Comparative analysis of training programs for ophthalmology residents in Europe and the situation of ophthalmology training in Spain

Anaya-Alaminos, R.; González-Andrades, M.

doi:10.1016/j.oftale.2023.03.003

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Anaya-Alaminos, M. González-Andrades" "autores" => array:2 [ 0 => array:3 [ "nombre" => "R." "apellidos" => "Anaya-Alaminos" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 1 => array:4 [ "nombre" => "M." "apellidos" => "González-Andrades" "email" => array:1 [ 0 => "Miguel.gonzalez@imibic.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario San Cecilio, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Clínica Oftalmológica VISIÓON, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis comparativo de los programas formativos para residentes de oftalmología en Europa y situación de la formación oftalmológica en España" ] ] "textoCompleto" => "The European Union of Medical Specialists seeks to harmonise the training of medical specialists by providing guidelines that European countries should follow. However, the extent to which these guidelines are adopted is ultimately decided by each country. Therefore, although residency programmes are considered an essential pillar of specialist training, there is currently no consensus on the medical and surgical skills that a resident should acquire in order to obtain accreditation to practise as an ophthalmologist in the different European countries.We have recently published a paper<a class="elsevierStyleCrossRef" href="#bib0005">1</a> with the aim of comparing the training of ophthalmology residents in different European countries. To this end, we conducted a survey of European ophthalmologists to assess the differences and possible shortcomings of the training programmes in each country, as well as the degree of satisfaction of the residents with their training. Potential participants were considered to be European ophthalmologists who were completing their ophthalmology residency and those who had completed their ophthalmology residency within the previous 2 years. Respondents were asked to fill in the survey on the basis of their experience up to the time of their participation therein. A total of 214 respondents were obtained from 36 European countries, all of which offered a training programme in ophthalmology, of which 6.07% (13) were Spanish.The results revealed significant differences between countries in relation to the duration in years of residency training. A median of 4 years was obtained (also for Spain), which is close to the 3 years considered by the European Union of Medical Specialists as the minimum duration for the training programme. This may explain why non-EU countries have training programmes of less than 3 years, such as Ukraine and Russia with 2 years or Belarus with 1.5 years. At the other extreme are Ireland and the United Kingdom, which have training programmes with a duration of 7 years, the maximum described by respondents.The survey also showed discrepancies regarding the need for an examination to certify the training of new specialists. Fifty-five percent of respondents indicated that a certification process was mandatory, either in the form of a specific national examination or one developed by a supranational board such as the European Board of Ophthalmology. Twenty percent of the respondents reported that they were not required to undergo any accreditation process before they could practice as an independent ophthalmologist. This was the case for participants from Denmark, Finland, France, Italy, Norway, Sweden, Turkey and Spain.The majority of participants reported a good level of confidence and satisfaction with the clinical skills acquired during their training period. While the majority were completely satisfied (6.1%) or very satisfied (39.7%) with their medical skills, only 16.3% were completely or very satisfied with the surgical competencies acquired. On the other hand, 42.1% were completely dissatisfied with their surgical skills. As for the degree of satisfaction of the Spanish participants, all were satisfied with the medical abilities acquired and only 23.1% were totally dissatisfied with the surgical skills acquired.In some countries, residents did not perform any surgery at all. If we consider residents from the fourth year onwards, including this year, more than 34% would have graduated without performing a single phacoemulsification surgery, 47% without removing a single pterygium and 31% without repairing a single palpebral laceration. Such findings are surprising, as these procedures are considered essential for any ophthalmologist. Focusing on cataract surgery in this group of respondents, only 3 countries reached or exceeded 200 phacoemulsification surgeries: Spain with 200, UK with 336 and Portugal with 355.The majority of participants were in favour of harmonising ophthalmology training in Europe, with 69% in favour of an official programme common to all European countries. Likewise, the majority of participants agreed (64.4%) with the need for an accreditation process in order to be able to practice as an ophthalmology specialist. In relation to Spanish participants, 69.3% agreed with the need to establish a common official curriculum, and 46.2% were totally or strongly in agreement with the need to establish a system that accredits the adequate training of residents once they have completed their residency.Our results show a significant heterogeneity in the different training programmes and in the skills acquires by ophthalmologists in training according to the country of residence, especially with regard to surgical abilities. Recognising this challenge of standardisation and harmonisation, the European Union of Medical Specialists should establish European Training Requirements and, more specifically, surgical requirements. Spain is at the forefront of ophthalmology training in Europe along with countries such as the United Kingdom and Portugal. However, there is still substantial room for improvement in our country, as illustrated by the fact that 92.3% of respondents indicated that a training accreditation process was not compulsory, or that 23.1% were very dissatisfied with the surgical skills acquired. This should lead to the implementation of new strategies at national level to correct these deviations, such as the establishment of board-type exams to certify the knowledge acquired once the residency has been completed, with ophthalmologists only being able to practise as such after passing said exams, the implementation of a register of the resident’s healthcare activity, at least surgical, which allows accreditation of their practical training and monitoring of the suitability of the programmes in the different hospitals that train residents; and lastly the need to carry out periodic surveys of the majority of residents in Spain to determine in detail the situation in each training centre and the correct monitoring of the training plans.Conflict of interestNo conflicts of interest were declared by the authors." "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:1 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparative analysis of European residency programs: benchmarking and harmonizing ophthalmology training in Europe" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Anaya-Alaminos" 1 => "M.L. Rassmussen" 2 => "S.S.M. Fung" 3 => "J. Potic" 4 => "M. González-Andrades" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/s41433-022-02040-3" "Revista" => array:3 [ "tituloSerie" => "Eye (Lond)" "fecha" => "2022" "numero" => "March" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009800000004/v2_202304071550/S2173579423000282/v2_202304071550/en/main.assets" "Apartado" => array:4 [ "identificador" => "5814" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009800000004/v2_202304071550/S2173579423000282/v2_202304071550/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423000282?idApp=UINPBA00004N"]

ISSN: 2173-5794
e-ISSN: 1989-7286

Archivos de la Sociedad Española de Oftalmología is the official journal of the Ophthalmology Society of Spain, that has over 4,000 members. It gives priority to the publication of basic, translational and clinic research including reviews, original articles, short communications, editorials, letters to the editor and clinic practice guides related to Ophthalmology and its subspecialties. A small section of the journal is reserved for the most relevant papers presented at the annual Congress of the Society. All manuscripts considered for publication are reviewed by expert examiner peers (double blind). The journal is published monthly and even though its official language is Spanish all articles are translated into English to increase the dissemination of scientific information. At present, Archivos is the only Spanish language Ophthalmology journal indexed in PubMed/MEDLINE in addition to other prestigious international databases such as Scopus.

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Vol. 98. Issue 4.

Pages 185-186 (April 2023)

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