Glaucoma, Vitreoretinal Surgery
• 12-18 months – Ocular Motility, Uveitis, Paediatric Ophthalmology, Medical Retina, Neuro-ophthalmology
• 6-12 months – Urgent Eye Care, Community Ophthalmology
• 6-12 months – Cataract Surgery (to be integrated longitudinally)