Importance of a clinical ophthalmology placement in the UK undergraduate medical syllabus

Dear Sir

The UK undergraduate medical curriculum no longer necessitates a clinical placement in ophthalmology (Baylis et al. 2011). The General Medical Council’s Tomorrow’s Doctors documents on undergraduate medical education outcomes and clinical placements underline the importance of core clinical placements, of which an ophthalmic placement is not stipulated. However, basic ophthalmic knowledge and assessment skills are fundamental to a complete clinical examination. This is reflected in postgraduate curricula starting from the junior doctor’s Foundation Programme requiring basic competency in ophthalmoscopy through to numerous Specialty Training Programmes such as Paediatrics, Emergency Medicine and General Practice requiring more extensive ophthalmic competencies.

Following medical school junior doctors in the UK undertake a two-year Foundation Programme, which commonly includes an Emergency Department placement. This study assessed the proportion of presentations with an ophthalmic component at a large District General Hospital Emergency Department in Hertfordshire from 1 February to 28 February 2014. Presenting complaint was screened for ophthalmic-related cases with inclusion criteria based on Royal College of Ophthalmologists documents on undergraduate training. The aim was to demonstrate the frequency and variety of ophthalmic related presentations from the onset of a junior doctor’s clinical practice.

Within the calendar month 7.4% (486/6354) presentations had an ophthalmic component. Head injuries, non-specified eye problems and headaches were the top three accounting for 65% (318/486) of cases. Stroke and TIA accounted for 15% (73/486) of cases. The remaining included a spectrum of core ophthalmological complaints including red eye, painful eye and flashing lights.

From an international standpoint, a number of publications report declining undergraduate ophthalmic education worldwide. Shah, Knoch and Waxman have recently highlighted similar findings in the US and Canada. Subsequently, a proposal of potential approaches to tackle this trend was put forward (Albert & Bartley 2014).

To conclude, ophthalmic presentations with potential sight and life-threatening implications are commonly reviewed initially by junior doctors. A clinical placement in ophthalmology at medical school would provide the practical experience to complement the core knowledge required to safely manage these patients.

Declaration of interest: The authors report no conflicts of interest.