Requirements for Residency Training in Ophthalmology

Requirements

• A.The “Special Requirements for Residency Training in Ophthalmology” set forth the educational prerequisites for trainees and the minimum components that a residency training programme in ophthalmology must possess, including the duration of training, and content of clinical experience, institutional facilities, support and administration.
• B.Residency training programmes in ophthalmology should be organised to provide a stable, well co-ordinated progressive educational experience for the resident rather than simply to provide health care to patients.
• C.Participation in the scheme is a purely voluntary act and there is no compulsion on individual Institutes or trainees to take part.

I PREREQUISITES

All Centres entering ophthalmology training programmes must have fulfilled the national entrance requirements

II DURATION OF TRAINING

• A. The length of training in ophthalmology must be at least 48 calendar months, including appropriate short periods for vacation. Absence of greater than 3 months, for whatever reasons, must be compensated for.
• B. The length of time of residency training for a particular resident may be extended by the local programme director if a resident progresses at a slower pace than provided by the standard rotations. The programme director should notify the Residency Review Committee of the extension.

III INSTITUTIONAL SUPPORT AND PROGRAMME ADMINISTRATION

• A. General
  The institution should ensure that the local programme directors are given sufficient authority, financial support, and facilities by the governing body of the sponsoring institution to permit them to organise and supervise the following activities of their training programme: resident selection and evaluation, instructional programme, patient management, research, and initiation of recommendations for staff recruitment.
• B. Qualifications of the Local Programme Directors
  • 1) The programme director must be a specialist ophthalmologist of at least five years standing certified by the national organisation and approved by the European Board of Ophthalmology. The term of appointment of the programme director must be adequate to ensure stability and continuity of the programme.
  • 2) The programme director who serves as administrator, educator, and research co-ordinator must devote sufficient time to the administration and conduct of the residency training programme so that educational experience for the residents is satisfactory. The Residency Review Committee for ophthalmology will evaluate the overall effectiveness of the programme director as an administrator, educator, and research co-ordinator.
• C. Administrative responsibilities of the Programme Director
  • 1) The programme director, with the support of the institution, must develop and maintain current documentation of institutional or inter- institutional agreements, resident agreements, patient care statistics, faculty evaluations, and assessment of resident performance. This document must be provided to the Residency Review Committee in the Application Form supplied by the Administrator of the Residency Review Committee.
  • 2) The programme director is responsible for notifying the Chairman of the Residency Review Committee of any changes in programme director and/or departmental chairman as well as of a formal affiliation with another institution. He is also responsible for informing the Residency Review Committee of changes in permanent staffing and departments of those involved in the training programmes or of any major changes in the programme.
  • 3) The programme director is required to have prior approval of the Residency Review Committee for the following changes:
• • A. A required rotation of six months or more to any institution other than that of the parent.
  • B. The number of resident positions in the training programme, both total number and the number at any level. This number should be maintained even when the holders of these posts do not meet requirements for permanent residency or settlement within the European community. If the change in resident complement results from the extension of training of a current resident and is not greater than 6 months, only prior notification of Residency Review Committee is required.
  • C. The appropriate educational justification and documentation must accompany all of these requests in order that the Residency Review Committee may evaluate whether the quality of the programme and the resources available are adequate to support the requested change.
• 4) Supervision Residents must be provided with rapid, reliable systems for communication with an appropriate supervisory member of staff or faculty.

IV MINIMUM RESIDENT COMPLEMENT

The Residency Review Committee recognises the importance of interaction among trainees themselves as well as between staff and trainees in the conduct of conferences and patient care. A critical mass or minimum number of residents is essential in order to provide an opportunity for meaningful interaction throughout the training period. Each programme must be structured to have a minimum of two residents in each year of training. Where this is impractical, and smaller numbers are to be considered, then that staff/student ratio should be at least one to one (Vide infra).

V TEACHING FACULTY

• A. The faculty must be highly qualified and possess appropriate clinical teaching skills. The faculty should devote adequate time to the education of residents. The faculty should possess a broad range of sub-speciality expertise. Such expertise will usually be acquired by sub-speciality fellowship training.
• B. Faculty members should be certified by the European Board of Ophthalmology or possess suitable equivalent qualifications.
• C. There must be sufficient faculty in the programme to provide a minimum of one full-time equivalent faculty person to every two residents with the exception of training programmes where there are fewer than two residents in each year of training when there should be at least one full time equivalent faculty person for every resident in the programme.
• D. The programme may be conducted on more than one location.

VI EDUCATIONAL PROGRAMME

The programme director is responsible for the structure and content of the educational programme and must provide the Residency Review Committee with a statement of objectives, methods of implementation, and procedures for assessment of the programme by the faculty and the residents. The educational experience must be designed and supervised by the programme director. The education programme should include:

• A. Didactic Instruction in the Basic and Clinical Sciences: Residents should be educated in basic and clinical sciences through lectures and/or regularly scheduled discussions relevant to the practice of ophthalmology. The didactic syllabus must encompass a minimum of one hour per week of instruction for residents during the normal academic year. The programme director is responsible for resident attendance at these conferences.
• B.Clinical Experiences: The volume and variety of clinical ophthalmological problems in children and adults must be sufficient to afford each resident a graduated supervised experience within the entire spectrum of ophthalmic diseases so that the resident may develop diagnostic, therapeutic, and manual skills and judgement as to their appropriate use.
  • 1) Outpatient Experience:
    • A. Residents should be responsible for the care of an adequate number of outpatients during the course of training. The outpatient experience for a resident during the programme should consist of patient visits appropriately distributed through a broad range of ophthalmic disease in adults and children. There must be appropriate supervision in all visits. Residents should have a major management responsibility under direct supervision in some of those visits. The level of responsibility of residents should be commensurate with their progression in the programme.
    • B. Residents must be capable of refraction and assessing and fitting patients for contact lens wear. They should have experience in the prescription and fitting of magnifying devices, low vision aids and fitting of prisms and the full range of optical devices.
    • C. Since ophthalmologists are widely concerned with screening programmes for the detection of glaucoma, diabetic eye disease etc., residents should have experience in preventive ophthalmology. In addition, ophthalmologists-in-training should be aware of the national, international and European Union regulations regarding visual standards. Residents should have the knowledge of medico-legal aspects of ophthalmology.
  • 2) Surgical Experience: Surgical experience is a necessary part of the training programme. A log book of surgical (including laser) experience should be kept.
  • 3) Case presentations: Formal teaching should include case representations and clinical conferences attended by several faculty and a majority of residents.
  • 4)Pathology: The training experience in ocular pathology should comprise lectures, clinicopathological conferences and microscopic examination of pathological specimens. Microbiology should form part of this discipline. Residents should receive comprehensive teaching in the mechanisms of disease processes.
  • 5) Scientific Literature: Residents should be exposed to critical discussion of current literature with guidance of faculty members.
  • 6 )Duty Hours and Personal Responsibility: Duty hours and night and weekend call for residents must reflect the concept of responsibility for patients and provide for adequate patient care. Residents must not be required regularly to perform excessively longer difficult periods of duty or an excessive workload. They should, however, appreciate the concept of continuing patient care.
  • 7) Fellowship Programme: If the residency programme is conducted in conjunction with fellowship training programmes for teaching advanced competence in specialised areas of ophthalmology, such fellowship programmes must not adversely affect the experience of residents in the core training programme.
  • 8) Ethics: Residents should have an appreciation of medical ethics.

VII PARTICIPATING INSTITUTIONS

A residency programme in ophthalmology must have a designated parent institution where the majority of the required clinical and didactic educational experiences occur and are co-ordinated by the programme director. The training programme may encompass more than one independent institution to allow for an adequate clinical exposure of the trainees and to provide complementary educational experiences. Programmes that depend on a rotation involving hospitals other than the parent institution must submit additional documentation that the following criteria are being fulfilled:

• A. Purpose:
  There should be a clear statement in the narrative section of the Programme Information Forms regarding the purpose of each participating institution, indicating how they enhance the total programme and how they are co-ordinated with the components of the overall educational experience.
• B. Deputy Director in Peripheral Hospital or Institution:
  There should be a designated local deputy director of the programme at each participating institution. The programme director must appoint or be consulted in the appointment of the local deputy director, and this arrangement should be documented in writing by the appropriate individuals at each institution. There should be evidence of ongoing co-ordination of the various components of the overall programme which would include planning of the rotations, evaluation of residents, and evaluation of each institution by the resident.
• C. Physical Facilities:
  The programme director should assure that the physical facilities of each participating institution, including outpatient clinic, inpatient facilities, operating rooms, and their respective equipment, meet the “Special Requirements”.
• D. Educational Experiences:
  • 1) The programme director is ultimately responsible for the schedule and composition of the residents’ rotations at each participating institution, as well as the extent of faculty supervision of the clinical service in the operating room.
  • 2) The programme director is ultimately responsible for the content and quality of didactic lectures and conferences, and must assure that these are co-ordinated with the overall educational activities of the programme. Sample schedules should be submitted along with those from the parent institution.
  • 3) If a participating institution is sufficiently remote from the parent institution to prevent regular attendance by residents at the didactic and clinical conferences at the parent institution, or if the rotation otherwise prevents such attendance, the programme director should demonstrate that each resident is exposed to a formal educational experience that fulfils the “Special Requirements”.
  • 4) Case presentation should be included at each peripheral institution to assure optimal utilisation of patients for teaching purposes; alternatively, cases should be brought from peripheral institutions to the parent institution for presentation if formal teaching case presentations are held only there.
  • 5) The programme director must assure that all residents have equivalent educational experiences.
  • 6) A training programme should normally be conducted within national boundaries.
  • 7) Periods of training may be spent at institutions outside the European community. These institutions must be recognised by the National Institutions or the European Board of Ophthalmology. Periods of not more than six months formal training at these formal institutions may be recognised for requirements as numerated in paragraph IIIA above. Prior approval of the European Board Residency Review Committee must always be sought if the training period is to be recognised.
  • 8) For programme exchanges within the European Union, special rules will be drawn up and will be available in a separate document.
  • 9) Residents who undertake to do research may have six months of this time recognised as six months formal training. Prior approval of the institution and of the research time should be sought from the Residency Review Committee.
  • 10) If the training period is interrupted for more than one year, for whatever reason, then the adjusted training programme must be submitted to the Residency Review Committee for approval.

VIII FACILITIES

• A.Clinic:
  The outpatient area of each participating institution must have a minimum of one fully equipped examination station for each resident working in the clinic. There must be access to current diagnostic equipment. This should encompass equipment designed for ophthalmic photography (including fluorescein angiography), perimetry, ultrasonography, keratometry and retinal electrophysiology and orthoptic services as well as other appropriate equipment deemed necessary to meet current standards of practice. There should be access to Pathology, Microbiology, and Radiology services.
• B.Operating Room Facilities:
  The surgical facilities should have access to sufficient space and beds for good patient care. An eye examination room with a slit lamp should be available and conveniently located within or near the inpatient area of each participating institution. Facilities must include an operating microscope. There should be laser facilities for treatment of the anterior and posterior segment.
• C.Patient Facilities:
  Some inpatient facilities should be available for special patient care. There must be outpatient facilities with access to sufficient space and beds for good patient care. An eye examination room with a slit lamp should be available and conveniently located within or near the inpatient area of each participating institution.
• D.Library:
  Residents should have access to a major medical library. In addition, there should be readily available a collection of ophthalmological and general medical texts, journals, films and tapes.E.Research:
  Residents should be encouraged to undertake research

IX CERTIFICATION

Residents who plan to seek certification by the European Board of Ophthalmology should communicate with the Secretariat of the Board regarding specific requirements for certification.

Requirements: Inspection Approval Re-Inspection

Inspection

The EBO aims to promote and recognize training centres of high quality and standard with the intention of recruiting centres of excellence throughout the EU. The Residency Review Committee Document 1 sets out the guidelines supporting the training requirements of junior ophthalmologists. One of the means of quality assurance of training, throughout the European Union is the inspection of institutes providing training. By this means it is intended that residents will receive not only a good training but also support should there be problems. It is also intended that facilities should be available to offer advice and support to any training institutes who seek such assistance. Recognition of a training institute by the Board does not affect the unit’s national status as a training centre. The training institutes should be following the guidelines laid down in Residency Review Committee Document 1.

I INSPECTION

• 1)Training institutes will voluntarily invite inspection for the purposes of recognition by the Board by application to the secretariat of the Residency Review Committee as the relevant agent of the European Board of Ophthalmology (herein referred to as the Board).
• 2)Institutes will be asked to provide documentation, to the Board to assist both the Board and the inspectors by completion of an application form.
  This form will collect the following information:
  • A.Name and address of Training Institute
  • B.Staff:
    • 1) Name and address of programme director and where relevant any local programme directors. When there is no overall programme directors or the local programme directors should be given.
    • 2) The number (and where relevant the grades) of trainee ophthalmologists.
    • 3) The accumulated time already spent in training for each trainee.
      • Whether full time or part time.
      • The number of trainees within the rotation who are not European Union nationals.
    • 4)The numbers of and status of staff involved in training with brief biographical details.
      These data to include those supervising research which is specifically recognised for training purposes.
    • 5) The numbers of fellows and other medical staff and grades working in the training institution.
    • 6) The numbers of orthoptists, physicists, technicians, nurses and optometrists, (if practised). (These posts to be recorded in full time equivalents.)
  • C.Workload
    • 1)Out-patient
      • Consultations per annum• New (as defined by the local hospital)

      • Return visits

      • Accident and emergency visits

      • Primary care visits (where this concept is recognised)

      • Additional/extramural consultation

    • 2)Inpatient workload
      • Medical cases• Surgical cases including breakdown of cases e.g. cataract, cornea, glaucoma, cornea, squint, retina, lacrimal, orbit and plastic; and indication of percentage performed as day-case procedures.

      • Minor procedures, laser treatments (and nature)

• D.Timetables
  • 1) The working week of each trainee should be documented including on call rotas.
  • 2) How this programme changes with time should be recorded.
  • 3) The rotation or rotations through which each trainee will pass should be documented.
  • 4) Details of the academic training or teaching sessions should be presented.
• E.Facilities of Training CentreClinical
  • 1)The number of in-patient beds (male/female (Adult)/ paediatric – [where breakdown is recognised])/ wards; operating theatres, examination rooms and ancillary facilities should be documented.Educational
  • 1)The library facilities should be described including approximate number of relevant books and journals. Listing the ten most important journals. The access and location of the library should be noted.
  • 2)The number/size of lecture and seminar rooms should be documented, including private study rooms or desks, and wetlab facilities, video/slide/interactive teaching facilities. Computer facilities should also be included.
  • 3)Facilities for trainees to undertake research should be itemised (laboratories, technicians etc.).External
  • 1)Special relationships with other departments and institutions should be highlighted. It should also be noted whether the Eye Department is incorporated within a major hospital complex.

II CHARGES AND EXPENSES

• 1) The cost of is certification is €1200
• 2) The centre wishing to be inspected must pay the due fee of reasonable travel expenses and administrative charges at the time of application. A proof of payment must be included with the application form and sent to the chair of the Residency Review Committee
• 3) An administrative charge at a rate determined by the committee will be requested for re-certification after five years as well as for re-visitation if this is needed.

III APPOINTMENT OF INSPECTORS

• 1) The Board will approve a panel of potential visitors from names suggested to it through the Residency Review Committee. A minimum of two visitors will inspect each unit but more may be required where size of the unit suggests that a larger number may be necessary.
• 2) One visitor should be a national of the country in which the training centre is situated and the others should be from another European Union state. Wherever possible one visitor should have experience of inspections.
• 3) Inspectors should be in active practice when appointed and may not continue more than two years after retirement. Appointment will be for five years and may be reappointed.

IV THE VISIT

The inspectors will agree a mutually convenient date for the visit directly with the programme director. At the visit the programme director will make arrangements for facilities to be viewed including outpatient departments, operating theatres, libraries etc. Adequate time for the trainees to be interviewed should be allowed. Their log books should be available for inspection. Time should be set aside for the trainers to be interviewed. Where log books are not kept a full list of the trainees experience should be available.

V THE REPORT

1) A confidential written report will be prepared for the Residency Review Committee within one months of visitations.

2) On the basis of the completed form (part 1) and the written report, the Committee and the members of the executive board will decide whether to approve the training institute. The report will follow a standard format.

3) If the visitors feel that there are deficiencies they should make appropriate recommendations to the Committee for improvements.

4) If recognition is granted it may be for a five year period or when there are problems, for a lesser period to allow minor deficiencies to be corrected.

5) If the training appears unacceptable, recognition may be withheld and further visits arranged.

6) The EBO will be informed of the Committee’s decision.

VI RECOGNISED UNITS

A published register of all approved posts will be kept by the Residency Review Committee.

Requirements: Inspection Approval Re-Inspection

Approval

1) Chairman/Administrator of Residency Review Committee receives completed application form from director of training.

2)Residency Review Committee allocates (at least) 2 inspectors:- one from same country as centre one from another country represented on European Board of Ophthalmology

3)The inspectors agree a mutually convenient date to visit the centre with the director of training. Confirm financial arrangements for reimbursement. (N.B. This arrangement must be organised directly between the centre and the inspectors).

4)Guidelines for inspectors:- (see Residency Review Committee Document 2)
• meet with director of training
• our facilities
• interview trainers
• interview trainees
• final meeting with director

5)Inspectors prepare and agree final report.

6)Residency Review Committee receives report; discusses in Committee, comments, and alters, where relevant. On the basis of the report in light of Residency Review Committee Document 2 approval is granted for five years, limited approval is granted to allow time for improvements to be instituted if approval is withheld. The director of training will then be sent a copy of the report and the Residency Review Committee’s comments and advice. Where approval is limited or withheld specific clear recommendations must be given to allow the director of training to institute the necessary changes to meet with the Committee’s requirements.

7)Report and recommendations will be sent to:-
• European Board of Ophthalmology
• the director of training of the centre
• the administrator/chief executive officer of the training centre

8)Appeals against the Residency Review Committee’s decision will be considered by the European Board of Ophthalmology.

ALL APPLICATIONS MUST BE SUBMITTED ELECTRONICALLY

Requirements: Inspection Approval Re-Inspection

Reinspection

After the successful EBO certification, the accredited department needs to re-certify after five years. The Re-certification application form (only stating eventual changes) must be sent to the chair of the residency review committee. A re-visitation is in general not needed unless major changes in the department have occurred (geographical, administrative, functional etc). In that case the Committee will take the decision of an eventual revisitation

I RE-INSPECTION

1) Training institutes will automatically receive an invitation via mail from the RRC for re-certification after five years.

2) Institutes will be asked to fill in the short re-certification application form by stating eventual major changes that could be reason for a re-visitation by members of the RRC.
CLICK HERE to view the information this form will collect

3) The cost of re-certification is €500