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The paper by Professor Fielder and his colleagues (April 2004 JRSM1) provides information that confirms the experience of the Training Committee of the Royal College of Ophthalmologists from our programme of hospital inspections. The issue is complex, and even within a hospital that is well disposed towards surgical training for senior house officers (SHOs) the experience can vary within any given year depending upon the SHOs in post. In general terms, around half of the units we inspect provide reasonable training to their trainees at the time of inspection. The bulk of the remaining units are capable of providing appropriate training experience if they are pressurized into monitoring the training experience of their SHOs and submitting their returns.
Modernizing Medical Careers offers ophthalmology an opportunity to restructure our training programmes. Ophthalmology will require approximately 50% of the current number of SHOs if we intend to move towards a run-through training grade. The principal issue is the service workload being undertaken throughout the UK by the remaining 50% of SHOs. This is the problem that needs to be addressed. If the number of SHOs in training were reduced, one would anticipate that a better quality of training would be available to this lesser number of trainees. It is also of great importance that consultant trainers are given sufficient time within their working week to engage with trainees and that the culture of the NHS is not driven by service alone.