Training Committee COVID Recovery Team

Effects of COVID-19 on training – Trainee Survey 1

August – September 2020

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Contents

Section page

1 Objectives 3

2 Responses 3

3 Results 3

Demographics 3

Clinical Training 7

OOPR / Academic Training 16

Wellbeing 19

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1 Objectives

COVID-19 has had significant effects on the training programme and continues to effect the way ophthalmology is delivered. In order to measure the impact on training, and to consider what derogations may be required for ARCPs next year, ophthalmologists in training have been asked to participate in this survey and answer questions about their experience in 2020.

2 Responses

17.5% response rate.

3 Results

Demographics

4

5

Female Male Other / prefernot to say

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

Gender

Responses

6

7

LTFT Out ofProgramme

(OOP)

Academic trainee

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

During this time you have been

Responses

8

Clinical Training

9

10

Q. What is you main concern about progression (free text) The lack of patients coming through ophthalmology meant I’ve had 6 months with very little clinical

ophthalmology at all. My plans for exams have been pushed back, and it’s getting very tight towards

the end of training. I’m being asked to apply for tsc jobs, but I feel that I’ve lost 6 months of clinical

ophthalmology and cataract surgery. I’ve asked in my school for an extension to training, and have

been told this is not possible.

Total disruption to training

Lack of surgical time. I had made significant progress but I have now not been operating regularly for

as long as I had been regularly operating beforehand. Exams being psotponed means I am sitting

them later than planned near to deadlines for progression. Lack of experience in on call settings

before being moved to my senior and independent decision making positions out of hours. There

isn't just one concern regarding progression as unfortunately when you lose 5 out of your first 12

months in OST it has a significant effect on all of your practice.

Surgery.

Reduced theatre lists available and my training being prolonged.

Not having enough cataract surgery numbers and now being behind with surgery. Part 1 exam being

delayed potentially causing issues with progression.

Being stuck doing service provision of casualty clinics and telephone consults only in the specialist

clinics with consultants doing face to face

Time to make up experience in special interest.

Completing requisite subspecialty DOPS and adequate continued exposure to complex cataract

surgery. Disproportionate focus by our department on clearing service backlog rather than getting

us back to training.

I was ST2 during the COVID pandemic. Whilst I was not redeployed, the workload in the

ophthalmology OPD dropped dramatically and surgery stopped completely. I feel my progression and

exposure to clinical practice was significantly impacted - essentially one quarter of my "SHO" years

was lost and I'm worried I am not at a level I should be now that I am ST3.

Lack of surgery during past 6 months during the pandemic.

Lack of surgical experience caused by the pandemic. also lack of clinical face to face patient

experience e.g. in eye casualty etc.

TSC applications are approaching and opportunities to complete portfolio and cataract audit in time

for this are few.

Surgical experiance. The number of theatre sessions is significantly reduced as well as the number of

patients on a list. This is limiting surgical experience.

Not enough surgical exposure, luckily have completed oculoplastic placement previously hence

enough experience. If this was my first placement this would not of been possible.

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Although I have achieved sufficient cataracts in the past rotation I am concerned about being able to

achieve the required competencies in this one as elective surgery has not yet recommenced for me

and I have not operated since March.

Surgical training.

Progression with Cataract surgery.

Cataract surgery progression

Reduced surgical numbers.

Fitting Neuro-Ophth sign off into remaining training without impacting on TSC.

Fewer surgical opportunities.

I feel that I was not ready to become a ST3 whereby expectations are much higher. I am not ready to

supervise juniors and have not achieved certain competencies which are important for on call.

Not enough surgical time. At present we only have 1 or no theatre sessions per week.

Needing to take extra time given the constraints of ACF.

I was redeployed to ITU so I was unable to achieve any objectives during this time. After we

returned, theatres were suspended and we were all put onto virtual clinics in different teams, so I

was removed from oculoplastics and put onto VR to help out the team.

Access to squint surgery.

Have CCT'd but missed half of TSC year training due to COVID.

Lack of cataract surgery training.

Surgical numbers. Will need repeat subspeciality placements to achieve specific WBAs and surgical

numbers.

Lack of surgical opportunities.

Cataract surgery numbers.

Achieving my cataract numbers during ST2

I am pregnant so even after COVID first wave I'm now going to have to shield. Hard to get through

DOPS without being in hospital.

There won't be scope to make up lost training without extension, especially with smaller theatre

lists. This will be my 3rd time re-starting surgical training, and with low volumes of cases, and routine

cataracts moving to AQPs, I don't envisage access to the training I need in the next two years.

Did not complete a full case of cataract surgery in ST1. Currently only allocated to one theatre

session every 2 weeks. Concerned about attaining numbers/ proficiency in cataract surgery.

Lack of theatre time. I am near the end of my training I need as much surgery as possible.

12

I need to complete a Glaucoma TSC, but this is not possible due to effect of current covid restrictions

on theatre opportunities

Cataract surgical opportunities

Surgical training

I have been shielding so the potential for a second surge is concerning.

No surgical experience for 6 months and not properly starting again yet.

Unable to complete work based assessments and gain confidence in oculoplastic surgery.

Lack of clinical opportunities and subspecialty exposure for both clinics and surgery. No concerns

regarding general ophthalmology exposure.

The uncertainty of how long clinical activity will be paused for in view of the pandemic.

Requiring another year in training. Being a poorer surgeon than someone without delays in prior

years.

That I will need to spend another 6 months repeating the rotation to gain competencies (mainly

surgical). If COVID continues to affect theatres then it will pose difficulties catching up.

Not completing surgical logbook.

Unable to get adequate surgical experience or cases to be considered appointable as ST3.

Given my previous extension to training I had planned to try and get as much of my portfolio

completed to allow more subspecialty experience in my chosen field prior to CCT. This would

hopefully limit the number of fellowships required.

Need to extend training.

Not enough surgery or clinics.

Surgical competencies.

Not enough cataract surgeries.

No cataract surgery at all.

Interruption to surgical training, reduced clinic numbers making some WBAs more difficult to

achieve, lack of conferences and courses for further training.

Achieving retinal laser outcomes.

Exposure to more complex uveitis cases.

Surgical numbers.

Thankfully I had already had a placement in this specialty so massive loss of specialty clinics and

theatre did not prevent me completing assessments necessary for training, but it would have been

very problematic otherwise.

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Lost clinical experience may not be regained -- perhaps trainees should be given the option to extend

their training programme by 6 months if they wish.

I did not have the opportunity to do enough face to face clinics to gain the understanding of

examination findings that I would like.

Lack of surgery.

Uveitis is a firm which allows trainees to undertake more complex cataract surgeries, but due to

covid i have had little if any opportunity.

Loss of surgical experience.

Not enough surgery.

Restarting surgery.

Unable to complete competencies that may affect my time in training.

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15

Q. If you would like to declare that you had individual circumstances that affected your progression please enter here (e.g. LTFT, shielding) – free text

Pregnant Pregnant therefore worked remotely during the COVID-19 period Shielding as pregnant I was shielding, I have managed to finish the competencies only because I had previous experience. so shielding from the end of March did not affect my overall progression I was redeployed from Ophthalmology to the covid wards, for 8 weeks. While I still attained the outcomes required to pass ST1 ARCP I don't think that reflects how seriously my training has been affected. As an ST1 when I rotated in February I had completed just 2 full cataract operations by myself, then because I had a new trainer for cataracts in my new rotation it took a while for them to allow me to do more and more steps, I only had a month and a half with them before surgeries were all cancelled and I was not allowed back into theatre before July, because I had had so long off I was very rusty. As it stands I peaked in February at the end of my first rotation and my surgical skills have decreased then. Now I am ST2 on a new rotation again, my new hospital isn't even providing a regular cataract session for us as they are happening at a private hospital without a teaching microscope. Although the need for 50 full cataracts before end of ST2 has changed to ST3 I still think I will be on the back foot surgically compared to a lot of my colleagues and I am not confident that this will be taken into account. Redeployed for 2 months to Covid rota. Shielding due to pregnancy since March so no patient contact since then. Shielding I am pregnant so even after COVID first wave I'm now going to have to shield. Hard to get through DOPS without being in hospital. Hampers surgical progression. I was shielding, and have been told by my Deanery that even though I remained in post, doing non-face to face work, I will be held back regardless of my ARCP outcome. I regret not being supported/allowed to take time OOP, as having worked for 5 months without recognition of my time towards training feels pointless. I was shielding from March to August 2020 I have been shielding. My ES and head of school stated early on that this period could not contribute to my training, but I have since gathered from other trainees elsewhere that it might have been possible for my training to continue with the right clinical caseload and supervision. I am very disappointed to find this out only at the end of the shielding period, and would greatly appreciate a more unified approach to this situation across regions should a second surge occur. Redeployed to intensive care

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Unable to train in IVT due to social distancing limiting amount of people in the room. Shielding I'm a Clinical Lecturer (ACL), which has made things even more difficult for both clinical and academic aspects. Clinical Lecturers are 50:50 split between academia and clinical activities. The hospital stopped all cataract operation and I cannot progress through my training I have done zero cases! All what is happening is casualty clinics without consultant.

OOPR / Academic Training

17

18

0.00%10.00%20.00%30.00%40.00%50.00%

If you were unable to achieve your objectives which best describes

the reason for the deficit? (Please select all that apply.)

Responses

19

Q (Academic Training). What is you main concern about progression (free text).

Under significant time pressure to write up thesis.

Unable to collect all the expected research data due to reduced research facilities due to social distancing and reduction in laboratory time

Availability of research funding in ophthalmology

Winning a project grant in order to take up a post-CCT academic career- (senior lecturer / associate professor) post. Without a large project grant attained from work undertaken during the ACL, I would have to return to a full-time clinical career.

Not been given any surgical training so far

Having enough research output to successfully obtain PhD fellowship.

Funding for my PhD programme.

Wellbeing

20

Any other concern on wellbeing (free text) Worried that my exam was cancelled when I was prepared to sit it and now my preparation is difficult due to other issues (e.g. lack of childcare, uncertainty for the winter period ahead, e.g. second spike) and concerns my training may be prolonged if consultants do not sign me off on a specialist placement as there are reduced clinics and theatres. Feeling isolated during COVID-19 period of social isolating (due to pregnancy), combined with concerns about impact of maternity leave on training. I feel like the onus was put on me to find/engage with support - little was offered, the Deanery didn't know I was off until I enquired about RTT, and the HoS/TPD never enquired as to how I was/what I was doing until the end of July when I was looking into return. I've lost another 6-12 months of training time to the degree where I can't really see the merit in trying to catch up. I have had virtually no supervision or support whilst shielding. This has taken a toll on my wellbeing and enthusiasm for training. Very anxious. Felt need to compete with colleagues to get training opportunities. Concern is that having previously tried to organise extra sessions/activities to fill in gaps in training/knowledge, this hasn’t always been met with approval from TPD. This has been a particularly challenging time for trainees with young families.