Preservation and Restoration of Vision:

Vision for the Future, Part 2: Ophthalmic Education and Training: Ophthalmology Resident and Specialist Training in Ophthalmology

On this page:

• OPHTHALMOLOGY RESIDENT AND SPECIALIST TRAINING IN OPHTHALMOLOGY
  
  
• CHARGE TO TASK FORCE ON SPECIALIST EDUCATION
  
  
• GENERAL PRINCIPLES AND GUIDELINES OF OPHTHALMOLOGY SPECIALIST TRAINING
  
  
• OBJECTIVES
  
  
• PREREQUISITES FOR OPHTHALMOLOGY SPECIALTY EDUCATION
  
  
• OPHTHALMOLOGY CURRICULUM TOPICS
  
  
• DURATION OF OPHTHALMOLOGY SPECIALTY TRAINING
  
  
• PROCESS OF RESIDENT EDUCATION
  
  
• FACILITIES

OPHTHALMOLOGY RESIDENT AND SPECIALIST TRAINING IN OPHTHALMOLOGY

Ronald E. Smith, MD

An ophthalmologist is a physician (medical doctor) with additional specialized training, qualifications, and skills in the diagnosis, medical and surgical management of disorders of the eye and visual system; in the prevention of blindness; in the promotion of eye health in individuals and in the community; and in the rehabilitation of patients with visual disability.

Ophthalmologists have a unique role in society as the professionals with a distinct body of knowledge, skills, and attitudes dedicated to maintenance and improvement of eye health.

The education and training of physicians who choose ophthalmology as a profession is therefore of critical importance.

This Task Force report summarizes the status of ophthalmology resident education worldwide and suggests principles and guidelines for the education and training of ophthalmologists.

The need for eye care specialists, especially in some developing countries, is clearly critical.

The Task Force will continue to collect and analyze curricula used to educate specialists in ophthalmology, recognizing the great variations in social and economic status of regions of the world, and the urgency of the need to eliminate avoidable blindness.

CHARGE TO TASK FORCE ON SPECIALIST EDUCATION

The Task Force was charged to suggest general principles and guidelines for the education of ophthalmologists.

The Task Force recommends that a spectrum of training requirements, depending on geographic location, be considered for different regions of the world.

Furthermore, the necessity for ophthalmic surgeons may be so urgent in certain regions that an ophthalmic surgeon may need to be taught in an expedited fashion.

Numerous training programs from around the world responded to the request for curricula.

These form the database for the current draft report for review by the International Council of Ophthalmology.

The Task Force is grateful to the countries and individual ophthalmologists contributing information and data to this process. The collection and analysis continues.

We are also grateful for the permission to reproduce specific language that best captures the principles, guidelines and curriculum details that form the substance of this report. Some of the language in this report is reproduced verbatim from such documents as received from around the world.

GENERAL PRINCIPLES AND GUIDELINES OF OPHTHALMOLOGY SPECIALIST TRAINING

The proposed guidelines suggest the basis for the development of a curriculum for ophthalmology residency training in any country or region.

These guidelines are not fixed or set in stone and should not be viewed as rigid or mandatory.

Resident learning and development should be provided through a combination of lectures, supervised patient care, graduated hands-on procedural and surgical experience, research and independent study. the focus should not only be on acquisition of knowledge and skills related to ophthalmology itself, but also on development of an appreciation for the importance of vision research, life-long learning, and the education of the public and other physicians.

The curriculum should be three to five years in length, depending on the individual country or region.

These guidelines are inclusive of both didactic knowledge acquisition and acquired skills transfer and are set forth in broad terms and by subspecialty.

The goal of a curriculum developed based on these guidelines is to train an ophthalmologist who is capable of providing modern comprehensive ophthalmologic care.

The training program should also prepare the graduating ophthalmologist for an examination process which will test, to the extent possible, the graduate's competence and aptitude for practice as an ophthalmologist.

The public, government agencies, and our specialtyís long-standing commitment to continuous improvement and excellence demand such demonstration of competence upon completion of the resident education experience.

OBJECTIVES

The curriculum should provide the following educational experiences:

1. Supervised direct patient care experience which allows the resident to:
   
   

   a. Master ophthalmologic examinations skills

   b. Formulate and work-up differential diagnoses

   c. Manage medical ophthalmology problems of increasing complexity

   e. Develop and exercise clinical and ethical decision-making abilities

   f. Develop patient communication techniques, including communication to communities and populations as well as individual patients and families

   g. Work effectively as a member of the medical care team

2. Supervised direct patient care experience which allows the resident to:
   
   

   a. Modern cataract and anterior segment surgical techniques including strabismus, glaucoma, cornea, ocular trauma, and ocular-plastics techniques

   b. Anterior and post-segment laser surgery

   c. Exposure to all areas of subspecialty surgery

3. Development of a broad fund of basic science and clinical knowledge through lectures, reading and interactive conferences, and review sessions
   
   
4. Exposure and opportunities for research, to teach residents to knowledgeably research results and to motivate residents to pursue projects
   
   
5. Development of teaching skills related not only to teaching of fellow ophthalmologists and residents, but also designed to address the education of other physicians, and medical students
   
   
6. Preparation for examinations which assess ophthalmic knowledge and competence

PREREQUISITES FOR OPHTHALMOLOGY SPECIALTY EDUCATION

In most countries surveyed, there were mandatory requirements for entry into ophthalmology training.

While variable, these in general included the equivalent of:

1. Medical School
Successful completion of a formal medical school or medical education program as defined or prescribed in the region or country; the applicant for ophthalmology residency training must have successfully completed a basic medical school education.

2. General Medical Practice:
In many countries, a year or more of general medical practice is required prior to entry into training for the specialty of ophthalmology. In some instances, this general medical practice or ìinternshipî year is merged into the specialty training in ophthalmology.

3. Licensure:
Obtaining a license and/or certificate to practice medicine is a requirement for ophthalmologists-in-training either before or during the ophthalmology specialty training program. Some form of licensure is required to practice medicine in most areas of the world. Such licensure is in addition to, and distinct from, a certificate of residency training completion provided at the end of residency training program.

OPHTHALMOLOGY CURRICULUM TOPICS

1. Basic Sciences
Most responding residency training programs from around the world included most of the following topics as part of the curriculum for residency education:

• Anatomy of the eye
  
  
• Neuro-anatomy related to the visual system
  
  
• Physiology of the eye
  
  
• Embryology of the eye
  
  
• Pharmacology related to general medicine and ophthalmology
  
  
• Pathology of the eye
  
  
• Microbiology and immunology of the eye
  
  
• Genetics of eye disease
  
  
• Molecular and cell biology related to the eye
  
  
• Statistics, biometry and ophthalmic epidemiology
  
  
• Basic principles of ophthalmic surgery.

2. Optics and Refraction
All programs included education and training in Examination of the optical and refractive status of the eye and the importance of acquiring the necessary education skills to refract the eye and prescribe appropriate correction and also to understand the principles of fitting glasses and contact lenses:

Physical and geometric optics

• Clinical optics
  
  
• Clinical refractions
  
  
• Instrumentation required for refraction
  
  
• Methods of clinical examination
  
  
• Instruction and use of fitting and management of contact lenses of all types

3. Clinical Training
Clinical training is accomplished in various ways. Whether clinical training is initiated in the first year or in later years of the program, there was a broad consensus on the categories of eye disorders which should constitute ophthalmology specialty training:

• External eye diseasesóinfections, inflammations, neoplasia
  
  
• Intraocular inflammation and infection
  
  
• Glaucoma
  
  
• Lens and cataract
  
  
• Choroid and retina-vitreous disorders
  
  
• Diseases of the orbit, eyelids and lacrimal system Diseases of childhood, especially strabismus and genetic disorders
  
  
• Neuro-ophthalmology
  
  
• General medical conditions
  
  
• Ophthalmic-plastics and surgery
  
  
• Surgical retina, including lasers
  
  
• Ocular oncology
  
  
• Eye pathology

DURATION OF OPHTHALMOLOGY SPECIALTY TRAINING

There is significant variation in the length of training for ophthalmologists, from a minimum of two years to a maximum of six years.

In some instances, training also included the last stages of general medical education or the equivalent of an "internship."

The Task Force makes no specific recommendation concerning the duration of ophthalmology specialty training, but rather recommends that the duration be adequate to achieve the goals and principles of training as outlined in this report, at all times sensitive to the needs of the particular country or region.

In general, specialty education should be no less than two years and probably three to five years in duration.

PROCESS OF RESIDENT EDUCATION

The Task Force emphasizes that medical education, including specialty education for ophthalmologists, is a life-long commitment for all physicians in order to maintain competency in any specialty, including ophthalmology.

Ophthalmology residency is part of this continuum of education from medical school (or its equivalent) to post-residency continuing medical education.

This graduated process includes all aspects of resident education, whether in the basic sciences or clinical training, including graduated hands-on procedural and surgical experience. Residents should proceed through such a graduated training process according to their success in achieving curriculum goals and milestones over the training period.

FACILITIES

A Culture of Learning and Teaching
The Task Force suggests that the single most important characteristic of a successful resident education program is the development of a culture and tradition of learning and teaching which is not so much dependent on the nature of the physical facilities themselves but rather on the commitment of the faculty ophthalmologists responsible for the residency education program.

The most modern facilities are no substitute for committed and dedicated educators.

That said, assuming that such a culture and tradition exist, most surveyed programs recognize the need for adequate facilities in order to achieve educational goals for specialist training. These include:

1. Up to date ophthalmic equipment and instruments
   
   
2. Examining rooms dedicated for ophthalmologist education
   
   
3. Access or association with a hospital in which there are 24-hour anesthesia, laboratory, radiology and other diagnostic services
   
   
4. Operating suites with equipment to assure modern surgical experience and training, including the use of operating microscope, micro-surgical instruments, suture material, etc.
   
   
5. Suitable library facilities or the equivalent (internet access, etc.) which include access to ophthalmologic educational materials, journals, text, video tapes, etc.
   
   

Facilities for Conferences and Lectures
Almost all programs made arrangements for adequate facilities for lectures and conferences in order to accomplish educational goals. This included appropriate audio-visual equipment.

Regular Audit and Examination of Ophthalmologists-in-Training Progress
Most programs referred to the importance of some form of periodic evaluation of the resident-in-training as he/she progressed through the curriculum.

Examples included annual in-service examinations, the maintenance of a logbook or record of the residentís surgical and medical experience, and oral or written examinations developed by the faculty of the training program.

The Task Force recommends that some form of regular (annual) Examination be built into the curriculum.

Documentation of adherence to established performance standards and milestones throughout the training program provides assurance that the resident is progressing through the training program in an appropriate manner. It also provides a measure of quality assurance for external agencies or organizations which may require such documentation.

Examination upon Completion of Residency
Information about the Examination of ophthalmology residents after successful completion of the residency program was not available in many instances.

It is the opinion of the Task Force that a formal examination of graduating ophthalmologists, at some point within one to three years after completion of the residency training program, is a desirable and important goal.

The International Council of Ophthalmology has undertaken the development and conduct of International Examination for Ophthalmologists. The Task Force supports the principle of requiring such an evaluation as part of the education and training for ophthalmology residents.

July 29, 2000

Next: International Examinations for Ophthalmologists

Also see: Table of Contents for Vision for the Future