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One conclusion drawn from the survey in the April JRSM1 is that senior house officers (SHOs) in ophthalmology get more experience in teaching hospitals than in district general hospitals (DGHs). I take issue with this interpretation of the data. Competition for SHO posts in teaching hospitals is particularly intense, and the usual route of entry to these posts is via a ‘good’ DGH ophthalmic SHO post offering plenty of surgical training. Although no details are given in the paper, I imagine that most of the neophyte SHOs (less than 12 months' experience) were in DGH posts. Given that teaching hospital SHOs are likely to be a selected population in terms of previous surgical experience, the study may overestimate the quality of surgical training provided in teaching hospitals. The Royal College of Ophthalmologists requires that, after the first two years of training, a minimum of 50 phaco operations per year should be performed. It would have been interesting to know what proportion of 3rd and 4th year SHOs were achieving this standard.
Protected surgical teaching time can be quantified as the difference between the time allocated to the list and the time the trainer would take to complete the list without the trainee. A reasonable minimum at SHO level is an hour of protected surgical training time per SHO per week. The College requirements should be achievable at this level of exposure, and there is no reason why training agreements between postgraduate deans and trusts cannot specify it, with financial sanctions for trusts that short-change their trainees persistently.