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Alexander Jones asks what impact the current pandemic will have on ophthalmology trainees.

 

In my work as a Clinical Teaching Fellow, I have to admit that chaos is uncommon. Neither the anxious excitement of rushing to help an unwell patient nor the flush of satisfaction following a patient’s surprise recovery is often mimicked in small group discussion*.

As an aspiring ophthalmologist, I suppose I may be among good company in preferring control over my actions and their consequences. Wherever possible I try to take my time, consider options and often discuss ad-nauseam. In short, I’m a planner, before a doer. Nevertheless, I recognise the power of ‘urgency for change’ created with an outside impetus. Though uncertainty can spawn anxiety, cause mistakes and freeze us in hesitation, it can also help us reconsider what is important, and drive positive changes to the status quo.

The COVID-19 pandemic has caused upheaval in healthcare systems around the globe. In a recent taster week in ophthalmology, I was struck by its impact on both patients and services. One patient had been brought in by her daughter, who was terrified at taking her mother outside of her house for the first time in months following her husband’s hospitalisation with the disease. Patient safety is the first concern of all healthcare professionals, and the health risk posed by the pandemic has mandated unprecedented response throughout society and the NHS.

Ophthalmology services have responded quickly, due to high risk of transmission in the close confines of the slit lamp examination or in the aerosol generation precipitated by some operations. Non-emergency procedures have been cancelled and patient appointments are being prioritised for sight threatening conditions [2]. Virtual clinics are being allowed to replace some face to face appointments.

 

 

From my perspective as an educator, I have been considering the impact of the pandemic on ophthalmology training and the opportunity for positive change. Traditional learning opportunities are likely to be fewer, with theatre lists crippled in the short and medium term, even as services begin their phased re-introduction. How can we best support development of technical skills without real patients? The Royal College has suggested that additional time and support may be necessary for some trainees [3]. I hope that the pandemic may generate the urgency necessary for impactful change in training practices to cope with the shifting clinical landscape.

I produced and delivered a virtual learning course to the first undergraduate students kept from clinical placement by national policy. With a mix of online resources and small group video discussions, we were able to provide some elements of their usual teaching and innovate with virtual interactive simulation sessions. Technical skill training may prove more challenging to replicate, but existing technologies may provide part of the solution.

“Perhaps broadening the scope of ophthalmology training to other areas of medicine or surgery would offer opportunities for development in holistic patient care.”

With video capture at the slit lamp, trainees could observe examinations and procedures. Eyesi surgical simulation offers opportunities to train surgical skills without patient contact [4]. Broader adoption of these facilities could supplement clinical opportunities but would require substantial financial investment.

I anticipate that the deficit the UK faces in the wake of the pandemic could deter significant investment in training. Financial backing may rightly be directed to a safe and swift return towards normal practice, though it is unclear how this can best be achieved. Will funding be withdrawn from training posts to allow focus on service provision? Will new trainees be required in greater numbers to meet the backlog of service demand?

Perhaps the ophthalmology service model will be streamlined, with allied health professionals filling other roles in the evolving requirements of a modern ophthalmology department [5]. Many trainees have spent time in unfamiliar roles while on ‘Emergency Rotas’. I worked as a supported ICU nurse, learning a range of skills in caring for sick, ventilated and filtered patients. I am sure I will not be alone in finding a host of valuable transferable skills while working in a new role. Perhaps broadening the scope of ophthalmology training to other areas of medicine or surgery would offer opportunities for development in holistic patient care.

I suppose I am a hopeless optimist, and I can’t resist concluding on an unexpectedly cheesy note like the taste of a bad yoghurt. I am excited to see the response to the challenges of these difficult times. I hope that the uncertainty felt throughout the NHS will be met with a willingness to work with and for each other and to think not only of surviving the present, but of building for the future.

 

*Unless, I will admit, somebody correctly utilises the Starling equation for fluid filtration – a personal favourite!

 

References

1. Propper C. The wider impacts of the coronavirus pandemic on the NHS. 2020:
https://www.ifs.org.uk/
publications/14798

2. Royal college of ophthalmologists. RCOphth: Managmeent of Ophthalmology Services during the Covid pandemic. 2020:
https://www.rcophth.ac.uk/wp-content/
uploads/2020/03/RCOphth-Management-of
-Ophthalmology-Services-during-the
-Covid-pandemic-280320.pdf

3. Royal college of ophthalmologists. FAQs for Trainees during COVID-19. 2020:
https://www.rcophth.ac.uk/training/
covid-19-support-for-trainees/faqs
-for-trainees-during-covid-19/

4. Ferris JD, Donachie PH, Johnston RL, et al. Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 6. The impact of EyeSi virtual reality training on complications rates of cataract surgery performed by first and second year trainees. Brit J Ophthalmol 2020;104:324-9.
5. Gibbons H, Bourne RRA. Extending a nurse practitioner’s role to undertake advanced procedures. Nursing Times 2009;105:40xx-yy.

(All links last accessed July 2020)

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Alexander Jones

Papworth NHS Foundation Trust, UK.

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